Sushruta Samhita, volume 3: Sharirasthana

by Kaviraj Kunja Lal Bhishagratna | 1911 | 36,821 words

This current book, the Sharira-sthana (english translation), deals with anatomy, the human body, cosmology, embryology and various other subjects. The Sushruta Samhita is the most representative work of the Hindu system of medicine. It embraces all that can possibly appertain to the science of medicine. Susruta-samhita is recognized as the first a...

Chapter VI - The Marmas (vital parts of the body)

Now we shall discourse on the Sharira which specifically treats of the Marmas[1] or vital parts of the body (Pratyeka-marma-nirdesha Sharira.) 1.

Classification of Marmas:—

There are one hundred and seven Marmas (in the human organism), which may be divided into five classes, such as the Mansa-Marmas, Shira-Marmas, Snayu-Marmas, Asthi- Marmas and the Sandhi-Marmas. Indeed there are no other Mannas (vulnerable or vital parts) to be found in the body than the preceding ones. 2.

Their different numbers:—

There arc eleven Mansa-Marmas (vulnerable muscle-joints); forty- one Shira-Marmas (similar veins, anastomosis); twenty- seven Snayu-Marmas (vital ligament-unions); eight Asthi-Marmas (bone-unions) and twenty Sandhi-Marmas (vulnerable joints). 3.

Their Locations:—

Of these, eleven are in one leg, thus making twenty-two in the two lower extremities The same number counts in the two hands. There are twelve Marmas in the regions of the chest and the abdomen (Udara); fourteen in the back; and thirty-seven in the region of the neck (Griva) and above it. 4.

Names and distributions of Marmas:—

The Marmas which are situated in each leg are known as Kshipra, Tala-Hridaya, Kurcca, Kurcca-Shirah, Gulpha, Indravasti, Janu, Ani, Urvi, Lohitaksha and Vitapa. The twelve Marmas which are situated in the thorax and the abdomen (Udara) are Guda (anus), Vasti (bladdery), Nabhi (umbilicus), Hridaya (heart), Stana-mula (the roots of two breasts), the Stana-Rohita, (muscles of the breasts), the two Apalaps and the two Apastambhas. The fourteen Marmas to be found in the back are the Katika-tarunas (Taruna-bones of the waist), the two Kukundaras, the two Nitamvas (hips), Parshva-Sandhis (the two side-joints), the two Vrihatis, the two Ansa-phalakas (shoulder-blades) and the two Ansas (shoulders). The eleven Marmas to be found in an arm are known as the Kshipra, Tala-Hridaya, Kurcca, Kurcca-Shirah, Manivandha, Indravasti, Kurpara, Ani, Urvi, Lohitaksha and Kakshadhara. What is said of the one arm holds good of the other. The Marmas situated above the clavicle regions are known as the four Dhamanis, the eight Matrikas, the two Krikatikas, the two Vidhuras, the two Phanas, the two Apangas, the two Avartas, the two Utkshepas, the two Shankhas, one Sthapani five Simantas, four Shringatakas and one Adhipati. 5—9.

The different heads of Marmas:—

Of the aforesaid Marmas, those known as the Tala-Hridaya, Indravasti, Guda and Stana-rohita, are Mansa-Marmas. Those known as Nila-dhamani, Matrika, Shringataka, Apanga, Sthapani, Phana, Stana-mula, Apalapa, Apastambha, Hridaya, Nabhi, Parshva-Sandhi, Vrihati, Lohitaksha and Urvi, are Shira-Marmas. Those known as the Ani, Vitapa, Kakshadhara, Kurcca, Kurcca-Shirah, Vasti, Kshipra, Ansas, (shoulders), Vidhura and Utkshepa, are Snayu-Marmas. Those known as the Katika-taruna, Nitamva, Ansaphalaka, Shankha, are Asthi-Marmas. The Janu, the Kurpara, the Simanta, the Adhipati, the Gulpha, the Manivandha, the Kukundara, the Avarta and the Krikatika are Sandhi-Marmas. 10–14.

