Understanding the concept of Marma and their clinical applicaion in Shalya...

[Full title: Understanding the concept of Marma and their clinical applicaion in Shalya Tantra w.s.r. to Vital points]

[Find the meaning and references behind the names: Sri, Shankar, Swamy, Sura]

ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 89 Understanding the concept of Marma and their clinical applicaion in Shalya Tantra w.s.r. to Vital points Dr. Mamatha TS, 1 Dr. Shankar S. Swamy, 2 Dr. S. V. Shailaja 3 1 Post Graduate Scholar, 2 Assistant Professor, 3 Professor & HOD, Department of Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital & Research Centre, Bangalore, Karnataka, INDIA. I NTRODUCTION Marma is one of the unique and important topics discussed in Ayurveda. It plays an important role in surgery. Hence it is rightly called as Shalya Vishayardha. We get many references of major surgeries being Address for correspondence: Dr. Mamatha TS Post Graduate Scholar, Department of Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital & Research Centre, Bangalore, Karnataka, INDIA. E-mail: mamathamanjunath 555@gmail.com Submission Date : 18/08/2018 Accepted Date: 20/09/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 3 i 5.13823 carried out by Sushruta in our classics by administering Sura or Madira . But it seems that there was some kind of Bandha or Pressure being applied over Marma Sthana which is a seat of Prana to create anaesthetic or analgesic effect for performing surgeries. In present days we see same kind of analgesic or anaesthetic effect being done by acupuncturists for performing some minor surgeries and to treat many of chronic ailments. Marma point (Vital point) is defined as the site where there is confluence of structures like Mamsa (Muscular component), Sira (Vascular component), Snayu (Neuroconnective tissue component), Asthi (Sclerous component) and Sandhi (Articular component) and Prana (Life force) resides making it as its specific place. Knowledge of the Marma is described as half the knowledge of Shalya Tantra (Science of surgery), as A B S T R A C T Marma therapy is the original point system of healing in the body. “ Marma ” come from the sanskrit “ Mru ” and which means “To kill” the 107 Marma points are categorised in terms of their effect on the vitality of the body. Marma is one of the unique and important topics discussed in Ayurveda. It plays an important role in surgery. Hence it is rightly called as Shalya Vishayardha . Marma plays a significant clinical role and may be correlated to the Acupressure/Acupuncture. Marma are the critical points of body associated with different organs and nerves. Ayurveda describe use of Marma therapy for various diseases and identification of Marma points which is to be cured, since injury to these Marma points may causes serious harmful effect. Different types of muscles, veins, bones, ligaments and joints meets with each other at the Marma point thus these points acts as a physiological junction. Discussion of Marma points is found in most of the great texts of Ayurveda but the most famous text to explore the subject is the Sushruta Samhita . Vaidya Sushruta described ‘the locations of the Marma points, as well as how they influence Prana . He stated that it is important for the surgeon to have knowledge of these points for the purpose of avoiding them, so as to cut into them could result in a catastrophic outcome. This article summarizes various perspectives of Marma and their clinical importance as per Ayurveda. Key words: Marma, Shalya Tantra, Marma therapy, Acupressure, Acupuncture, Vital points.

[Find the meaning and references behind the names: Guna, Tamas]

