A wonderful descriptiopn of marm given in Sushruta Samhita, Sharira Sthana in chapter no. 6.
“मर्मणि शल्यविषयार्धमुदाहरन्ति, यस्माच्चर्ममंसु हता न भवन्ति सद्य ।जीवन्ति तत्र यदि वैद्यगुणेन केचित्, ते प्राप्नुवन्ति विकलत्वमसंशयं हि ।। (सु. श. 6/33)”
Marma are considered as the half of the surgery subject as any injury to them can prove to be fatal so if patient is promptly treated by a skilled doctor even though the patient will suffer from excessive pain.
The renowned Acharya also states that person encountering injury leading to damage to it head, viscera or leading to loosing his limb or even trauma to his whole body may survive if marmas of the body escape the injury
Any trauma to them will surely produce pain or can cause death and if any disease involving the marm and will always difficult to treat.
WHAT ARE MARMA :-
1) According to the charaka :-
“हृदर्येमूर्न्बिस्तो च नूणां प्राणाः प्रतिष्ठिताः। तस्मात्तषां सदा यंत्नं कुर्वीत पारिपालने।। (च. सि. 9/9)”
Marmas are the vital parts and seat of prana or chetna in the body. Charaka had advocated that the marmas must be safeguard cautiously and for this he considered Svastharuta.
2) According to Sushrut :-
“मर्मणि नाम मांस सिरास्नायुसंध्यस्थिसन्निपातास्तेषु स्वभावत एव प्रणास्तिष्ठन्ति। (सु. श. 6/6)”
The marmas are (anatomically site) juncture (meeting) place of mamsa (muscular tissue), sira (blood vessels), snayu (nervous tissue), asthi (osseous tiussue) and sandhi (joints). The prana arer specifically situated in these marm by the virtue of their nature, hence a trauma to any one of these invariably causes physical disturbances in accordance with their particular types.
3) According to Vridhha Vagbhata :-
“तत्पुमर्मासि सिरास्नायु अस्थि सन्धि सन्निपातः।तेन तस्मिन् पीड्यमाने विशेषतः प्रणाबाधः।। (अ. सं. श 7/13)”
Like, Sushruta he has also recognized the marma as an agglomeration of mamsa (muscular tissue), sira (blood vessels), snayu (nerves), asthi (bones) and sandhi (joints), any trauma to these specific stuctuires of the body is likely to cause death, hence such area or spots in the body have been designated as “marma”
Marma is the part of the body showing irregular pulsation and and on applying pressure generates pain and is composed of mamsa, snayu, dhamani, sira sandhi and also said it as ‘seat of jiva’.
CURIOUS ABOUT THENUMBER OF MARMA, LET US FIND OUT :-
There are 107 marmas and are of 5 types .
HOW ARE MARMA CLASSIFIED :-
Marmas are classified on the basis of :-
Structure or body organs involved
Consequences of trauma over the marma area
Sites and location of marma
Area or Site of marma
Sankhya (number) of marma
1) CLASSIFICATION BASED ON STRUCTURE OR BODY ORGANS INVOLVED :-
TYPES OF MARMA
CHARAKA
SUSHRUT
VRIDDHA VAGBHATA
VAGBHATA
MAMSA
–
11
11
10
SIRA
–
41
41
37
SNAYU
–
27
27
23
ASTHI
–
8
8
8
SANDHI