Qualitative classes:—

Again these Marmas (vital unions of the body) are under five distinct heads, namely, Sadya-Pranahara, (fatal within twenty-four hours), Kalantara-Pranahara, (fatal within a fortnight or a month), Vishalyaghna (fatal as soon as a dart or any other imbedded foreign matter is extracted therefrom), Vaikalyakara, (maiming or deforming) and Rujakar (painful) [according as an injury respectively produces the aforesaid effects]. Of these, nineteen Marmas belong to the Sadya-Pranahara group; thirty-three to the Kalantara-Pranahara group; three to the Vishalyaghna group; forty-four to the Vaikalyakara group; and eight to the Rujakara group. 15.

Memorable Verses:—

To the Sadya-Pranahara group (fatal in the course of a day if anyway hurt) belong the four Shringatakas, one Adhipati, the two Shankhas, the eight Kantha-Shiras, the Guda, the Hridaya, the Vasti and the Nabhi. To the Kalantara- Pranahara group (fatal later on, if any way hurt) belong the eight Vaksha-Marmas, the five Simantas, the four Tala-Marmas, the four Kshipra-Marmas, the four Indra-vastis, the two Katika-tarunas, the two Parshva-Sandhis, the two Vrihatis, and the two Nitamvas. To the Vishalyaghna class belong the two Utkshepas and the one Sthapani. To the Vaikalyakara (deforming) group belong the Marmas, known as the four Lohitakshas, the four Anis, the two Janus, the four Urvis, the four Kurccas, the two Vitapas, the two Kurparas, the two Kukundaras, the two Kakshadharas, the two Vidhuras, the two Krikatikas, the two Ansas (shoulder), the two Ansa-phalakas, (shoulder- blades), the two Apangas (tips of eyes), the two Nials (?), the two Manyas, the two Phanas and the two avartas. A learned physician should know that the two Gulphas, the two Mani-vandhas and the four Kurcca-Shirah (of the hands and legs) belong to the Rujakara group (painful if hurt). A piercing of the Kshipra-Marma ends in an instantaneous death; or death may follow at a later time. 16-21.

Firm unions of Mansa (muscles), Shira (veins), Snayu (ligaments), bones or bone-joints are called Marmas (or vital parts of the body) which naturally and specifically form the seats of life (Prana), and hence a hurt to any one of the Marmas invariably produces such symptoms as arise from the hurt of a certain Marma.[2] 22.

The Marmas belonging to the Sadya-Pranahara group are possessed of fiery virtues (thermogenetic); as fiery virtues are easily enfeebled, so they prove fatal to life (in the event of being any way hurt); while those belonging to the Kalantara-Pranahara group are fiery and lunar (cool) in their properties. And as the fiery virtues are enfeebled easily and the cooling virtues take a considerable time in being so, the Marmas of this group prove fatal in the long run (in the event of being any way hurt, if not instantaneously like the preceding ones). The Vishalyaghna Marmas are possessed of Vataja properties (that is, they arrest the escape of the vital Vayu); so long as the dart does not allow the Vayu to escape from their injured interior, the life prolongs; but as soon as the dart is extricated, the Vayu escapes from the inside of the hurt and necessarily proves fatal. The Vaikalyakaras are possessed of Saumya (lunar properties) and they retain the vital fluid owing to their steady and cooling virtues, and hence tend only to deform the organism in the event of their being hurt, instead of bringing on death. The Rujakara Marmas of fiery and Vataja properties become extremely painful inasmuch as both of them are pain-generating in their properties. Others, on the contrary, hold the pain to be the result of the properties of the five material components of the body (Panca-bhautika). 23.