Dr. Mamatha TS et.al. Concept of Marma and their clinical applicaion in Shalya Tantra w.s.r. to Vital points ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 90 persons injured in the vital spot die immediately or suffer from unforeseen ailment which is life threating; if anyone survives by the efficiency of the physician, is sure to suffer from deformities [1] Injury to the Marma , though slight, will produce severe pain; similarly, the disorders localized in the Marma Sthana . Hence they should be treated with great care and effort [2] Types of Marma and their importance in Ayurveda Marma has been described by several ancient Ayurvedic masters i ncluding Charaka and Vagbhata, among others. The best description however is given by Sushruta, the ‘father of surgery’ in the Sushruta Samhita . He covered many aspects of anatomy and surgery in this text, written centuries ago. According to Sushruta , Marma points are the seats of life. Marma are the places where the three Doshas ( Vata , Pitta and Kapha ) are present, along with their subtle forms ( Prana or vital force, Tejas or inner radiance and Ojas or essence of life). The three Gunas of Satva (beingness), Rajas (activity) and Tamas (darkness) are also present. Acharya Sushruta described 107 Marma points in the body and most of the ancient texts of Ayurveda have given importance to Marma and explained 107 Marma in a separate chapter [3] Aacharya Sushruta defined Marma as the vital points of the body which shows various fatal signs and symptoms on traumatic injury [4] Where Prana (vital energy) resides or flows through [5] In spite of great importance, there is no direct mention of therapeutic use in Ayurvedic literature. Depending upon traumatic effects and prognosis, various types of marmas mentioned in Ayurveda as follows [6] 1 Sadhyapranahara (Sudden death) 2 Kalantarpranahara (Death within short period) 3 Vaikalyakara (Deformity due to trauma) 4 Vishalyaghna (Person lives until removal of foreign body) 5 Rujakara (continuous pain due to trauma) These are superficial and deeply seated points in the body which involves 1 Mamsa (Muscle) (10 numbers) 2 Sira (Vein) (41 numbers) 3 Snayu (Ligament) (27 numbers) 4 Asthi (Bone) (8 nubmers) 5 Sandhi (Joints) (20 numbers) The Marma points by Dosha Here’s a breakdown of the 107 Marma points according to one’s constitution or, the predominant tissue or predominance of physical matrix present [7] There are 11 Marma points present in the muscle tissue. These are called Mamsa Marma. There are 41 Marma points predominant in the blood vessels. These are known as Sira Marma. There are 27 Marma points predominant in the ligaments and tendons. These are called Snayu Marma. There are 8 Marma points predominant in the bones. These are referred to as Asthi Marma. There are 20 Sandhi Marmas , or Marma points predominant in the joints. The Marma points by location [8] There are 22 Marma points in both upper limbs (11 Marma in each upper limb). There are 22 Marma points in both lower limbs (11 Marma in each lower limb). There are 26 Marma points in the thorax and abdomen. There are 37 Marma points located in the head and neck. The Marma points by effect of injury to the Marma [9] This classification was more suitable to ancient times when there were wars and fighting and people lived in forests and tribes

[Find the meaning and references behind the names: Manas, Sun, Heart]

Dr. Mamatha TS et.al. Concept of Marma and their clinical applicaion in Shalya Tantra w.s.r. to Vital points ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 91 In modern times, it is not really applicable as medical management of wounds and injuries has changed substantially with the advent of modern surgery, trauma management, life saving equipment, medicines and techniques However these Marma can be understood as ones which need to be protected from accidental injuries. If injured, these Marma warrant immediate medical attention and management to save mortality and morbidity Marma points are affected by injury Sadhya Pranahara Marma - Marmas with which, on getting inflicted with injury, cause instant death. Kaalantar Pranhar Marma - If these Marma are injured then gradual and slow death occurs. Vishalyaghana Marma - If these Marma are injured then death can occur. Vaikalyakar Marma , If these 44 Marma are injured, deformity and pain can result. Rujakara Marma , If these 8 Marma are injured, pain occurs. Trimarmam [10] Among 107 Marmas mentioned earlier in Sutrasthana, Basthi, Hrudaya and Siras ( Trimarma ) are given prime importance by eminent scholars. The reason behind is this three Marmas are Sthana for Prana , and any kind of Pida (injury - physical or mentally) may cause death of the patient. Hrudaya : As the spoke of wheel are attached to the centre, similarly the ten vessels, Prana Vayu, Apana Vayu, Manas, Bhudhi, consciousness, and Mahabhutas are attached to the heart. Siras : Head is the abode of senses, sensory channels and channels carrying elen vitae as the sun is the abode of its rays. Basthi : The urinary bladder, located in the midst of Sthula Guda (rectum), Muska (testicles), Sevani and seminal as well as urinary channels, is the receptacle of urine into which all the channels of the body carrying liquid elements converge as all the rivers on the earth flow into the ocean. Samanya Lakshanas of Trimarma injury Serious injury to Trimarma causes destruction of the body, since the destruction of the Asrayas leads to destruction of supra structures. Partial injury to these leads to afflication by serious diseases, therefore theses vital organs should be specially protected from external injury and application by Vayu etc Samanya Chikitsa [11] The Marmas are to be protected from aggravated Vayu , because the aggravated Vayu is responsible for aggravation of Pitta, Kapha and Vayu . The Vayu is best treated with Basti so, there is none other than Basti therapy which can safeguard the vital organs. Discussion The science of Marma is one of the exclusive concepts of Ayurveda which has been well developed by keen observations, especially at the time of surgical procedures. These are very special and vital superficial points spread on the whole body surface. They are special because these points are the sites of ‘ Prana’ (Life processes). Moreover, Vishama Spandana is also very phenomenal characteristics of these Marma points. Acharya Sushruta in his Marma Adhyaya , Acharya Charaka in his Trimarmiya Siddhi Adhyaya , and Chikitsa Adhyhaya, Ashtanga Hridayam in his Marma Vibhaga have made classical description throwing light on every aspect of Marma . The Marmas are very important from traumatological point of view. It has been observed that any Trauma at this very point is more threatening or found to be delayed in recovery from injuries. Acharya Sushruta has mentioned the same in Marmabhighta Lakshanas . The Lakshanas of Marma after trauma or injury is also depending upon its structural type. CONCLUSION Marmas are vital points, centers for the Prana . They can be used specifically for the diagnosis and treatment of disease or generally for promoting

