SCIENCE OF MARMA

(In Ayurvedic Diagnosis and Treatment)

Dr. Srinivas Hejmadi Acharya
B.S.A.M., M.D. (Ayu), Ph.D (Ayu),

Program Officer & Head, International Center for Ayurvedic Studies; Head of Panchakarma Department Gujarat Ayurved University Jamnagar

Abadhavarjanam Nityam Svasthavrittanuvartanam Utpannartivighatascha Marmanam Paripalanam. Paripalanam. ~aibiidviji^nio *nityio svisWiviVttiini#viti^nio utpinnii*ti^*viGiitiSci utpinnii*ti^*viGiitiSci mimi^Niiopi*rpiilinio~ mimi^Niiopi*rpiilinio~
To defy from dangers to Marma, to follow the hygienic measures every day and to treat the affliction, are the means to care Marma.

(Charaka Samhita. Sidhi Sthana 9th chapter 10th Sloka)

Science of Marma
(In India and Abroad)
1. Knowledge of Marma related to martial art & warfare medicine. 2. Knowledge of Marma with surgical importance.

3. Knowledge of Marma with medical importance a. Marma Chikitsa - manipulating & treating Marma in the management of diseases. b. Marma Nidana - utilizing Marma Pariksha in diagnosis of illnesses.

CONTEXT OF PRANA -1
Prana though prevailing ubiquitously in entire body, it performs the functions according to the organs situated in the local regions. In the local regions also, Prana gets more centralised in specific parts which can be called as its seat or chief centre. Apart from this, there are lesser centres belonging to that local region where Prana keeps moving to aid (Sanchara Sthana) the functions of those body parts. Such Sthana) movements by currents of Prana may also have specific directions. This is elucidated in adjoining picture.

CONTEXT OF PRANA -2
When Prana gets disturbed in localised regions only, then the disturbed function of that related region shall be exhibited. This may happen as a consequence to many causes (etiological factors) that hamper the local regional pathways of Prana. This is true with the sense that certain Prana. local packets of Prana (Marma) are also affected during such event. It may be hypothesised, that by tactful stimulation of local centres of Prana, the paths for Prana, movement of Prana become cleared and normal functioning ensues. This hypothesis is further discussed in the forth coming chapters.

CONTEXT OF PRANA -3

CONTEXT OF PRANA -4

CONTEXT OF PRANA -5

Marma Vastu (Matrix)

The site of Marma constitutes some physical substances of the body. These are five in number viz. 1.Mamsa (muscle) 2.Sira (vessels conveying body fluids & impulses). 3.Snayu (flat tapering substances like tendons) 4.Asthi (bone) and 5.Sandhi (articulative points especially bone joints).

Marma Vastu (Matrix)

The Agni, Soma and Vayu are seemingly important basis through which the multiple functions of Prana (life energy) in the body is made possible. Thus Marma Vastu is also considered by the predominence of Agni, Soma, and Vayu.

Marma Vastu (Matrix)

Marma

Types of Marma
a) Superficial (Uttana) Marma b) Deep (Gambheera) Marma c) Neither superficial nor deep (Ubhaya) Marma (such opinions are not prompted in classical books of Ayurveda.) Ayurveda.)

Types of Marma
Physical Matrix
Mamasa Marma Sira Marma Snayu Marma Asthi Marma Sandhi Marma Dhamani Marma Eleven in number Fourty one in number Twenty Seven in number Eight in number Twenty in number Nine in number (as per Vagbhata)

Types of Marma
Special Features Sadhya Pranahara Kalantara Pranahara Vishalyaghna Vaikalyakara Rujakara Death by 7 days Death by fortnight or month Death as soon foreign body removed Deforming Sever pain

Some comparison of Martial Marma with the classical ones.