Different Opinions on the Marmas:—

Some assert that Marmas, which are the firm union of the five bodily factors (of veins, ligaments, muscles, bones and joints), belong to the first group (Sadya-Pranahara); that those, which form the junction of four such, or in which there is one in smaller quantity, will prove fatal in the long run, in the event of their being hurt or injured (Kalantara-Pranahara).[3] Those, which are the junction of three such factors, belong to the Vishalya-Pranahara[4] group; those of the two belong to the Vaikalyakara[5] group; and those in which only one of them exists belongs to the last or pain-generating type (Rujakara)[6].

But the fore going theory is not a sound one, inasmuch as blood is found to exude from an injured joint which would be an impossibility in the absence of any vein, ligament (Snayu) and muscle being intimately connected with it. Hence every Marma should be understood as a junction or meeting place of the five organic principles of ligaments, veins, muscles, bones and joints. 24–25.

Metrical text:—

This is further corroborated by the fact that the four classes of Shira or vessels (which respectively carry the Vayu, Pitta, Kapha and the blood) are found to enter into the Marmas for the purpose of keeping or maintaining the moisture of the local ligaments (Snayu), bones, muscles and joints and thus sustain the organism.[7] The Vayu, aggravated by an injury to a Marma, blocks up (those four classes of vessels) in their entire course throughout the organism and gives rise to great pain which extends all over the body. All the internal mechanism of a man (of which a Marma has been pierced into with a shaft or with any other piercing matter) becomes extremely painful, and seems as if it were being constantly shaken or jerked, and symptoms of syncope are found to set in. Hence a careful examination of the affected Marma should precede all the foregoing acts of extricating a Shalya from its inside. From that similar aggravated conditions and actions of the Pitta and the Kapha should be presumed in the event of a Marma being any way injured or pierced into. 26—29.

A Marma of the Sadyah-Pranahara type being perforated at its edge brings on death at a later time (within seven days), whereas a deformity of the organ follows from the piercing of a Kalantara-Maraka[8] Marma at the side (instead of in the centre). Similarly, an excruciating pain and distressful after-effects mark a similar perforation of a Marma of the Vishalyaghna[9] group. And a Marma of the Rujakara[10] class produces an excruciating pain (instead of a sharp one) in the event of its being pierced at the fringe. 30.

An injured Marma of the Sadyah-Pranahara type terminates in death within seven days of the injury, while one of the Kalantara type, within a fortnight or a month from the date of hurt (according to circumstances). A case of injured Kshipra-Marma seldom proves fatal before that time (seven days). An injured Marma of the Vishalyaghna or Vaikalyakara group may prove fatal in the event of its being severely injured. 31.

Marmas of the Extremities:—

Now we shall describe the situation of every Marma. The Marma, known as the Kshipra[11], is situated in the region between the first and the second toes (Tarsal articulation), which, being injured or pierced, brings on death from convulsions. The Marma, known as the Tala-Hridaya[12], is situated in the middle of the sole of the foot in a straight line drawn from the root of the middle toe. An injury to this Marma gives rise to extreme pain which ends in death. The Marma, known as the Kurcca[13], is situated two fingers’ width above from the Kshipra one on each side of the foot. An injury to this Marma results in shivering and bending in of the foot. The Marma called Kurcca-Shirah[14] is situated under the ankle-joints, one on each side of the foot (Gulpha-Sandhi); an injury to it gives rise to pain and swelling of the affected part. A perforation of the Gulpha-Marma[15], which is situated at the junction of the foot and the calf, results in pain, paralysis and maimedness of the affected leg. 32–37.

An injury to the Marma which is. situated in the middle muscle of the calf to the distance of between twelve and thirteen fingers’ width from the ankle, and known as the Indravasti-Marma,[16] results in excessive hemorrhage which ends in death. 38.

An injury to or piercing of the Janu-Marma[17] situated at the union of the thigh and the knee, results in lameness of the patient. 39.

A piercing of the Ani-Marma,[18] situated on both the sides above three fingers’ width from the Janu (knee joint), brings on swelling and paralysis (numbness) of the leg. 40.

