‘Ayurveda’, the science of life is constituted by two words, ‘ayus’ and ‘Veda’ meaning the science of ayus or the knowledge of life. ‘Ayus’ in this context denotes the continuity of consciousness or unified state of physical body, cognitive organs, mind, and soul. The physical body ‘sareera’ represents the gross structural and anatomical component of ‘ayu’ upon which the abnormalities of even the other subtle elements of ayus manifest. The body and cognitive organs are perceptible only in the combination of ‘ayus’. The father of general medicine in ayurveda, Acharya Charaka explains the body; the seat of ‘chetana’ as an equilibrated combination of the modification of the five gross elements –‘Panchabhutavikara’. As per the principles of ayurveda, Panchamahabutas are involved right from the beginning of the development of fetus (fetal developments). the tridoshãs ‘vata’, ‘pitta’and ‘kapha’ performing the coordinating, transformative and generative functions of the body are also made up of panchmahabhutas (five elements). The entire body is constituted by ‘Paŕmanus”; the minutest units of panċhabhutas according to the philosophy of vaisheshika. The theory of tridoshã explains the process of health and diseases. Vata is predominantly constituted by Akashabhuta and vayubhuţa, Pitha by Agni bhuţa and Kapha by apbhuta and pŕthvibhuta. These somatic humors in a state of equilibrium work complimentary to each other, performing and controlling all physiological process of the body and mind to maintain health. The entire human body is constituted by panchabhutas. This fact has been asserted by all Acharyas of Ayurveda. However the on the basis of predominance of bhuta composition the srothrendiya, sabdha and the conducting system in the body has been attributed to akasha bhuta, the sparsanedriya, the tactile sensations and all the movements of the body to Vayubhuta, the chakshurindriya the perception of vision, luster and metabolism to agnibhuta, rasanendriya the nutritive faculty and the various fluids in the body to the apyabhuta and the ghranendriya, the faculty of smell and the still grosser components of body like asthi, mamsa etc to prithvibhuta. This clearly demonstrates that all the components of sareera that is dosha , dhathu, mala etc are fundamentally panchabhoutika in nature. Satwa, raja and thama are the trigunas. The satva guna predominance in human constitution leads to pure knowledge and health while the rajoguna and thamoguna predominance leads to ignorance, vitiation of tridoshãs and illhealth. Acharya Suśhruta, the father of Indian surgery has defined ‘maŕma’ as primary seat of trigunas , tridoshãs and prâna. He has stated that the fatality attributed to maŕmagata is due to the vitiation of the three factors leading to deadly manifestation or even death. Relevance of topic – maŕma Muskulo-skeletal disorders are one of the chief challenges en

1. Pragmatic concept of Maŗma Dr. Syyed Mohammed Jalaludheen MS(Ay) Ph.D(Ay) Associate professor, Dept of Salyatantra, Email: jalal_ayurveda@yahoo.com www.researchayurveda.org www.punarnava.net

2. Contents Relevance of the topic Introduction with definition Classification and comparison Pathology of marmabhigata Principles of marmabhigata treatment. General treatments 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 2

3. Relevance Acupuncture moxibustion, electric acupuncture (electro-acupuncture), laser acupuncture (photo-acupuncture) microsystem acupuncture Chinese medicine Anisodamine - related to atropine- Anisodustanguticus Yin –heat, yan – cold Physiotherapy Chiropractic/manipulation Marma therapy ? 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 3

4. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 4

5. Etymologically Derived from the root ‘ma’ means prâna or vayu, the repha indicates house or seat. Hence the word “maŕma means seat of vayu or prâna” 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 5 NIRUKTI

6. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 6  Marma science is a part of “Vedic” science.  The first references found in RIGVEDA which dates back 4000b.c.  In ATHARVAVEDA we can find the reference of the term kavacha {breast plate self protection in war}  In “MAHABHARATA” references in karnaparva,bheeshmaparva, virataparva, dronaparva, shalyaparva.

8. Early Dravidians

9. 18 Sidhars including Sage Agasthyar.

10. DhatuChikiltsa& Marma Chikiltsa

11. LordBrahma

12. Atreya

13. Dhanwanthiri

15. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 9 (Su Su 6/19) Marmas are considered as Ardhabhaga of Salyatanthra. (Su su 6/34)

16. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 10 Marmas are conglomerations of all or some of Mamsa (Muscles) Asthy (Bones) Snayu(Tendons & ligaments) Dhamani (Arteries) Sira (Veins) Sandhi (Joints) All of them are considered to be the seat of Prana.

17. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 11 Inference  Marmasare certain vital structures of the body.  They may result in death, serious functional impairment or deformities upon injuries.  Structurally they are composed of all the components of the human body in different propositions.  Injury to Marmas result in neurological disorders, as the injury may predispose atrophy,paralysis etc.  Equilibrium of Tridoshas are deranged on injuries.  Injury also result in psychic imbalance.

