Amsaphalaka Marma - A Cadaveric Study

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CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 228 Amsaphalaka Marma - A Cadaveric Study Omkumar V Kori 1 , Anju Thomas 2 1 Post Graduate Scholar, Department of Sharira Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Kuthpady, Udupi, Karnataka, India. 2 Associate Professor, Department of Sharira Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Kuthpady, Udupi, Karnataka, India. I NTRODUCTION The term breath is emphasized in equivalence to the subtle life force energy for the existence of mankind. This vital energy is termed as prana, which paves way in understanding different structures in the human body. Term Atma Swaroopa is coined for prana due to existence all over. Concept of Marma was first introduced in Samhita Kala . There are 107 Marma [1] described, as these are the Sannipata of Mamsa , Sira , Snayu , Asthi , Sandi where Prana resides [2] These are classified into 5 variety on the basis of predominant of structure involved, effect of injury, location on the body [3] and also detail about the each Marmabhighata Address for correspondence: Dr. Omkumar V Kori Post Graduate Scholar, Department of Sharira Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Kuthpady, Udupi, Karnataka, India. E-mail: koriom 111@gmail.com Submission Date: 17/03/2024 Accepted Date: 22/04/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.5.38 Lakshana [4] are explained. Totally 8 Asthi Marma are explained in classics and accepted by various authors unanimously irrespective of any discrimination as evident in other types of Marma which quotes its uniqueness. Table 1: Classification of Marma based on structure [5,6,7] Marma Sushruta Vagbhata Bhavaprakasha Mamsa Marma 11 10 11 Sira Marma 41 37 47 Snayu Marma 27 - 21 Asthi Marma 8 8 8 Sandhi Marma 20 20 20 Dhamani Marma - 9 - Total 107 107 107 A B S T R A C T There are total of 107 Marma which are vital points where there is a Sannipata of Mamsa , Sira , Snayu , Asthi , Sandhi along with the Prana resides. Among them Amsaphalaka Marma is Prusthagata Asthi Marma , two in number and Vaikalyakara type of Marma , located on Pristhavansa Ubhaya to (both side of vertebral column) and is related to Trika. Trauma to Amsaphalaka Marma results in Baahuswapa and Shosha . Here Marmabhighata Lakshan can act as predictors of the structures involved. In this study, an attempt is made to find out exact location of Amsaphalaka Marma and its relations with other anatomical structures with the help of cadaveric dissection. The study concludes that the location of Amsaphalaka Marma may be considered as just above the superior border of the spine of the scapula on either side of the vertebral column. Key words: Marma, Amsaphalaka, Baahuswapa, Shosha, Trika.

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Omkumar V Kori et al. Amsaphalaka Marma - A Cadaveric Study ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 229 Amsaphalaka is Asthi Marma and 2 in number, Ardha Angula [8] in Pramana and Vailakyakara . M ATERIALS AND M ETHODS The study has been conducted in two parts: 1. Conceptual study - Classical literature, modern literature, books, thesis, journal articles, and internet materials were reviewed and related information and references were collected and analyzed scientifically to determine the location and anatomical aspects of Amsaphalaka Marma . 2. Cadaveric study - A thorough dissection of shoulder region and back was carried out on embalmed human male cadavers in the dissection hall of Rachana Sharira department and anatomical structures found in this region was confirmed. C ONCEPTUAL S TUDY Etymology The word Amsaphalaka is formed by the union of the two words i.e., Amsa and Phalaka . Amsa - अंस ् + अच् = अंस The Word Amsa means Skandha (shoulder) Phalaka – Nirukti of word Phalaka is “ Asthikhandam Iti’’ Table 2: Asthi Marmas [9] Marma Sushruta Vagbhata Katikataruna 2 2 Nitamba 2 2 Amsaphalaka 2 2 Shanka 2 2 Location Amsaphalaka Marmas are located one on either side of the upper part of the Prushta Vamsha (vertebral column) [10] It is Prustagata Asthi Marma , Vaikalyakara and Ardha Angula in Pramana [11] They are located in the region of Trika , injury of which causes Bahuswapa and Shosha [12] C ADAVERIC S TUDY The dissection of back was carried out on human male cadaver by following the guidelines of BD Chaurasia and Cunningham’s practical anatomy [13,14] The cadaveric study was carried out as follows Cadaver was placed in prone position. First Trika region was identified and marked by drawing one line from the Acromioclavicular joint of right side to the left side and a vertical line was drawn from the external occipital protuberance towards the previous line where it intersects with each other. Region of Amsa Phalaka Marma was marked on scapular region on the line extending laterally from Trika which lies on suprascapular fossa nearer to the medial border of scapula. The Marma point was marked as Ardha Angula Parivistara Pramana (0.9 cm) on both the sides of vertebral column and the skin was removed layer by layer gently. The anatomical structures superficial to deep were noted as follows 1 Trapezius muscle 2 Supraspinatus muscle 3 Supraspinous fossa of scapula 4 Suprascapular nerve Fig. 1: location of Amsaphalaka Marma