Ayurveda Sthapani Shankha Apanga Matrika Vasti Indrabasti Hridaya Kulabhyasa Thrikoodhyakam Sirasayam Kannunthi Kazhuthukochi Jalpandum Nadypathy Thilakusy Tamil Thilaskkla Chivukkutty Naksatram Vilanku Moothiram Nadupautha Neeramarma

Marma Nidana
(Investigation to pathognomy of Marma)

Examination of Marma (marma pareeksha)

 Signs of Affliction to Marma  Understanding the relation of Marma with

mind

 Clinical application of Marma

Palpation of Marma
The method for palpating specific Marma are described in the previous chapter. The patient must lie in a relaxed posture before physician starts palpating. It is always preferable to examine `Marma' in the morning hours after raising from the bed. Physician must make sure that the patient is not fasting neither of full stomach and he has attended morning toilette.

Palpation of Marma
The doctor has to look for Marma points carefully one by one making sure that he is palpating the Marma place and not any other injured tender part near by. Charaka says Marma are the sites of Chetana nibaddha i.e., specific places of Chetana (consciousness) and hence they are comparatively tender in nature. The pain originating in these Marma places (on affliction?) are sever in comparison to the other places of body (Charaka Samhita. Siddhi Sthana. 9th chapter 3rd Sloka). Thus feeling of pain on slight pressure is the only reliable index to identify as well to assess the vitiation of Marma. The physician must be attentive enough to assess the degree of tenderness. This one has to acquire only by constant practice and expertise. The tenderness being a varying factor related to the constitution of the patient and also illness. This phenomenon is similar to that of examining and grading bodily reflexes of the patient in neurological practice where without proper practice reflexes can not elicited. Vagbhata adds to above information that the Marma are the places where pulsations (Spandanam) are found along with some degree of tenderness.

Examination of Amsakoota

Examination of Amsapalaka

Examination of Sphik Marma

Examination of kukundara

Examination of Parshvasandhi

Examination of Indrabasti in legs

Examination of Aani Marma

Examination of Koorchashira in legs

Examination of Indrabasti in hands

Examination of Krikatika

Examination of Adhipati

Self Palpation of Shankha

General signs of Injuries to Marma

Bhrama Pralapa Patanam Pramoha Vicheshtanam Samlayanam Ushnata Srasthangata Murcha Urdhva Vata Teevra Ruja Mamsodaka Srava Sarvaindriyartha Uparama

Signs of affliction to Hridaya Marma

When Hridaya gets afflicted (Abhihate) with the vitiated Dosha in the body the following features supervene - cough and dyspnoea, reduced strength of the body (strength for exertion), dryness in the throat, peculiar extracting pain in lungs (Klomakarshana), protrusion of the tongue, dryness of buccal cavity (Mukhatalu Shosha), convulsions (Apasmara), psychosis (Unmada), delirium (Pralapa), disorientation (Cittanasha). Signs & symptoms shown above simulate cardiac arrest, shock, and also sever respiratory crisis, leading to neuro psychological disturbances. It will be a deviation from the main topic to consider the pathophysiological discussions here. However, an intelligent physician can grasp the underlying clinical picture by the above quotations.

Signs of affliction to Shiro Marma

The name of Shiro Marma is not used in the list of 107 Marma. It possibly refer collectively the important Marma found on the head (Shiras). Shiro Marma does not refer to the organs on the head like eyes, nose, ear etc. But more truly to the brain. The following features supervene when shiro Marma is vitiated by Dosha (intrinsic factors) - torsion of the neck like that of torticolis (Manyastambha), facial paralysis / transient paresis of half side of body (Ardita), visual disturbances (Cakshuvibhrama), delusion (Moha) binding ache in head (Veshtanam), loss of function in body parts (Chestanasha), cough, dyspnoea (Gadgada), drooping of eye lids, tics (Ganda Spandanam), excessive yawning (Jrambhanam), dribbling of saliva from mouth, loss of pitch of the voice i.e. monotonous (Svarahani), torsion or spastic facial muscles (Vadana Jihmatva) etc. There is no need to point out that above features indicate various kinds of organic neurological problems.

