Ayurveda Treatment Methods

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Importance Of Marma: Need for study


It is a science unique to Ayurveda, especially Sushruta Samhita and looks like it would have by all means influenced the modern surgery and practical surgery, if not by theory but by concepts.

Below mentioned are the points and materials which justify the importance of Marmas and also the need for its study – 

Marma Shaareera is half of Shalya Tantra (Knowledge of Marma is said to be half of all the knowledge of Surgical Science)
मर्माणि शल्यविषयार्धमुदाहरन्ति यस्माच्च मर्मसु हता न भवन्ति सद्यः ||३३||

जीवन्ति तत्र यदि वैद्यगुणेन केचित्ते प्राप्नुवन्ति विकलत्वमसंशयं हि |३४|
सम्भिन्नजर्जरितकोष्ठशिरःकपाला जीवन्ति शस्त्रनिहतैश्च शरीरदेशैः ||३४||
छिन्नैश्च सक्थिभुजपादकरैरशेषैर्येषां न मर्मसु कृता विविधाः प्रहाराः |३५|सु.शा.६/३५,३६

The knowledge of the Marmas constitutes half of the knowledge of Shalya Tantra (Ayurvedic Surgical science). This statement by Sushruta makes it clear that comprehensive knowledge of Marmas is mandatory for a physician to excel in the field of Surgery.

It is clear from the description of Marmas and the impact of injury on them that ‘the injury or damage to the Marmas essentially leads to the death of a part of the body or individual as a whole’. There is a chance factor that the person whose Marma is injured survives and stays alive by good efforts made by an efficient surgeon. Even these persons who escape death from injury to the Marmas definitely suffer from one or the other kind of deformity. Thus it is clear that the injury to a marma is bound to leave a bad impact either in the form of death, functional failure, damage to tissue or organ or deformity or severe pain.

In spite of the severe damage leading to breaking into pieces of the bones of the koshta (thorax and abdomen) and shira (skull) following injury or strike from weapons or amputation of the extremities, there will be good chance of the person to survive provided the Marma’s are not injured or damaged.

Marmas are the confluences of 5 important elements of the body, thus vital and delicate
Marmas are formed by the confluence of 5 important elements or structures of the body namely Mamsa, Sira, Snayu, Asthi and Sandhi.

Carefully observing, these are the main structures which make up the bulk anatomy of the body. According to the rule of predominance the marmas are called and categorized by the name depending on the predominant structure they are made up of.

Example, Mamsa Marma has predominance of mamsa dhatu (muscle) and small proportions of other structures. Therefore they are called Mamsa marmas. The same rule is applicable to other marmas also. Since they are formed by important structures, any damage to them causes structural or functional impairment, death and failure of an organ or tissue. Thus the knowledge of Marmas is important.

Marmas are seats of Prana or life element, thus vital
सोममारुततेजांसि रजःसत्त्वतमांसि च |

मर्मसु प्रायशः पुंसां भूतात्मा चावतिष्ठते ||३५||
मर्मस्वभिहतास्तस्मान्न जीवन्ति शरीरिणः |३६|सु.शा.६/३७)

Marmas being a congruence of vital structures of the body are also the abodes of Prana or life element. This is the reason for these points or spots of the body to be vital and sensitive. When they are injured the life element is damaged leading to structural and functional impairment, death and deformity. The Pranas are Soma (Kapha), Maruta (Vata), Teja (Pitta), Satwa, Raja, Tamas, Bhutas (5 elements of nature) and Atma (soul).

First ever explanation of applied anatomy or surgical anatomy
मारयन्ति इति मर्माणि उच्यते।स्रोतसि क्षते अपि न आवश्यतया मरणं; यतो वक्ष्यति स्रोतो विद्धं तु प्र्त्याख्याय उपाचरेत्।(डल्हण, सु.शा)

Those which cause death are called Marmas. There are some types of Marmas which do not cause death Ex. Rujakara and Vaikalyakara Marmas. This shows that some marmas cause death, some cause instant death (sadhyo pranahara), some gradual and slow death (kalantara pranahara), some cause deformity (vaikalyakara) while other cause pain (rujakara). But what is common in all the marmas is that they trouble us when they get injured or damaged. The type of damage depends on the extent and severity of insult or injury caused on the marma. But in all the types of Marmas, one or more of the 12 Pranas (life elements) are definitely affected.

Any injury to other parts other than these Marmas such as Srotas (channels of the body) etc may not lead to death. They can be treated by effective remedies. The Srotas are located along with the dhatus (which they help in forming and transportation) and are not found elsewhere. The srotas are thus found connected to their respective dhatus which include mamsa (muscles), asthi (bones) etc which are again the types of marmas. Therefore there are no other Marmas other than the 5 types of Marmas explained by Sushruta (Mamsa, Sira, Snayu, Asthi and Sandhi).

Marmas are scattered all through the body and covers all the major components forming the body. They also include the vital organs and systems of the body. The knowledge of the Marmas gives us an idea and comprehensive knowledge of the vital areas of the body. This knowledge is essential for the surgeons because they need to protect these spots while putting the instruments over them.

Thus the knowledge of Marmas can be considered as the first and comprehensive explanation of the applied aspects of surgery i.e. applied surgery, applied anatomy and surgical anatomy.