–
20
20
20
DHAMANI
–
–
–
9
TOTAL
107
107
107
107
1. Mamsa Marma :-
Marma
Sushruta
Vagbhata
Talahridaya
4
4
Indravasti
4
4
Guda
1
–
Stanrohita
2
2
Total
11
10
2. Sira Marma :-
Marma
Sushruta
Vagbhata
Neela
2
2
Manya
2
2
Matrika
8
8
Srigngatka
4
–
Apanga
2
–
Sthapani
1
1
Phana
2
2
Sthanmoola
2
2
Apalapa
2
2
Apasthambha
2
–
Hridaya
1
1
Nabhi
1
1
Parswasandhi
2
2
Brihati
2
2
Lohitaksha
4
4
Urvi
2
2
Kakshadhara
2
2
Vitapa
2
2
Total
41
33
3. Snayu Marma :–
Marma
Sushruta
Vagbhata
Ani
4
4
Vitapa
2
–
Kakashadhara
2
–
Kurcha
4
4
Kurchashira
4
4
Vasti
1
1
Kshipra
4
4
Amsa
2
2
Vidhura
2
2
Utshepa
2
2
Apanga
–
2
Total
27
23
4. Asthi Marma :-
Marma
Sushruta
Vagbhata
Kateekataruna
2
2
Nitamba
2
2
Amsaphalaka
2
2
Shankha
2
2
Total
8
8
5. Sandhi Marma :-
Marma
Sushruta
Vagbhata
Janu
2
2
Kurpara
2
2
Seemantha
5
5
Adhipati
1
1
Gulpha
2
2
Manibandha
2
2
Kukundara
2
2
Krikatika
2
2
Total
20
20
6. Dhamani Marma :-
Marma
Vagbhata
Guda
1
Apasthambha
2
Vidhura
2
Sringataka
4
Total
9
2) CLASSIFICATION BASED ON CONSEQUENCES OF TRAUMA OVER THE MARMA AREA :-
TYPES OF MARMA
SUSHRUT
Predominant Mahabhuta
Result of Injury
SADHYA PRANAHARA
19
Agni
Immediate death
KALANTARA PRANAHARA
33
Jala+Agni
Death within 15 – 30 days if proper treatment is not given
VISHALYGHNA
03
Vayu
Soon the removal of injury object the person is going to die but if injury object falls itself the person can survive.
VAIKALYAKARA
44
Jala
Cause Deformities
RUJAKARA
08
Agni+Vayu
Highly painful but no deformities.
TOTAL
107
3) CLASSIFICATION BASED ON SITES AND LOCATIONS OF MARMA :-
SL.NO
NAME OF MARMA
SUSHRUT
1.
SAKTHIGAT MARMA
22
2.
BAHUGAT MARMA
22
3.
UDARGAT MARMA
3
4.
VAKSHAGAT MARMA
9
5.
PRISHTHAGAT
14
6.
JATROORDHVAGAT MARMA
37
TOTAL
107
4) CLASSIFICATION IN THE BASIS OF MEASUREMENT/SIZE/AREA OR PARIMAP/PARIVISTAR :-
1) EKA ANGULA PRAMANA MARMA
NAME OF MARMA
SUSHRUT
URVI
2
BAHVI
2
KURCHSHIR
4
VITAP
2
KAKSHADHAR
2
STANMOOL
2
TOTAL
14
2) DWI ANGULA PRAMANA MARMA
NAME OF MARMA
SUSHRUT
GULF
2
MANIBANDH
2
TOTAL
4
3)TRI ANGULA PRAMANA MARMA
NAME OF MARMA
SUSHRUT
JANU
2
KURPAR
2
TOTAL
4
5) CLASSIFICATION BASED ON SANKHYA (NUMBER) OF MARMA :-
1) MARMA= ONE IN NUMBER (EKA SANKHYA)
SL.NO
NAME OF MARMA
SUSHRUT
1.
HRDAYA
1
2.
NABHIU
1
3.
VASTI
1
4.
GUDA
1
5.
STHAPANI
1
6.
ADHIPATI
1
TOTAL
6
2) MARMA= TWO IN NUMBER (DWISANKHYA)
SL.no
NAME OF MARMA
SUSHRUT
1.
GULPA
2
2.
JANU
2
3.
URVI
2
4.
VITAPA
2
5.
MANIBANDHA
2
6.
KURPARA
2
7.
BAHVI
2
8.
KAKSHADHARA
2
9.
STANMULA
2
10.
STANAROHITA
2
11.
APALAPA
2
12.
APASTHAMBHA
2
13.
KATIKATARUN
2
14.
KUNDARA
2
15.
NITAMBA
2
16.
PARSHVASANDHI
2
17
BRUHATI
2
18.
AMSA
2
19.
AMSAPHALAK
2
20.
KRIKATIKA
2
21.
NILA
2
22.
MANYA
2
23.
VIDHURA
2
24.
PHANA
2
25.
APANGA
2
26.
AVARTA
2
27.
UTKSHEPA
2
28.
SHANKHA
2
TOTAL
56
3) MARMA= FOUR IN NUMBER (CHATURSANKHYA)
SL.NO
NUMBER OF MARMA
SUSHRUT
1.