Signs of affliction to Basti Marma

When the vitiated Dosha in the body afflict the Basti Marma the following features appear. Retention of flatus, retention of urine & faecal matter, pain in the regions of groin genitals & bladder, rotating & constricting pain as that of obstructive uropathy due to prostatitis (Kundala), group of signs occurring due to Avarana of Apana (udavarta), tumor/hyperplasia of Vata origin (Ashteela), stillness in bladder (Upastambha), restrictive pain (Graha) in umbilicus abdomen, rectum & pelvis etc. The above sings & symptoms are indicative of anomalies in bladder and obstructive uropathic conditions associated with consequences.

Relation of Marma with Mind

In majority of the psychosomatic illness ,the involvement of different Marma in the body is invariably found. The mind exhibits proximal relations with the Marma zones. Ayurvedic classics state that mind prevails throughout the body and its seat is Hridaya (Marma). The channels of mind in the body are ubiquitous & cannot be specified as in case of Tridosha too. Prana has intricate relation with mind and Vata is the sole cause for motivating & controlling the mind (Charaka Samhita. Sutra Sthana. 12th chapter. 8th Sloka). We have discussed enough in earlier chapters regarding Prana / Vata in relation to the Marma. Therefore it is not astonishing that the state of mind influence upon Marma points in the body. It is also true that the three qualities such as Sattva, Rajas, and Tamas are also found in the Marma which are three contents of the mind itself. This makes an easy explanation that why the status of mind & its disturbances are reflected upon Marma. More the mind is susceptible & sensitive, so is the state of Marma. Following are the examples of certain psychosomatic and neurotic condition where the Marma are generally noted affected in our hospital.

The Clinical Applications of Marma

Under this title author wishes to emphasise on the utilisation of Marma Pareeksha in clinical examination and assessment of the patients. We have discussed that morbidity at the site of Marma has direct relation with the vitiated Dosha & Dhatu of the body. Therefore, the vitiated Marma is desirably related to the pathogenesis of particular diseases. Many a time Marma Pareeksha becomes a valuable tool for differential diagnosis. The subtitle running below incorporates clinical details as experienced by the author & clinical datas are used wherever needed.

Relation of Marma with some Diseses

Lumbar Degenerative Diseases and Sciatica --Indrabasti,Katikataruna,Kukundara,Nitamba Inflammatory conditions & Ama Kshipra,Talahridaya, Kurchashira, Indrabsti. Different Headaches --Shankha,Krikatika,Utkshepa,Avarta,Sthapani Cervial pain (spondylosis)--(spondylosis)--Krikatika,Amsapalaka,Amsakoota. Epilepsy, psychosis --- Krikatika, Utkshepa,Sthapani etc.

Marma Chikitsa (The Care of Marma) Abadhavarjanam Nityam Svasthavrittanuvartanam Utpannartivighatascha Marmanam Paripalanam. ~aibiidviji^nio *nityio svisWiviVttiini#viti^nio utpinnii*ti^*viGiitiSci mimi^Niiopi*rpiilinio~
1. Abadavarjanam (Preventive Aspect) 2. Svasthavrittanuvartanam (Towards Positive Health) 3. Treating Diseases of Marma (utpannartivighata)

General line of Treatment

Principally, the treatment should involve the replenishment of basic physical matrix (Dhatu) of Marma, the control of Vata Dosha & pacifying the Pitta Dosha, which in turn supplement the loss of Prana too. In case of traumatic conditions, healing drugs & blood coagulants are to be used. Thus the medicines having the properties of Snigdha, Madhura, Tikta, Jeevaneeya, Balya, Brimhana, Vata Shamaka, Pitta Shamaka , are utilised in the treatment. Only if specified, tactful removal of Kapha is performed.

Treatment of Marma
The treatment to the problems of Marma can be superficially understood under the following categories, I. The internal treatment given by oral and other routes. II. The treatments given locally at the site of Marma III. However, thirdly the psychological component should be remembered by the physician.