A perforation of the Urvi-Marma,[19] situated in the middle of the Uru (thigh), results in the atrophy of the leg, owing to the incidental hemorrhage. An injury to the Lohitaksha-Marma,[20] situated respectively a little above and below the Urvi-Marma and the Vankshana (groin-joint), and placed near the thigh, is attended with excessive hemorrhage and causes paralysis (of the leg). 41–42.

An injury to the Vitapa-Marma,[21] situated between the Scrotum and the Vankshana (inguinal region), brings on loss of manhood or scantiness of semen. Thus the eleven Sakthi-Marmas of one leg have been described; those in the other being of an identical nature with the preceding ones. The Marmas in the hands are almost identical with those of the legs, with the exception that Manivandha, Kurpara and Kakshadhara Marmas occur in the place of the Gulpha, Janu and Vitapa Marmas respectively. As the Vitapa-Marma is situated between the scrotum and the Vankshana (inguinal region), so the Kakshadhara-Marma is situated between the Vaksha (chest) and the Kaksha (armpit). An injury to these causes supervening symptoms. An injury to the Manivandha-Marma (wrist-marma) results specially in inoperativeness (Kuntha) of the affected hand; an injury to the Kurpara-Marma ends in dangling (Kuni) of the hand; and an injury to the Kakshadhara results in hemiplegia. Thus the forty-four Marmas of the upper and the lower extremities have been described. 43–46.

Marmas on the Thorax etc.:—

Now we shall describe the Marmas, situated in the region of the thorax and the abdomen (trunk). A hurt to the Gruda-Marma[22], which is attached to the large intestine and serves as the passage of stool and flatus, ends fatally (within twenty-four hours of the hurt). An injury to the Vasti-Marma,[23] situated inside the cavity of the pelvic region and the bladder and composed of small muscles and blood (and which serves as the receptacle of urine), proves fatal within the day, except in the cases of extracting the gravel, only when the injury to the organ is short of complete perforation of both of its walls. The urine oozes out through the aperture in the case where only one of its walls has been perforated, and which may be closed and healed up with proper and judicious medical treatment. An injury to the Nabhi-Marma,[24] the root of all the Shiras and situated between the Amashaya (stomach) and the Pakvashaya (intestines) ends in death within the day. 47-50.

A hurt to the Hridaya-Marma,[25] which is situated in the thorax between the two breasts and above the pit of the amashaya and forms the seat of the qualities of Sattva, Rajas and Tamas, proves fatal within the day. An injury to the Stana-mula-Marmas,[26] situated immediately below each of the breasts and about two fingers in width fills the Koshtha (thorax) with deranged Kapha, brings on cough, difficult breathing (asthma) and proves fatal. An injury to any of the Stana- Rohita-Marmas,[27] situated above the nipples of the breasts about two fingers in width, fills the cavity of the Koshtha (thorax) with blood, producing symptoms of cough and asthma, and ends fatally. An injury to the Apalapa-Marmas,[28] situated below the Ansa-kuta (balls of the shoulders) and above the sides (meeting of the different branches of the sub-clavicle veins i.e. axilla), transforms the blood of the organism into pus and proves fatal thereby. 51–54.

An injury to any of the Vayu-carrying vessels, known as the Apastambha-Marma[29] (meeting of the bifurcated branches of the bronchi lying on both the sides of the breast), fills the Koshtha with the deranged Vayu (tympanites) accomapanied by cough and dyspepsia, and terminates in death. Thus the twelve Marmas situated in the thorax and abdomen are described. 55-56.

