Study of Manibandha or Gulpha Marma

Etymology—The word Manibandha has various meanings like o Inter phalangeal joints, □ wrist joint, □ elbow joint, to tie the precious stones, □ counting machine. Description A perforation to this Gulpha marma which is situated at the junction of the foot and the calf, result in pain, paralysis and maimedness of the affected leg. The situation of the Manibandha marma is at the junction of the hand with the fore arm (wrist). Injury causes pain and paralysis. This is termed as Gulpha in the lower limb. (Ankle joint). It has the bhuta structure - agni and vata. It's ashraya is sandhi. Prognosis is vaikalyakara in nature. It has an extent of two anguli. Adhidevata is Brahma. 238

Radial artery Flexor carpi radialis tendon Flexor pollicis longus tendon in radial bursa Palmar carpal ligament (reflected) Synovial tendon sheath Trapezium bone 1st metacarpal bone Opponenes pollicis muscle Adductor pollicis brevis muscle (reflected) Flexor retinaculum Ulnar artery Ulnar nerve Flexor carpi ulnaris tendon Pisiform bone Abductor digiti minimi muscle Flexor digiti brevis muscle Opponenns digiti minimi muscle Superficial palmar arterial arch Plate No. 32: The anatomical area of Manibandha Surface Anatomy Both of these marma are better palpable on the ventro medial part of the respective limbs. Gulpha marma can be located on applying slight pressure with thumbs on ventromedial part of ankle joint in slightly flexed position. This examination can be made with patient lying on lateral position. In patient lying on supine position, raise the leg little above the bed and supporting the leg with one hand comfortably palpate the marma with another hand. Manibandha can be easily located on ventral aspect of wrist joint. Underneath are the inter carpal or tarsal ligaments and the nerve branches passing underneath. 239

Soleus muscle Peroneus longus muscle Peroneus brevis muscle Calcaneal (Achiles) tendon Subcutaneous calcaneal bursa Subtendinous calcaneal bursa Common Sheath of pernous longus and brevis tendons Calcaneus Extensor digitorum longus muscle Superior extensor retinaculum Sheath of tibialis anterior tendon Lateral malleolus and subcutaneous bursa Inferior extensor retinaculum Sheath of extensor digotum longus and peroneus tertius tendons Sheath of extensor hallucis longus tendon Peroneus tertius tendon Peroneus brevis tendon Tuberosity of 5th metatarsal bone Extensor digitorum brevis muscle Abductor digiti minimi muscle Superior and interior peroneal retinacula Plate No. 32a: The anatomical area of Gulpha Anatomical Structures corresponding to this marma Upper limb ☐ Ulnar artery ☐ Median Nerve ☐ Flexor carpi radialis Flexor digitorum superficialis ☐ Flexor digitorum profundus ☐ Flexor pollicis longus Extensor retinaculum ☐ Digital branch of radial nerve pa Extensor carpi ulnaris ☐ Extensor digiti minimi P Extensor digitorum ☐ Extensor indicis 240

☐ Extensor pollicis longus Extensor carpi radialis longus and brevis Lower Limb ☐ Superficial Peroneal Nerve ☐ Extensor retinaculum ☐ Deep Peroneal nerve P Extensor digitorum longus ☐ Extensor hallucis longus m Tibialis anterior ☐ Anterior tibial artery ☐ Peroneal retinaculum on lateral side of ankle. ☐ Peroneus tertius muscle ☐ Greater Saphenous vein P Small Saohenous vein 0 Flexor retinaculum ☐ Flexor digitorum longus tendon ☐ Posterior tibial artery ☐ Posterior tibial nerve ☐ Flexor hallucis longus Discussion ☐ Tibialis posterior Wrist and ankle are the major joints where one may invariably injure many times during ones life time. The classical old woman's fracture or Colle's fracture of the wrist joint and also Pott's injury seen around the ankle are some among the common injury we come across. 241

Complications like Sudecks Atrophy delays healing and stiffness are very common complications which are still confusing the modern orthopedic surgeons. Gulpha sandhi and Impotency Vahata in Ashtanga Sangraha narrates symptoms like Ruk (Pain), Sthabda Sakthitha (Impaired movements of lower Limbs) Shandata (Impotency). In the Indu commentary it is described shantata as Ayoshitha Yogyatvam (Loss of libido). All other Acharyas have kept silence regarding this. To explain rationally is very difficult However the following can be the argument. The nerves which causes erection and ejaculation is related to lumbosacral plexus. Nerve supply to the ankle is related to lumbosacral plexus. Common peroneal is the he branch sciatic nerve which supplies the superficial and deep peroneal nerve to the ankle. An injury to that nerve can cause complete degeneration of that particular nerve from that end to the root and may deter impulse transmission for the plexus to the reproductive organs which in term might precipitate impotency. 242

Tamil varma sastra In Tamil also this is named as Manipantha varma. This varma is situated on the inside of the foot towards the little toe. As it lies very close to the ankle it is termed as Manipantha varma. Odimurivu 41 says this lies 5 fingers above the sootu varma which lies above the big toe. The pain at the side subsides but the inflammation goes on if not treated within 60 nazhigai. Contrary to our belief there are two varma seen in and around this joint. The other one is Meka varma which lies in the same line of Manipantha varma but on the medial side. Here the treatment should be initiated within 9 Nazhikai. Kulayana marma Kalari people consider this as Nadipathy. The injury ultimately lead to weakness of the hands and inability to clench the fingers.