Trimarma Ka Rachnatmak Adhyan and their clinical aspect - A Literary Review

[Find the meaning and references behind the names: Guna, Gupta, Kumar, Hitesh, Shir, Jan]

REVIEW ARTICLE Jan-Feb 2022 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2022 | Vol. 7 | Issue 1 282 Trimarma Ka Rachnatmak Adhyan and their clinical aspect - A Literary Review Gupta Kanika 1 , Kumar Hitesh 2 1 Post Graduate Scholar, Dept. of Rachna Sharir, Babe Ke Ayurvedic Medical College, Daudhar, Punjab, India. 2 Post Graduate Scholar, Dept. of Dravya Guna, Babe Ke Ayurvedic Medical College, Daudhar, Punjab India. I NTRODUCTION Knowledge of Marma is considered essential in Ayurveda. Explaining the importance, Acharya Sushrut defined Marma as the vital points of the body which shows various fatal signs and symptoms on traumatic injury [1] Marma are termed as anatomical positions which are either superficially or deeply seated points in the body which is juncture of Sira (vein), Asthi (bone), Mamsa (muscle), Snayu (ligament) and Sandhi (joint). Thereby as per Sharir Rachna, Marma can be divided into Sira Marma, Asthi Marma, Mamsa marma, Snayu Marma, Sandhi Marma . Marma are also called Jeevasthana and Pranayataana where Prana (vital Address for correspondence: Dr. Gupta Kanika Post Graduate Scholar, Dept. of Rachna Sharir, Babe Ke Ayurvedic Medical College, Daudhar, Punjab, India. E-mail: kanikagupta 29@gmail.com Submission Date: 13/01/2022 Accepted Date: 18/02/2022 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA energy) resides or flows through [2] In Sushrut Samhita , depending upon traumatic effects and prognosis Marma are classified into following 5 categories [3] 1 Sadhyapranahar (causes immediate death) 2 Kalantarpranahar (Death occur within short period) 3 Vaikalyakar (Any trauma to this cause the deformity) 4 Vishalyaghna (causes death as soon as foreign body is removed) 5 Rujakar (Trauma causes continuous pain) Marma are of utmost importance in Samhita and their concept developed during the times of war [4] The utmost importance of Marma due to pain/deformity or even sudden death on trauma lead to the development of Marma therapy, which involves the utilization of the Marma points during Abhyanga (to relief pain/ stiffness at particular point) and Mardana . To achieve the state of wellness, balanced Tridosha at physical levels and balanced Triguna at mental levels are essential. With respect to Triguna and Tridosha imbalance, the injuries to these Marma lead to complications and sometimes sudden death of the person A B S T R A C T The one and only purpose of Ayurveda is maintaining the health of healthy person while treating the diseased individual by maintaining the state of health (mentally, physically and spiritually). In Ayurveda , concept of Marma is of utmost important concept of applied or surgical anatomy. Marma is defined as the anatomical area where the five principle anatomical structure Mamsa, Sira, Snayu, Asthi and Sandhi are present; thereby are critical points in body with different organs, structure and nerves lying underneath. In Charak Samhita, Chikitsasthan chapter 26, Trimarma i.e., Shir, Hridayam and Basti described by Acharya Charak possesses significant clinical importance. This review will provide a complete summary of Trimarma regarding its location, structural entity and clinical importance. Key words: Trimarma, Basti, Hridya, Shir, Prana, Marma Abhighata