Injury to the Marmas more dreadful than losing limbs
छिन्नेषु पाणि चरणेषु सिरा नराणां संकोचमीयुः असृक् अल्प मतो निरेति।

प्राप्याम् इति व्यसनम् उग्रमतो मनुष्यः संच्छिन्न शाख तरुवत् निधनं नयन्ति॥(सु.शा.६/३२)

When the hands and legs of a man is cut off or when they get amputated, the blood vessels contracts and prevent profuse loss of blood. The person in spite of losing his limbs and being put in a condition wherein all his daily activities are brought to a standstill, doesn’t die, just as a tree which doesn’t die even when all its branches are cut off.

On the contrary when the marmas are injured leading to severe blood loss, the person dies quickly. Sushruta explains this with the example of Kshipra and Talahridaya Marmas which are located in the hand.

When the Kshipra and TalaHridaya Marmas are injured, they cause severe hemorrhage. This in turn causes aggravation of Vata. This Vata further causes severe pain. The person may die just like a tree dies or degenerates whose roots are abruptly cut off by a weapon.

In this condition, immediate amputation of the foot or hand (above the ankle or wrist joint) is advisable to save the life of the person resulting from excessive bleeding.

Surgeon should know the accurate measurement of Marmas
The measurements of each and every marma in terms of anguli pramana have been briefed in the above context. The knowledge of their measurements is very essential for a doctor, to a surgeon to be precise. This helps the surgeon to conduct the surgery cautiously without damaging the marma points, thus avoiding complications leading to deformity or death. It is also helpful to omit the areas of neighboring marmas which may also produce similar hazardous consequences on getting injured.

Thus the knowledge of marmas is essential for conducting successful surgery. Even in modern surgery the precise knowledge of anatomy and surgical anatomy (applied anatomy or surgery) is essential for conducting surgery successfully.

Effects of injury of different Marmas
Sadhyo Pranahara Marmas –
 When these Marmas get injured, death occurs in 7 days. Other symptoms of injury include – loss of perception of sense organs (indriyartheshu asampraapti), perversion in the activities of mind and intellect / cognitive functions (mano buddhi viparyayaha), different types of severe pains (rujaaha cha vividhaaha teevraaha) and quick death (aashu hata). These marmas are predominantly composed of Agni Maha Bhuta (fire element) and by the effect of agni (which is quick acting and quick destroying), these marmas cause death in quick time.

Kalantara Pranahara Marmas – When these Marmas get injured, there is gradual death. The person may die within a 15 days or one month (30 days). This happens due to the unique composition of these Marmas. These Marmas are made up of Agni (fire) and Jala (water) elements. Agni acts and effects quickly and Soma (jala) acts and effects slowly. Due to the association of water element, the death is slow. Other associated symptoms are emaciation or depletion of tissues (dhatu kshaya) and pain due to emaciation (kshayaja vedana). An injury in the surrounding area of Sadhya Pranahara Marmas may lead to effect on Kalantara Pranahara Marmas also. 

Vishalyaghna Marmas – These Marmas kill the person once the shalya or the foreign body stuck in the site of Marma is removed. These marmas are chiefly composed of Vayu (wind) element. The foreign body which injures this marma prevents the escape of vayu (the life element) as long as it is in its place. Thus the person survives as long as the foreign body has not been removed. But once the foreign body which has impacted at the site of Marma is removed, the vayu gets expelled leading to immediate death. In case if the wound heals by itself and the foreign body later drops down from the point of impaction spontaneously, there is a chance that the person survives.

Vaikalyakara Marmas – They are predominantly formed by Soma guna (water element). These Marmas on getting injured causes deformity. Soma or jala dhatu by the virtue of its stability and cold qualities protects the Pranas located in the marmas (life elements discussed already). Therefore these marmas do not cause death on injury but will surely cause deformities. Severe injury may cause death. Proper treatment by an efficient physician will limit the injury to cause deformity but not death. This means to tell that even a proper treatment cannot prevent deformity but can avoid further damage leading to severe deformity and death.

Rujakara Marmas – Rujakara Marmas cause severe pain on getting injured. They are predominantly composed of Vayu Guna (wind element). According to others it is made up of pancha maha bhutas (all 5 elements of nature). On getting injured they cause severe types of varied proportions and intensities. If neglected, they may also cause deformity as in Vaikalyakara Marmas. Occasionally, when injured these marmas may directly produce vaikalya or deformity.

Any sort of injury around Marma site would cause similar effect of injury of marma
छेद भेद अभिघातेभ्यो दहनात् दारणात् अपि।

उपघातं विजानीयात् मर्मणां तुल्य लक्षणम्॥(सु.शा.६/४२)

Any sort of injury or assault around the site of Marma like cheda (incised wounds), bheda (excised wounds), abhighata (trauma), dahana (burn) or daarana (split) would cause similar symptoms of those of marmopaghata or ‘direct injury to the marma’.

Any disease which involves Marma or occurring in Marma site is difficult to cure
मर्माणि अधिष्ठाय हि ये विकारा मूर्च्छन्ति काये विविधा नराणाम्।

प्रायेण ते कृच्छ्रतमा भवन्ति नरस्य यत्नैः अपि साध्यमानाः॥(सु.शा.६/४४)

Any disease (systemic) which occurs in the vicinity of Marma or involves Marma in a later period of its manifestation becomes difficult to cure in spite of all attempts being made to address them with good medicines and treatments. Among the diseases caused in various directions or places in the body, Marmasthi Sandhigata (diseases occurring in the marmas, asthi or bones and sandhis or joints) are considered to be difficult to handle. They are also considered as Madhyama Roga Marga (intermediate pathway of disease formation). Among the tissues, Asthi (bones), Majja (bone marrow) and Shukra (semen) are considered as Marmas (Deeper tissues). The diseases occurring in them are also difficult to treat.


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