Prishtha Marmas:—

Now we shall discourse on the Marmas in the back (of a man). An injury to any of the Katika-tarunas[30] (sacro-iliac articulation), situated in the region of the Shroni (sacrum) on both sides of the spinal column, gives rise to an excessive hemorrhage and consequent pallor and ends in death. A hurt to any of the Kukundara Marmas[31] (lit:—a hollow—the great sacro-sciatic notch), situated on both sides of the spinal column and in the region slightly below the waist (in the loins), results in complete anesthesia and inoperativeness of the lower extremities. A hurt to the Nitamva-Marmas,[32] attached to

the side above the Sroni (pelvis) and attached inside to the muscles of the waists, gives rise to Sosha (atrophia) in the lower extremities, weakness and ultimately brings on death. An injury to the Parshva-Sandhi-Marmas[33] (celic axes) which are situated just at the middle below the extremities of the sides (Parshva) and which lies attached at the middle between the loins at their lower regions, feels the Koshtha (abdomen) with the blood and results into death A hurt to the Vrihati-Marmas[34] which commencing from the roots of the breast course round both the sides of the spinal column (Pristha-vamsha), cause excessive bleeding, and the patient dies, as supervening symptoms arise from an excessive loss of blood. An injury to any of the two Amsa-phalaka-Marmas[35] situated on either side of the vertebral column and connected with the scapula brings on anesthesia or atrophy (Shosha) of the arms. There are two Marmas known as Amsa-Marmas[36] which are situated on either side midway between the neck and the head of the arms and connect the Amsa-Pitha (glenoid cavity) and the Skandha (shoulder). An injury to any of these Marmas is attended with an incapacity of moving the hands. Thus the fourteen Marmas in the back have been described. 57–65.

The Jatrugata-Marmas:—

Now we shall describe the Marmas which are situated in the regions above the clavicles (Urddhva-Jatru). There are four Dhamani (arteries) about the two sides of the Kantha-Nadi (wind-pipe). Two of them are known as Nila, and the other two as Manya. One Nila and one Manya are situated on either side of the larynx, (i.e., anterior and posterior side of the larynx) An injury to any of them produces dumbness, and change of voice (hoarseness), and also the loss of the faculty of taste.[37] An injury to any of the eight Shiras (arteries), four being on each side of the neck (Griva), and known as Shira-Matrika-Marmas[38]) ends fatally within the day. 66–69.

An injury to any of the two Marmas lying at the junction of the head and neck (Griva) and known as Krikatika[39] (transverse process of the arch of the atlas) results in a free movement of the head. A hurt to any of the Marmas attached to the lower end of an ear (posterior extrensic ligament) and known as the Vidhura[40] Marma results in the loss of hearing. An injury to the Phana-Marmas[41] attached to the interior channels of both the nostrils, results in the loss of the faculty of smell. An injury to the Apanga-Marmas[42] (Anastomosis of the infra-orbital artery) situated below the tips of the eye-brows and about the external corners of the eyes, brings on blindness or defective vision. An injury to the A varta-Marmas[43] situated above and below the eye-brows, brings on blindness and impaired vision. An injury to the Sankha-Marmas[44] (meeting or suture of the temporal, frontal and sphenoid bones—Pterion), situated over the tips of the eye-brows and between the ears and the forehead, results in death within the day. The Marmas situated over the two temples (Sankha) and at the border of the hair (sculp) are called Utkshepa-Marma (meeting of the posterior and anterior temporal arteries)[45]. An extraction of a shaft (Shalya) or of any extraneous pointed thing lodged into these Marmas, results in the death of the patient, who, on the contrary, lives as long as the shaft is allowed to remain inside or if the shaft comes out itself (after putrefaction). 70–75.

An injury to the Sthapani-Marma[46] (nasal arch of the frontal veins), situated in the middle of the eyebrows, ends in the manner of the preceding one. An injury to any of the five joints of the head which are known as the Simanta-Marmas[47], results in fear, insensibility and madness of the patient and terminates in death. An injury to any of the four Sringataka-Marmas[48] which forms the junction of the four Shiras (nerves), (branches of the facial artery) and soothes the nose, the eyes, the ears and the tongue, proves fatal within the day. An injury to the Adhipati-Marmas[49] (the vertical groove on the frontal bone) which is marked in the inner side of the roof of the cranium by the Shira-Sannipata (superior longitudinal sinus), and on the exterior side by the ringlet of the hair (Romavarta) proves fatal within the day. Thus we have described the thirty-seven Marmas, situated in the region above the clavicles (Urddhva-Jatru). 76–80.

