Introduction to Marmabhighata Samprapti (injured marmas)

Each and every disease has got its own samprapti. The study on the mechanism of the manifestation of disease is samprapti. Even a slight discomfort either physical or mental has got its own reasons. Disease is a derangement of the physiological systems. It is the ultimate outcome manifested as a result of derangements or physiological processes caused by the different nidanas undergone by the individual. According to Ayurveda, doshas, dhathus and malas are the fundamental factors which conduct the whole physiological processes of the body. It has already been mentioned that severe pain, deformity, or death will be resulted due to injuries on marmas. For such fatal result also, there should be some minor or major impairments in the physiological process. According to Vagbhata and Susruta the seven hundred siras in the body which are classified into 11

four as Vatha, Pitha, Kapha and Sudhasonithavahisiras nourish the whole body and they are said to be circulating all over the body centralizing on the marmas. Therefore the injuries to the marmas will cause trauma to the Siras (blood vessels) resulting in sudden raktasrava (hemorrhage). It is a fact that the nourishment of the whole body is through rakta (blood) and loss of blood due to the injuries results in dhathukshaya, causing the vitiation of vatha. The vitiated vatha causes severe pain and also the vitiation of other dosas, mainly the pitha. As a result of the vitiation of pitha thirst, dryness, giddiness, vertigo, perspiration and relaxation of joints occur. This results in the failure of the vital functions of the body causing death. 23 Susruta does not mention the vitiation of pitha. He observes that the four types of siras, being centralized on the marmas always nourishes the snayus, asthis, mamsas, sandhis, the ultimate result of these factors is the total nourishment of the body." 24 Though the siras are classified into four as vatha, pitha, kapha and sudha sonitha vahees, it is nothing but the vatha which conducts the circulation 12

25 of blood in the whole body. The vyanavayu being seated in the hrdaya conducts the circulation of blood all over the body. So whenever there is disturbance in the circulation, naturally the vatha will vitiate. The same thing will happen in marmabhighata also. When the marmas are injured, loss of blood occurs along with the vitiation of vatha. The vitiated vatha causes excruciating pain, and the patient becomes unconscious due to this and as a result of the failure of the whole system the individual dies. From the detailed description above it can be enumerated that the mechanism of fatal effects of injuries to marmas are as under :- 1. Excess loss of blood due to kshata of blood vessel. Injury Raktakshaya Blood loss 2. Dhatukshaya due to Raktakshaya. 3. Vatakopa due to dhatukshaya. Dhatukshaya Doshakopa 4. Pittakopa. Vatakopa Pittakopa Kaphakopa 5. Manifestation of symptoms or death. Manifestation of illness or death 13

From the above it could be understood that shock is the main cause of death. Shock is explained as a peripheral circulatory deficiency or anoxaemia. It is of two types namely primary shock and secondary shock. The primary shock is a neurovascular reaction, syncope or fainting which develops immediately after some injury and is usually transient. Secondary shock does not occur immediately after some injury, but is a type of circulatory failure due to agony and abnormal permeability of capillary wall, Anyhow, shock is the result of circulatory deficiency. Vagbhata's illustration, that the injuries to blood vessels being on the marmas cause excessive loss of blood resulting in dhathukshaya, is the apt comparison to the condition of shock. Samanya Lakshanas of Marmabhighata It has already been mentioned that there are 107 marmas in the human body. These are classified into several groups, which will be dealt later. The symptoms of injuries on each marma have been described in detail in the Samhita granthas. Furthermore, the symptoms on injuries to the different marmas such as mamsa marma, asthi marma, are also 14

described in the Samhita granthas. There are certain general symptoms as brema (giddiness), pralapa (delirium), patana (falling down), pramoha (unconsciousness), vichostanam (abnormal movements of the body), Samleena (semiconsciousness), ushnatha (rise of temperature), srastamgatha (relaxation of joints), moorcha (fainting), oordhavatha (belching), ruja (pain) and different lakshanas due to the vitiation of vatha will be manifested due to the injuries in any of the five type of marmas. Moreover, there will be bleeding where the blood will be like a fluid washed with mamsa, observing capacity of Indryas also will be lost. 26 Vagbhata also describes certain general symptoms manifested on injuries to marma. He says that deha prasupthi (numbness of the body), gurutha (heaviness), moha (unconsciousness), seethakamitha (likeness of cold), sweda (perspiration), moorcha (fainting), vami (vomiting) and swasa (dyspnoea) are the symptoms of injury to marmas. Along with the above mentioned general symptoms particular symptoms related to each marma which is injured can also be seen. 27 15

Prognosis A Marmabhighata in which frequent (extreme vikshepa (convulsion), brisamsadanam weakness), soonyatha (loss of sensory observations), brema (vertigo), vepanam (shivering), oordhaswasam (severe dyspnoea), srastangatha (fatigue), hrdaya dahyatha (burning sensation in the chest) are observed and the patient will feel no relief from symptoms at any stage, may probably die. 16

Figure No. 3 Ayurveda Marmas I 17 Krikatika Amsa Amsaphalaka Brihati Koorparam Parshva Sandhi Nitamba Kateekatarunam Oorvi Aani Jaanu Indravasthi Gulpha

Manya Matruka Stanarohita Oorvi Aani Indravasthi Manibandha Koorcha Kshipra Vitapam Jaanu Gulpha Figure No. 4 Ayurveda Marmas II 18 Adhipati Sthapani Hrdaya Oorvi Kurpara Nabhi Vasthi Manibandha Lohita Oorvi Ani Janu Gulpha

Kurpara Apanga Oorvi Lohitha Apalapa Sthapani Shringataka Amsa Nabhi Vasthi Oorvi Janu Hrdaya Indravasthi Manibandha Koorchashira Talahrdaya Koorcha Gulpha Kshipra Kshipra Figure No. 5 Ayurveda Marmas III 19