I. The internal treatment

In general, while prescribing drug regimen for Marma Vikara the Physician shall have to take into account following points ; a. The general state of Dosha vitiation in the body b. The substance quality of Marma relating to vitiation (which include the Dhatu of Marma) c. The Srotas or Ashaya (system) to which the specific Marma belongs d. Preferably, the specific type of Vata (out of the five) which resides in that Marma.

I. The internal treatment

Some Imporatant Herbs
Bala (Abitulum indicum) Rasna (Vanda Roxbhurgi) Amalaki (Embelica officianalis) Arjuna (Terminalia arjuna) Ashwagandha (Withenia somnifera) Jeevanti (Leptadena reticulata) Taila (Sesum oil) / Eranda (Castor Oil) Milk and Ghee

Some Mineral & herbo-mineral Preparations

Ajasthi Bhasma (Goat bone Bhasma)

Kacchapaprishta Bhasma (Tortoise shell Bhasma ) Peranda Bhasma Kapardhika Bhasma Muktashukti Bhasma (Pearl shell Bhasma) Jaharmohar Pishti Rajata Bhasma (Silver Bhasma) Suvarna Bhasma (Gold Bhasma) Navajeevana Rasa Marma Gutika

II. The treatments given locally

The Marma are also treated locally at the site. This suites more preferably for the superficial Marma largely existing on extremities, back and some on face. But for the deeper Marma also, in some instances treatments are given locally upon the superficially referring anatomical area above them. Such treatments include oil applications, Abhyanga (massage), heat applications/Agnikarma (cautery) in the surrounding area, upanaha (hot poultice), Dhara, Lepa, Udvartana etc.

Palpation of Marma locally, however, counts first in the treatment of Marma existing superficially. Applying comfortable pressure and stroking with fingers and palms upon the Marma sites is a best way to treat them. The knowledge of accupressure may be helpful for the practitioners willing to use the knowledge of Marma.

Some Useful local remedies

Marma lepam Ghee, Milk, Cool water, Mud, Mahanarayana Taila, Ksheerabala Tailam etc. Some useful Therapies under Panchakarma Abhyanga (particularly over Marma) Unmardana Dhara Chikitsa (including Piszhichil) Pinda Sveda Shirodhara Shirobasti Urobasti Katibasti Pichu Dharana Alepa (poultice) etc. Marma Kshobe Lepa This is a compound herbal mixture recommended especially for Marma external application mentioned in the book of Sahasrayoga (2nd chapter under Gutika Prakarana).

Benefits of Treating Externally

Establish proper nutrients to marma sites which are basically made of Dhatu (metabolic discete) Help in cleaning the channels (Srotas) or Rasavahini situated at the site , which convey the Dosha. The qualities of the medicaments used in Taila shall also counteract the morbid factors vitiating the Marma.

The Psychological Component

Thirdly, the intricate relation of Marma with mind has to be considered in treatment aspect also. Physician should observe for the source of mental stress by counselling with patient. The patient must be appraised of the gravity/or the role of mental grief, tension etc. in the physical disturbances. Psychosomatic illnesses for instance provide enough material to understand the relation of Marma with mind. Obviously certain Medhya Rasayana (brain rejuvenators) drugs and treatments like Shirodhara are note worthy at this context. These assist in bringing the mind to relaxed state.

Yoga in treating Marma

The replenishment of physical content of Marma is a beneficial point by Yogasana. However, the effect of Yogasana and Pranayama are not limited to the physical exercises. They are closely related with movement of Prana in different Nadi of the body. The relative terms like Prana. Nadi and Vata in respect of Marma are already discussed, there is no need to highlight Prana & Nadi Shudhi in the care of Marma. Preservation of Prana through the control over mental activities & relaxed state of body & mind is an important aspect, in the treatment of Marma too. There are specific Mudra which help in purifying specific Chakra in the body,so that the Prana moves freely in channels (Nadi) unobstructed.