Memorable Verses:—

An incision should be made at the spot a fingers width remote from the Urvi, Kurcca-Shira, Vitapa, Kaksha and a Parshva- Marma; whereas, a clear space of two fingers should be avoided from its situation in making any incision about the Stanamula, Manivandha or Gulpha-Marma. Similarly a space of three fingers should be avoided from the Hridaya, Vasti, Kurcca, Guda or Nabhi Marma; and a space of four fingers should be avoided in respect of the four Sringatakas, five Simantas and ten Marmas in the neck (Nila etc.); a space of half a finger being the rule in respect of the remaining (fifty-six).[50] Men, versed in the science of surgery, have laid down the rule that, in a case of surgical operation, the situation and dimension of each local Marma should be first taken into account and the incision should be made in a way so as not to affect that particular Marma, inasmuch as an incision, even extending or affecting, in the least, the edge or the side of the Marma, may prove fatal. Hence all the Marma-Sthanas should be carefully avoided in a surgical operation. 81.

The amputation of a hand or a leg may not prove fatal whereas a wound in any of the Marmas situated therein is sure to bring on death. The vessels become contracted in the case of a cut in the leg or in the hand of a man, and hence the incidental bleeding is comparatively scantier. Therefore it is that a cut in any of these parts of the body, however painful, does not necessarily prove fatal, like the lopping off of the branches of a tree. On the contrary, a man pierced into in any such Marmas, as the Kshipra or the Tala, suffers from excessive hemorrhage (from the affected part) and attended with an excruciating pain, owing to the derangement of the Vayu, and meets his doom like a tree whose roots have been severed. Hence, in a case of piercing or of injury to any of these Marmas, the hand or the leg should be immediately amputated at the wrist or at the ankle (respectively). 82.

The medical authorities have described the Marmas to have covered half in the scope of Shalya Tantra (Surgery), inasmuch as a person hurt in any of the Marmas dies presently (i. e., within seven days of the hurt). A deformity of the organ is sure to result from an injury to one of these Marmas, even if death be averted by a course of judicious and skillful medical treatment. 83.

The life of the patient is not to be despaired of even in the case of fracture or crushing of a bone of the Koshtha, Shirah and Kapala or perforation of the intestines etc, if the local Marmas are found not to be in any way hurt or affected. Recovery is common in cases of cuts (pierce) in the Sakthi, Bhuja, Pada and Kara or in any other part of the body and even where a whole leg or hand is found to be severed and carried away if the Marmas are not in any way hurt or affected. 84.

These Marmas form the primary seats of the Vayu, the Soma (lunar) and Tejas (fiery principles of the organism), as well as of the three fundamental qualities of Satva, Rajas and Tamas, and that is the reason why a man, hurt in any of the Marmas, does not live. 85.

An injury to a Marma of the Sadyah-Pranahara class (in which death occurs within a day) is attended with the imperfection of the sense organs, loss of consciousness, bewilderment of Manah (mind) and Buddhi (intellect) and various kinds of pain. An injury to a Marma of the Kalantara group (of a person) is sure to be attended with the loss of Dhatus (blood etc.) and various kinds of supervening symptoms (Upadrava) which end in death. The body of a person, hurt in any of the Vaikalyakara Marmas, may remain operative only under a skillful medical treatment; but a deformity of the affected organ is inevitable. An injury to any of the Vishalyaghna Marmas ends in death for the reasons mentioned above. An injury to any of the Rujakara Marmas gives rise to various kinds of pain in the affected organ, which may ultimately bring about a deformity of the same, if placed under the treatment of an ignorant and unskillful Vaidya (Surgeon). 86.