KSHIPRA
4
2.
TALAHRIDAYA
4
3.
KURCHA
4
4.
KURCHA SIRA
4
5.
INDRAVASTI
4
6.
ANI
4
7.
LOHITAKSHA
4
8.
SRINGATAKA
4
TOTAL
32
4) MARMA= FIVE IN NUMBER (PANCHASANKHYA)
SL.NO
NUMBER OF MARMA
SUSHRUT
1.
SIMANTA
5
TOTAL
5
5) MARMA= EIGHT IN NUMBER (ASTASANKHYA )
SL.NO
NUMBER OF MARMA
SUSHRUT
1.
MATRKA
8
TOTAL
8
MARMA OF UPPER LIMB :-
1) KSHIPRA MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
It is situated in between the thumb and index finger. This marma is better felt on the dorsal part of the palm when the thumb and the index finger are slightly abducted (separated) so that the space between them is widend.
1)The tendon of adductor pollicis. 2)Tendon of deep portion of flexor pollicis brevis. 3)Branches of radial artery in hand. 4) Branches of deep volar/ palmar arch. 5)Arteria volaris radialis indicis. 6) Digital branches of the median nerves. 7) First dorsal interosseous muscles. 8) First dorsal metacarpal artery .
2) Tala Hridaya marma
ANATOMICAL SITE
REGIONAL ANATOMY
It is situated in the mid of the palm at joining the line along with the middle finger
1)Intermediate part of the palmar aponeurosis. 2)Superficial palmar arch. 3)Deep palmar arch. 4) Adductor pollicis. 5)Flexor pollicis brevis. 6)Interosseous lumbricals.
3) KURCHA MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
It ia situated above the kshipra (between thumb and index finger) in the upper extremity.
1)At the palmar surface. a)Tendon of flexor pollicis longus. b)Tendon of flexor carpi radialis. c)Median nerves. 2)At the dorsal surface. a)Tendon of extensor pollicis longus. b)Tendon of extensor carpi radialis,longus nad brevis.
4) KURCHA SIRA
ANATOMICAL SITE
REGIONAL ANATOMY
It is situated below the manibandh sandhi and two angula above kurcha marma . This area points to the thenar eminence.
1)Ulnar and radial collateral ligaments.2)Intercarpal ligaments.3)Transverse carpal ligaments .4)Ulnar artery.5)Median nerve and superficial branch of ulnar nerves.6)Intercarpal articulations.
5) MANIBANDHA MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
It is situated at the junction of arm and hand.This indicates towards the wrist joint .
All Acharya are of view that this marma can beJustifiedly correlated with wristjoint(radiocarpal) and distal radio-ulnar joints.Since both are in close proximity
6) INDRA BASTI MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
It is present in the middle of the forearm.This are corresponds to the muscular area in the forearm.
1)Radial artery and its branches .2)Palmar interosseous branch of ulnar artery .3)Pronator teres .4)Flexor digitorum.5)Flexor carpi radialis .
7) KURPARA MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
It is situated at the junction of forearm and arm i.e at elbow joint.This marma includes both elbow joint and superior radioulnar joint .
All anatomist are of opinion that this marma corresponds to both elbow jopint and superior radioulnar joint.
8) ANI MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
This marma is present three angula above the kurpara marma .
It is situated in middle of arm above the ani marma.The whole length of the arm is sixteen angula,so this marma should be present at eight angula from the kurpara sandhi.
Dr.Pathak is of opinion that Brachial artery,,Brachial vein, Median and Ulnar nerve present in close proximity on upper part of arm,this area should be accounted as urvi marma of upper limb .
10) LOHITAKSHA MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
It is situated above the bhavi(urvi) marma and below the kaksha sandhi(shoulder joint), at the root of upper limb.
a)Brachial artery with its venae comitants.b)Median and ulnar nerve .c)Pectoralis minor and major.
11) KAKSHADHARA MARMA
ANATOMICAL SITE
REGIONAL ANATOMY
It is situated at the junction of thorax and shoulder joint.This is area of two inches below the point joining the lateral 1/3rd and medial 2/3rd of clavicle .
Most of the anatomist are of opinion that this marma corresponds to the region of brachial plexus with axillary vessels.i,e area of two inches below the point joining the lateral 1/3rd and medial 2/3rd of clavicle.This region corresponds to the first part of axillary artery .