[Find the meaning and references behind the names: Meet, Sharma, Govind, Indu, Soma, Bhaskar, Main, Deep, Nil, Med, Satyanarayana]

Dr. Mamatha TS et.al. Concept of Marma and their clinical applicaion in Shalya Tantra w.s.r. to Vital points ISSN: 2456-3110 REVIEW ARTICLE Sep-Oct 2018 Journal of Ayurveda and Integrated Medical Sciences | Sep - Oct 2018 | Vol. 3 | Issue 5 92 health and longevity Human body when exposed to trauma shows various sign and symptoms depending on severity and types of trauma. Acharya Sushruta mention 107 deep or superficial points on body surface when get traumatized produce various signs and symptoms not only on the basis of type of injury but on the basis of its constituents. Our physic comprises vessels, muscles, bones, joints, nerves, ligaments etc. every where in more or less proportion. According to Acharya Sushruta , the point where all the above structures meet and is the site of Prana (vitality) is nothing but Marma . “ Agni Soma Vayu ” are basic components of Marma . Ayurveda emphasized on anatomical knowledge as part of diagnosis and treatment. The surgical interventions needed great consideration of anatomical perspective, any misconception regarding anatomical framework may leads failure of medical procedure. Marmas are integral to all Ayurvedic therapies from simple self treatments to complex clinical procedures. They form one of the main pillars of Ayurvedic thought and practice. This article described Marma points which need to be covered while Marmaghatha to prevent fatal conditions. REFERENCES 1 Acharya YT. Shareera Sthana chapter 6 verse 26 Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya. Reprint ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010.;p.55. 2 Sharma SP. Shareera Sthana chapter 7 verse 24 Astanga Sangraha with Sashilekha Sanskrit commentary of Indu. 2 nd ed. Varanasi (India): Chaukambha Orientalia; 2008; p.326. 3 Sushruta Samhita Dalhana Acharya Virachita Nibhandhasangraha vyakhya, Vaidya Yadavaji Trikamaji Acharya, Choukhambha Surabharati Prakashana, Varanasi, reprint 2010. Page no: 369. 4 Dr. Bhaskar Govind Ghamekar, Sushruta samhita, Ayurveda sandipika, Hindi, vyakhya, 3 rd edition 1997, Meherechandre Lakashamendas (Sanskrit) 6/44. 5 Dr. Bhaskar Govind Ghamekar, Sushruta samhita, Ayurveda sandipika, Hindi, vyakhya,3 rd edition 1997, Meherechandre Lakashamendas (Sanskrit) 6/14. 6 Dr.Bhaskar Govind Ghamekar, Sushruta samhita, Ayurveda sandipika, Hindi, vyakhya,3 rd edition 1997, Meherechandre Lakashamendas (Sanskrit) 6/24. 7 Sushruta Samhita with Hindi commentary by Kaviraj Ambikadutta Shastri, Part-1, page no. 67,Sharir Sathan 6/4, by Chaukhambha Sanskrit Sansthan, 2011. 8 Sushruta Samhita with Hindi commentary by Kaviraj Ambikadutta Shastri, Part-1, page no. 67,Sharir Sathan 6/5, by Chaukhambha Sanskrit Sansthan, 2011. 9 Sushruta Samhita with Hindi commentary by Kaviraj Ambikadutta Shastri, Part-1, page no. 67, Sharir Sathan 6/8, by Chaukhambha Sanskrit Sansthan, 2011. 10 Caraka samhita of Agnivesha revised by Caraka and Drdhabala with introduction by Vaidya samrata Sri Satyanarayana Sastri, Chikitsa sthana part 2 published by choukamba Bharati Academy, Varabasi reprint:2001, pg no:716 pp:1208. 11 Caraka samhita of Agnivesha revised by caraka and drdhabala with introduction by Vaidya samrata Sri Satyanarayana Sastri, Siddhi sthana part 2 published by choukamba Bharati Academy, Varabasi reprint:2001, pg no:1050 pp:1208. ******************************* How to cite this article: Dr. Mamatha TS, Dr. Shankar S. Swamy, Dr. S. V. Shailaja. Understanding the concept of Marma and their clinical applicaion in Shalya Tantra w.s.r. to Vital points. J Ayurveda Integr Med Sci 2018;5:89-92. http://dx.doi.org/10.21760/jaims.v 3 i 5.13823 Source of Support: Nil, Conflict of Interest: None declared.

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