An injury to the adjacent part of a Marma, whether incidental to a cut, incision, blow (Abhighata), burn, puncture, or to any other cause exhibits the same series of symptoms as an actually affected one. An injury to a Marma, whether it be severe or slight, is sure to bring deformity or death.[51] 87.

The diseases which are seated in the Marmas, are generally serious, but they may be made to prove amenable with the greatest care and difficulty. 88–89.

 

Thus ends the sixth Chapter of the Sharira Sthana in the Sushruta Samhita, which treats of Marmas.

Footnotes and references:

1.

Places where veins, arteries, ligaments, joints and muscles unite and an injury to which proves generally fatal.

2.

Some are of opinion that hallucination, delirium, death, stupor and coma as described in the Sutrast?(h)?ana are the results of injuries to these Marmas.

3.

The Marmas, such as Stana-mula, Apalapa, Apastambha, Simanta, Katika-Taruna, Parsva-Sandhi, Vrihati, and Nitamva belonging to the Kalantara-maraka group, are devoid of Mansa (muscles); and the ‘Marmas’ known as Stanarohita, Talahridaya, Kshipra, and Indravasti, belonging to the same class, are devoid of Asthi (bones).

4.

The Utkshepa marma, belonging to the Vishalya-pranahara group, is devoid of Mansa (muscles) and Sandhi (joint).

5.

The Sthapani-Marma, belonging to the Vaikalyakara class, is devoid of Mansa (muscle), Shira and Snayu;
the Lohitaksha-marma (of the same group) is devoid of Snayu, Sandhi and Asthi (bones);
the Janu-marma (of the same group) is devoid of Mansa, Shira and Snayu:
the Urvi-marma (of the said group) is devoid of Asthi, Mansa and Snayu;
the Vitapa-marma (of the same class) is devoid of Mansa, Shira and Asthi;
the Kurpara-marma (of the same class) is devoid of Mansa, Shira, and Snayu;
the Kukundara-marma (of the same class) is devoid of Mansa, Shira and Sandhi;
the Kakshadhara-marma (of the same class) is devoid of Shira, Asthi, and Sandhi;
the Vidhura-marma (of the said group) is devoid of Mansa, Sira and Sandhi;
the Krikatika-marma is devoid of Mansa, Shira, and Sandhi;
the Ansa-marma (of the same group) is devoid of Mansa, Snayu and Sandhi;
the Ansa-phalaka-marma (of the said group) is devoid of Mansa, Snayu and Sandhi;
the Nila, Manya and Phana Marmas (of the same group) are devoid of Mansa, Sandhi and Asthi;
the Avarta-marma is devoid of Shira, Snayu and Mansa;
the Apanga-marma (of the said class) is devoid of Mansa, Snayu and Sandhi.

6.

The Gulpha, Manibandha, and Kurcca-shira Marmas, belonging to the Rujakara group, are devoid of Mansa, Shira, Snayu and Asthi, i.e. Sandhi alone is present in these.

7.

Hence the piercing of a bone is attended with bleeding.

8.

If any of the Marmas of the Kalantara-Pranahara group be deeply perforated, then this perforation is sure to bring on death within a day (i.e. it will act like a slightly injured Marma of the Sadyah- Pranahara group).

9.

Any Marma of the Vishaiyaghna-group, being deeply perforated, brings on death within seven days (i. e. it will behave like a slightly injured Marma of the Kalantara-Pranahara class).

10.

Any Marma of the Rujakara class, being deeply perforated (injured), is sure to bring excruciating pain etc, (i.e., it will act like a slightly injured Marma of the Vishalyaghna group).

11.

It is a Snayu-Marma (ligament) to the width of half a finger, and belongs to the Kalantara group.

12.

It is a Mansa-Marma to the width of half a finger and belongs to the Kalantara group.

13.

It is a Snayu-Marma to the length of four fingers’ width, and belongs to the Vaikalyakara group.

