Importance Of Marma: Need for study

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
Marmas are important anatomical landmarks having surgical importance. Marma Shaareera is the first ever explanation in any medical science about the ‘comprehensive study of surgical anatomy or applied anatomy’. 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.
Read related: Marma Shaareera: Definition, Composition: Vital Points of The Body

Importance of knowledge of Marmas

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

Half knowledge of Shalya Tantra

Marma Shaareera is half of Shalya Tantra (Knowledge of Marma is said to be half of all the knowledge of Surgical Science)
marmANi zalya viSaya ardham udAharanti yasmAt ca marmasu hatA na bhavanti sadhyaH|
jIvanti tatra yadi vaidhya guNena kecit te prApnuvanti vikalatvaM asaMzayaM hi||
saMbhinna jarjarita koSTha ziraH kapAlA jIvanti zastra nihataiH ca zarIra dezaiH|
cchinaiH ca sakthi bhuja pAda karaiH azeSaiH yeSAM na marmasu kRtA vividhAH
prahArAH||(su.zA.6/35,36)

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.
Read related: Classification Of Marma Based On Location In The Body

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.

Confluence of 5 structures

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.

Seat of Prana

Marmas are seats of Prana or life element, thus vital
soma mAruta tejAMsi rajaH sattva tamAMsi ca|
marmasu prAyazaH puMsAM bhUtAtmA ca avatiSThate||
marmasu abhihatAH tasmAt na jIvanti zarIriNaH||(su.zA.6/37)

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).

Explanation of surgical anatomy

First ever explanation of applied anatomy or surgical anatomy
mArayanti iti marmANi ucyate|srotasi kSate api na AvazyatayA maraNaM; yato vakSyati
sroto viddhaM tu prtyAkhyAya upAcaret|(DalhaNa, su.zA)

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.

Effect of Marma injury

Injury to the Marmas more dreadful than losing limbs
chinneSu pANi caraNeSu sirA narANAM saMkocamIyuH asRk alpa mato nireti|
prApyAm iti vyasanam ugramato manuSyaH saMcchinna zAkha taruvat nidhanaM
nayanti|| (su.zA.6/32)

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.

Measurement of Marma

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.
Read related: Marma Classification Based On Effect Of Injury

Effect of Marma injury

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
cheda bheda abhighAtebhyo dahanAt dAraNAt api|
upaghAtaM vijAnIyAt marmaNAM tulya lakSaNam||(su.zA.6/42)

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’.

Diseases in Marma sites

Any disease which involves Marma or occurring in Marma site is difficult to cure
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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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