MARMA OF LOWER LIMB :-
1) KSHIPRA MARMA
Situated in between the big toe and the second toe of the foot.This marma is better felt on the dorsal part of the foot when the big toe and second toe are separate apart.
Underlying important anatomical structures and their applied anatomy.1)Adductor Hallucis Brevis,.2)Lumbricalis muscles.3)Posterior tibial nerve.4)Dorsal metatarsal artery.5)Plantar arch and medial plantar artery .6)Metatarsal-phalangeal joint.
2) TALA HRIDAYA
ANATOMICAL SITE/SURFACE ANATOMY
REGIONAL ANATOMY
It is situated in the mid of the sole of the foot and in a straight line drawn from the root of the middle toe.Marma talahridaya is situated in the centre of the sole in a straight line drawn from the root of the madhyama anguli(middle tow).
Underlying important anatomical structures and their applied anatomy :corresponding to above description, the anatomical structures likely to fall under the area of this marma are-1)Muscles in the sole of the foot(from below upwards).2)Plantar aponeurosis Plantar arch of arteries.4)Long plantar ligament.5)Deep branch of lateral plantar nerve(accompanies the plantar arch).
3) KURCHA MARMA
ANATOMICAL SITE/SURFACE ANATOMY
REGIONAL ANATOMY
Above the kshipra marma(between the big toe and the second toe )is the lower extremity the kurcha marmna exist. Acoording to vagabhata above marma is situated 2 fingers above the kshipra .
Underlying anatomiucal stuctures1)At the dorsal surface .a)Tendon of flexor hallucis longus .b)Tendon of flexor digitorum longus.2)At the plantar surface.a) Tendon of peroneus longus.b)Tendon of extensor hallucis longus.c) Tendon of extensor digitorium longus .d)Medial plantar nerve.
4) KURCHA SIRA MARMA
ANATOMICAL SITE/SURFACE ANATOMY
REGIONAL ANATOMY
This marma is situated below gulpa sandhi .
Underlying important anatomical structures and their applied anatomy1)Tributaries of short saphenous vein .2) Peroneal nerve .3)Peroneus brevis and longus muscle.4)Peronial artery .5)Flexor and extensor retinaculum.6)Deltoid ligaments,talocalcaneal and calcaneofibular ligaments.
5) GULPHA MARMA
ANATOMICAL SITE/SURFACE ANATOMY
REGIONAL ANATOMY
This marma is situated at junction of foot and leg. This indicates towards ankle joint.
Underlying important anatomical sturctures and their applied anatomy: Dr.Patil and Dr. J.N.Mishra considered the ankle joint in this marma while Dr.Ghanakar considered ankle joint (talocrural) and inferior tibiofibular joint to be included in this marma.
6) INDRAVASTI MARMA
ANATOMICAL SITE/SURFACE ANATOMY
REGIONAL ANATOMY
It is situated in the mid of jangha(leg) in the line of parsani (heel or calcaneum).This indicates towards the calf region of leg.
1)Posterior tibial nerve .2)Drainage of lymph to the popliteal lymph glands .3)Calf muscles-gastrocnemius, soleus and plantaris muscle .
8) Ani marma
ANATOMICAL SITE/SURFACE ANATOMY
REGIONAL ANATOMY
It is situated ion both sites(leg of lower one third part of femur)three finger above the janu(knee joint).
a)Tendon of quadriceps femoris.b)Tendon of bicep femoris.semitendinosus,semimembranosus, and gracilisc) Popliteal vessels and nerve(tibial and common peroneal nerve.d)Femoral artery .
It is situated above the urvi marma and below the vanksha sandhi(hip joint) and at the root of femur .
a)Femoral vessels and nerve .b) Great saphenous vein and its junction through saphenous opening with femur vein .c) Profunda femoral artery following its junction with femoral artery .d)Profunda femoral vein following its ju=nction with femoral vein.
11) VITAPA MARMA
ANATOMICAL SITE/SURFACE ANATOMY
REGIONAL ANATOMY
It is situated between vanksana (groin or hip joint) and the vrishana(testes) in both side.
A)Inguinal canal and its contents.b) Testicular and deferential artery.c) Testicular nerve .d) Fallopian tube .
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