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Omkumar V Kori et al. Amsaphalaka Marma - A Cadaveric Study ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 230 Fig. 2: Trapezius muscle Fig. 3: Dorsal aspect of scapula Fig. 4: Suprascapular nerves and vessels with muscles DISCUSSION Discussion on location: Amsaphalaka is Prustagata Asthi Marma associated with Trika . Acharya Sushruta stated that the Marma situated in upper part of the Prishtha (back) on both sides of Prishthavansha (vertebral column) and attached or near to Trika are known as Amsaphalaka Marma . According to Prof. D. G. Thatte, scapular region and supra scapular nerve are representative of Amsa Phalaka Marma injury of which are responsible for atrophy and loss of sensation in the upper extremities. The following structure found at the site of Amsaphalaka Marma - scapula bone, [15,16] spine of scapula, [17,18] supraspinous fossa, [19] suprascapular nerve [20] and vessel, [21] supraspinatus muscle, trapezius muscle [22] Discussion on Marma Vastu ▪ Asthi - Supraspinous fossa of scapula. ▪ Mamsa - supraspinatus muscle. ▪ Sira - suprascapular vessels. ▪ Snayu - suprascapular nerve. Discussion on Marma Pramana The measurement of Marma is about 0.9 cm on either sides of the vertebral column at the supra scapular fossa near the medial border of scapula. Discussion on Marma Viddha Lakshana Injury to this Marma cause Swapa [23,24] [numbness] and Shosha [25] [wasting] of the upper extremity. Numbness and wasting of the arm are usually caused by damage or compression of the suprascapular nerve passing through spinoglenoid notch. Injury to suprascapular nerve causes the wasting of supraspinatus and infraspinatus muscles. Main complaints are pain, weakness in shoulder, numbness in the arm and wasting in the arm [26] ▪ The injury to the spinal accessory nerve [27] leads to severe wasting of trapezius which can lead to drooping of the shoulder, weakness, numbness and wasting in the arm.