14.

It is a Snayu-Marma, one finger in length and belongs to the Vaikalyakara group.

15.

It is a Sandhi-Marma, to the length of two fingers’, and belongs to the Vaikalyakara group.

16.

Indravasti measures two fingers in length according to Bhoja and Gayadasa, though half a finger in width according to others. It is a Mansa-Marma and belongs to the Kalantara group.

17.

It is a joint-Marma, three fingers in length and belongs to the Vaikalyakara group.

18.

It is a ligament-Marma, half a finger in length, (three fingers according to Gayadasa) and is of the Vaikalyakara class.

19.

It is a Shira-Marma, half a finger in length and of the Vaikalyakara group.

20.

It is a Shira-Marma, half a finger in length and of the Vaikalyakara group.

21.

It is a Snayu-Marma to the length of one finger and of the Vaikalyakara group.

22.

It is a Mansa-Marma to the length of four fingers’ width and belongs to the Sadyo-maraka class.

23.

It is a ligament combination (Snayu marma) to the length of four fingers, belonging to the Sadyah-Pranhara class.

24.

It is a Shira-Marma to the length of four fingers, belonging to the Sadyah-Pranahara class.

25.

It is a Shira-Marma to the length of four fingers and of the Sadyah- Pranahara class.

26.

It is a Shira-Marma, two fingers in length and of the Kalantara class.

27.

It is a Mansa-Marma about half a finger in length and of the Kalantara class, (according to Vgabhata, of the Sadyo-Maraka class).

28.

It is a Shira-Marma, half a finger in length, and of the Kalantara class.

29.

It is a Shira-Marma, half a finger in length and belongs to the Kalantara class.

30.

It is an Asthi-Marma, half a finger in length and of the Kalantara-maraka class.

31.

They are Joint-mar mas (Sandhi), half a finger in length and of the Vaikalyakara group.

32.

It is a bone Marma, half a finger in length, and of the Kalantara class.

33.

It is a Shira-Marma to the length of half a finger and belongs to the Kalantara class.

34.

They are Shira-Marmas (arterial anestomsis) to the lengt of half a finger and belong to the Kalantara class.

35.

It is an Asthi-Marma, half a finger in length and is Vaikalyakara.

36.

They are Snayu Marmas, half a finger in length and of the Vaikalyakara class.

37.

They are Shira-Marmas, to the length of four fingers and of the Vaikalyakara class.

38.

They are Shira-Marmas, four fingers in length and of the Sadyo-Maran class.

39.

They are Sandhi-Marmas, half a finger in length, and of the Vaikalyakara group.

40.

It is a Shnayu-Marma, and is of the Vaikalyakara class.

41.

They are Shira-Marmas to the length of half a finger and of the Vaikalyakara class.

42.

They are Shira-Marmas to the length of half a finger and of the Vaikalyakara class.

43.

They are Sandhi-Marmas, to the length of half a finger and of the Vaikalyakara class.

44.

They are Asthi-Marmas to the length of half a finger.

45.

They are Shnayu-Marmas, half a finger in length and of the Vishalyaghna class.

46.

They are Shira-Marmas to the length of half a finger and of the Visalyaghna class.

47.

They are Sandhi-Marmas to the length of four fingers and of the Kalantara-Pranahara class.

48.

They are Shira-Marmas to the length of four fingers and of the Sadyah-Pranahara class.

49.

It is a Sandhi-Marma, half a finger in length and of the Sadyah- Pranahara class.

50.

Some are of opinion that a surgical operation (in the case of the remaining fifty-six) should be made, leaving a space equal in measurement to the dimensions of a palm (from the affected part). Gayadasa, having learnt from Bhoja, explains that a space of two fingers should be left (from the affected part) in making surgical operations of the ten marmas, namely, the two Gulphas, the roots of the two breasts, the four Indravastis, and the two Manivandhas.

51.

Gayadasa does not read this verse.

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