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

Gupta Kanika et al. Trimarma Ka Rachnatmak Adhyan and their clinical aspect - A Literary Review ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2022 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2022 | Vol. 7 | Issue 1 283 Marma are considered as the site of Prana , the vital energy considered equivalent to subtle life force energy for existence. Prana are considered to be present all over the body but still its pedigree being present at some specific regions like S nayu, Mansa, Sira, Asthi and Sandhi are termed Marma which are explained in detail in Sushrut Samhita by Acharya Sushrut in Marma Shareer . Amongst 107 Marma , Acharya Charak has considered three Marma as Trimarma as MUL in Chakitsasthan ( Tanmulatwashareerashtha ). As per Acharya Charak, “Trimarmas ” lie in “ Skandha ” ( Skandhastrit ). It means the part of body excluding the four limbs. Amongst these “ Skandhashrit ” Marma only Trimarma are having clinical significance than other Marma . So in Chikitsa , these Trimarma must be protected from Dosha imbalance and from injury / trauma. Trimarma are included in Sadyahpranahara Marma . A IM AND O BJECTIVES 1 To explain the conceptual aspect of Trimarma . 2 To explain the anatomical position and structural entity around Trimarma . 3 To explain clinical knowledge of Trimarma in Ayurvedic literature with respect to modern science. M ATERIALS AND M ETHODS Literary review regarding Rachnatmak (anatomical) constitution and clinical aspect of Trimarma was done through various Ayurvedic classical texts, journals and research papers. The collected references are critically assumed to frame the conceptual aspect. Since this is not a clinical trial, no clinical data is collected. Trimarma Since extremities are connected and dependent on trunk thereby Marma of trunk are more vital than Marma of extremities, amongst the Marma of trunk, Trimarma are utmost important 1. Shir Shir word is derived from root Sru with Asun Dhatu meaning the one that is full of Guna [5] (best qualities), indicating the superiority of Sira and dependency of other body parts for functionality on Sira . Acharya Charak in Sutrasthana chapter 17 has defined Sira as that part of body where the Prana resides along with all the sense organs and is considered as supreme organ [6] Thereby Shir contains “ Panchdnyanedriya ” i.e., sense organs and “ Indriyapranvah Strotas ”. Anatomical considerations and clinical importance Charak Samhita considered Shir as “ Surya ” (Sun) where the Panchindriya and their channels send impulses like the rays emitted from sun thereby significantly implying Shir (including all the Urdhwajatrugata Marma excluding the neck) as the upper most part of body i.e. brain controlling CNS [7] As Shir is considered as center for all Panchindriya thus it can be correlated to vital centers (Vagal centers respiratory centers) and centers of 12 cranial nerves, all responsible for body functioning. Shir is considered as important Marma , injury to whom may lead to fatal consequences. Acharya Sushrut also quotes that injury to Shir may lead to death of the patient. According to Acharya Charak, it may lead to facial paralysis, Eye agitation, neck-rigidity bilaterally, facial paralysis, stupefaction and constricting pain in the head, dyspnoea, loss of movement, cough, trismus, dumbness, stuttering speech, closed condition of the eyelids, twitching of the cheeks, yawning fits, ptyalism and aphasia. 2. Basti Basti refers to urinary bladder which stores urine secreted by kidneys and transmitted by ureters. Basti is related with reproductive organs, which, lies in pelvic cavity. Basti Marma is like Alabu being supported by Sira and Snayu. [8] Basti Marma is related to Jala Mahabhuta . Anatomical consideration and clinical aspect Basti Marma is 4 Anguli (Approx. 7 cm) in Parmana thus a Basti Marma is situated within the semicircle arch of 7 cm radius considered above from the inferior border of pubic symphysis. Basti Marma is situated in Kati Pradesh (pelvic region) & is surrounded by

[Find the meaning and references behind the names: Govind, Bhaskar, Chetan, Chand, Mala, Heart, Good]