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Omkumar V Kori et al. Amsaphalaka Marma - A Cadaveric Study ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 231 ▪ Injury at the site of spine of the scapula will damage the structure around it. Trauma at this site will cause damage to the suprascapular artery [28] which leads to massive hemorrhage and intraluminal thrombosis that will disrupt blood circulation to the supraspinatus and infraspinatus muscles and cause wasting of muscles, which subsequently causes numbness and wasting of the arm. ▪ If foreign body penetrate deeper parts – severe damage to brachial plexus which will lead to paralysis of upper extremity. ▪ Moderate damage of these nerves and vessels causes numbness and wasting [29] ▪ If foreign body penetrates superficial parts - damage to suprascapular nerves and artery which results in paralysis of abductor muscles (supraspinatus, deltoid, serratus anterior, trapezius) of the shoulder joint along with wasting of the same. CONCLUSION Marma are the physio-anatomical vital areas of the body in which Mamsa , Sira , Snayu , Asthi , Sandhi , Dhamani unite and where the prana resides. Injury to these vital areas leads to Marana or Marana Sadrushya Vedana . Based on the literary and cadaveric studies, it has been concluded that the Amsaphalaka Marma can be considered as the region of supraspinous fossa nearer to the medial border of scapula on either side of the vertebral column which has a measurement of about 0.9 cm. Based on Vidhha Lakshana Baahuswapa can be considered as numbness of the arm and Bahushosha as wasting of the arm. Baahuswapa and Bahushosha can be claimed as deformities which uphold Amsaphalaka Marma as Vaikalyakara Marma . Hence it seems appropriate to consider Amsaphalaka as a Prustagata Asthi Marma of Ardha Angula Pramana and Vaikalyakara type of Marma . REFERENCES 1 Patil VC, NM Rajeshwari, Editor, 1 st edition, English translation on nibhanda sangraha commentry of dalhana on sushruta samhita, sharira sthana, pratyaksha marma nidresha shareera, chapter 6, verse 15, Varanasi, chaukhamba sankrit santhana,2018; 199 2 Patil VC, NM Rajeshwari, Editor, 1 st edition, English translation on nibhanda sangraha commentry of dalhana on sushruta samhita, sharira sthana, pratyaksha marma nidresha shareera, chapter 6, verse 3, Varanasi, chaukhamba sankrit santhana, 2018; 194 3 Acharya Y T, Editor, commentary Ayurveda deepika of chakrapani datta on charaka samhita by agnivesha and revised by charaka and dridabala, siddi sthana, trimarmiya siddi adyaya, chapter 9, verse 3, Varanasi, chaukambika orientalia, 2011; 716 4 Vidya B H P, Editor, 10 th Edition, commentary sarvanga sundara of arunadatta and commentary ayurveda rasayana of hemadri of astanga hrudaya of vagbhata, shareera sthana, marma vubhaga shareeram adhyaya, chapter 4, verse 40, Varanasi, chaukambika orientalia, 2005; 413 5 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 370 6 Vidya B H P, Editor, 10 th Edition, commentary sarvanga sundara of arunadatta and commentary ayurveda rasayana of hemadri of astanga hrudaya of vagbhata, shareera sthana, marma vibhaga shareeram adhyaya, chapter 4, verse 40, Varanasi, chaukambika orientalia, 2005; 413 7 Bhavamishra, Bhava prakasha, 8 th Edition, part 1 with hindi commentary by pandit sri.brahma Shankar mishra, edited by pandit sri.brahma Shankar mishra, , Varanasi, chaukambika sankrit santhana, 2003; 66 8 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 371 9 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 372 10 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 26, Varanasi, cahukambika orientalia, 2007; 384 11 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka

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Omkumar V Kori et al. Amsaphalaka Marma - A Cadaveric Study ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 232 marma nidresha shareera, chapter 6, verse 26, Varanasi, cahukambika orientalia, 2007; 384 12 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 26, Varanasi, cahukambika orientalia, 2007; 374 13 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 819 14 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 820 15 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 822 16 www.uams.org 17 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 846 18 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 847 19 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 849 20 www.wikipedia.com 21 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 845 22 Rogerwick P L W, Editor, 39 th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 847 23 Vidya B H P, Editor, 9 th Edition, commentary sarvanga sundara of arunadatta and commentary ayurveda rasayana of hemadri of astanga hrudaya of vagbhata, shareera sthana, marma vibhaga shareeram adhyaya, chapter 4, verse 42, Varanasi, chaukambika orientalia, 2005,414 24 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 371 25 Acharya Y T, 9 th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 371 26 Rogerwick P L W, Editor, 39 th Edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 811. 27 www.medical dictionary.com 28 Rogerwick P L W, Editor, 39 th Edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 844 29 Rogerwick P L W, Editor, 39 th Edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 801 ******************************* How to cite this article: Omkumar V Kori, Anju Thomas. Amsaphalaka Marma - A Cadaveric Study. J Ayurveda Integr Med Sci 2024;5:228-232. http://dx.doi.org/10.21760/jaims.9.5.38 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 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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Skandha, Prana, Pramana, Amsha, Phalaka, Mamsa, Sandhi, Sira, Shosha, Vagbhata, Snayu, Marma, Sushruta, Trika, Bhavaprakasha, Vaikalyakara, Hemorrhage, Foreign body, Sira-Marma, Journal of Ayurveda, Vertebral column, Case report, Upper extremity, Cadaveric study, Cadaver, Snayu Marma, Vaikalyakara Marma, Asthi Marma, Sandhi Marma, Samhita Kala, Mamsa marma, Conceptual study, Dhamani Marma, Brachial plexus, Acromioclavicular joint, Sharira Rachana, Trapezius muscle, Amsaphalaka marma, Prana resides, Deltoid.