Gupta Kanika et al. Trimarma Ka Rachnatmak Adhyan and their clinical aspect - A Literary Review ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2022 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2022 | Vol. 7 | Issue 1 284 Sthoolguda (rectum), Mushka (scrotum), Sevani (pereneal sutures), Shukravaha (seminal vesicle) & Mutravaha Nadi (urinary channels) [9] Basti flushes the Mala (Urine) and Kleda (unwanted water or fluid components of the body Acharya Sushrut has mentioned that any injury to Basti Marma can cause immediate death, except for those caused by Vrana (wounds) and Ashmari (renal calculi). In case of severe injury, Basti can break bilaterally causing immediate death while in case of urine leakage only through one side, with prompt measures, the person can be saved. Trauma causes immediate death in following cases :- a Mutra Sanga (urine obstruction) b Mutrajanya Udavarta - obstruction of urine flow due to Vata vitiation leading to tilting of the urinary bladder upside thereby discharging the urine in upward direction ( Udavarta ), eventually leading to pressure over abdominal organs and heart, flooding the pelvic cavity with urine, ultimately causing the death. c Mutra Ati Pravritti - Injury causing the bladder ruptures leading to the urine discharge or internal bleed into pelvic cavity that leads to death. 3. Hridaya Acharya Charak has included the Hridya into Trimarma and is a sight for Prana , Budhi , Chetan and Oja thereby indicating Hridya as a vital organ in body. Hridya Marma is 4 Anguli in Pramana and is considered as a Sira and Sadyapranhar Marma . It is considered as site of Triguna. Anatomical consideration and clinical aspect Hriday Marma lies in thoracic cavity ( Urobhag ) in between two “ Stana ” (breast) above “ Amashaya ” (stomach), thereby the heart can be related to Hriday Marma. Acharya Charak has mentioned Hriday as a chief organ of the body. In case of acute injury, internal Dosha disarrangement may lead to cardiac attack and eventually can be fatal. Cardiac diseases may lead to acute myocardial infarction and massive thrombosis on coronary artery leading to sudden death. DISCUSSION Amongst other qualities of a good physician, the utmost quality is that he should have the clinical knowledge of Marma in order to protect Marma from trauma or during surgical procedures and thus, in case of injury they should be resuscitated as soon as possible. In ancient times, Marma Abhigata during war while in present era, Marma Abhigata during road accident and sports injury can be fatal, thereby any trauma or chronic diseases to these vital organs should be protected with prompt measures. Thus a better understanding of Sadyapranhara Marma and detail evaluation of structural entities underlying these sites can be used to avoid the serious injury, permanent deformity and even death, thereby can also be used in Marma Chikitsa . CONCLUSION The Ayurveda focus on cure to acute to chronic disorders along with treatment of medical emergencies caused due to external trauma at the times of war. The knowledge of vital organs can be correlated with Trimarma in Ayurved explained by Acharya Charak in detail. These are called Sadyapranahar Marma and are considered as important and delicate body parts. So these Marma should always be protected from any type of trauma or any internal diseases in all the situations. REFERENCES 1 Dr. Bhaskar Govind Ghanekar. Sushrut-Samhita, ayurvedsandipika, Hindi Vyakhya. 3 rd edition 1997, New Delhi: Meher Chand Lachmandas Publications (sanskrit). (Sharirsthan 6/44) 2 Dr. Bhaskar Govind Ghanekar. Sushrut-Samhita, ayurvedsandipika, Hindi Vyakhya. 3 rd edition 1997, New Delhi: Meher Chand Lachmandas Publications (sanskrit). (Sharirsthan 6/24) 3 Dr. Bhaskar Govind Ghanekar. Sushrut-Samhita, ayurvedsandipika, Hindi Vyakhya. 3 rd edition 1997, New

[Find the meaning and references behind the names: Nil, Med, Prakashan]

Gupta Kanika et al. Trimarma Ka Rachnatmak Adhyan and their clinical aspect - A Literary Review ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2022 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2022 | Vol. 7 | Issue 1 285 Delhi: Meher Chand Lachmandas Publications (sanskrit). (Sharirsthan 6/14) 4 Dr.Ambikadatta Shastri. Sushrutsamhita, Ayurved Tatwasandipika, Hindivyakhya. 24 th edition. Reprint 2007. Varanasi: Chaumkhmba Sanskrit Sansthan. (Shareersthan 6). 5 Pt. Kashinath Shastri & Dr. Gorakhanatha Chaturvedi. Charaka Samhita with Vidyotini Hindi Commentary Part- 1&2. 22 nd Edition. Varanasi: Chaukhambha Bharti Academy, 1996. (Viman Sthana 8/117) 6 Pt. Kashinath Shastri & Dr. Gorakhanatha Chaturvedi. Charaka Samhita with Vidyotini Hindi Commentary Part- 1&2. 22 nd Edition. Varanasi: Chaukhambha Bharti Academy, 1996. (Sutra Sthana 17). 7 Pt. Kashinath Shastri & Dr. Gorakhanatha Chaturvedi. Charaka Samhita with Vidyotini Hindi Commentary Part- 1&2. 22 nd Edition. Varanasi: Chaukhambha Bharti Academy, 1996. (Siddhi Sthana 9/4) 8 Sushruta: Sushruta Samhita, Teeka by Dalhana, Published by Chaukambha Surbaharati Prakashan, Varanasi, Nidansthan chapter no 3/ 20 page no 734-735. 9 Pt. Kashinath Shastri & Dr. Gorakhanatha Chaturvedi. Charaka Samhita with Vidyotini Hindi Commentary Part- 1&2. 22 nd Edition. Varanasi: Chaukhambha Bharti Academy Varanasi, 1996. (Siddh Sthana 9) ******************************* How to cite this article: Gupta Kanika, Kumar Hitesh. Trimarma Ka Rachnatmak Adhyan and their clinical aspect - A Literary Review. J Ayurveda Integr Med Sci 2022;1:282-285. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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