18. MAŔMA- THE SPECIALISED CARTEL OF ‘CHETANA’  Chaturvimshatithatwatmakpurusha’ is not the subject of therapeutic interventions.  Shaddhathujapurusha = chetana + panchamahabhutas  Purusha devoid of the spirit of chethanadhathu becomes obsolete in ayurvedic outlook.  Human life =incorporation of chethanadhathu/prana in to the jada(morbid) + fundamental elements (mahabhutas) 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 12 Maŕma - point of the chetana or prâna in the body.

19. Su Sa 6/35 Soma Kapha (liquid) Maruta Vayu (Vata) Marmas are the seat of Tejas Fire (Pitta) Rajas Mind (Manas) Satva Tamas Panchabhootas Bhootatma 13 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay)

22. Marma & Yoga 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 16

24. Thoduvarman 961-May-11 17 Dr.Jalaludheen.MS(Ay),PhD(Ay)

25. PADU VARMAN The place where the energy is blocked 12 in number. Each paduvarman is the junction of 8 thoduvarman sites. Paduvarman are travelling through the entire body. Subdivided in Siva kalai(male),Shaktikalai(female) Paramakalai(both energies together) 1-May-11 18 Dr.Jalaludheen.MS(Ay),PhD(Ay)

26. Thilarthakalam ----- located at the centre of two eyes(this is the sthapanimarma in ayurveda) Pidarivarman ----- similar to “ida” nadi in yoga Sumanivarman ----- at the site of visudha chakra(in throat) Nervarman ----- at the site of hridaya Urumikalam ----- at the site of manipura chakra Kallidaikalam ----- between two testicles Natchathirakalam ----- similar to gudamarma 1-May-11 19 Dr.Jalaludheen.MS(Ay),PhD(Ay)

27. 8. Sevikutrikalam ----- at the site of viduramarmam 9 . Urakkakalam ----- at the site of shrungataka marma 10 . Adappuvarman ----- located in chest 11 . Periyaasthichurukki ----- located one finger located one finger below the floating rib cage 12 . Siriyaasthichurukki ----- located one below the above marma. 1-May-11 20 Dr.Jalaludheen.MS(Ay),PhD(Ay)

29. Thattuvarman by blow — 08

30. Thadavuvarman by palpation—04

31. Nakkuvarman by licking —01

32. Nokkuvarma by sight — 01 ---------- 122 ? 1-May-11 21 Dr.Jalaludheen.MS(Ay),PhD(Ay)

33. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 22 Classification of Marmas in Ayurveda Vagbhata Susrutha 107 107 Marmas can be grouped under 5 major divisions, each of which is again divided into 5 sub divisions.

34. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 23 Major Divisions 1. According to the structure involved (niveshabheda) – mamsamarma, dhamaneemarma etc. According to traumatology / prognostic aspect (vyapathbheda) – Sadyapranahara etc. According to location / site (angabheda) – Udaramarma etc. According to metrics (samkhyabheda) – ekasamkhya etc. According to size (manabheda) – ex. Panithalonmana

35. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 24 107 107 107 107 107

36. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 25 Structural Classification - II Ashtanga Hridaya

37. General classiffication Ayurvedicmaŕma. Kulayanamaŕma - Same as in mentioned in Ayurveda. - it is for warriors to afflict the maximum possible injury in combat and also used as a self defense. - different symptoms of injuries and - different techniques applied to relieve the same. - Adankal - to relieve emergency symptoms of maŕmabhigata. 3. Abhyasamaŕma - practiced in the area of Malabar (north kerala) - martial arts - points to hurt the humans. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 26

38. Abhyasamarma 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 27

39. Kulayanamarma 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 28

40. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 29 Composition

42. HRIDAYA

43. VASTHYMahaMarmas

44. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 31 >>>>>TRIMARMEEYA Trimarmeeya Theory Siras (Head) Central Nervous System (Heart) Cardio Vascular System Hridaya Urinary System including the Kidneys,Ureters,Bladder& Urethra Vasthy (Bladder)

47. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 34 Dathukshayavatakopa- pithatheevrarujatrisna, sosha, mada , brama etcHV Shock vv shock death. SÉiÉÖÌ´ÉvÉÉκºÉ®úɺi´ÉRÂóMÉʴɦÉÉMÉä ªÉɺºÉ¨ÉÒÊ®úiÉÉ:* iÉ{ÉǪÉÎxiÉ ´É{ÉÖ: EÞòiºxÉÆiÉÉ ¨É¨ÉÇhªÉÉʸÉiÉɺiÉiÉ:** iÉiIÉiÉÉiÉÂIÉiÉVÉÉiªÉilÉÇ|É´ÉÞkÉävÉÉÇiÉÖºÉÆIɪÉä* ´ÉÞrù¶SɱÉÉä ¯ûVɺiÉÒµÉÉ: |ÉiÉxÉÉäÊiÉ ºÉ¨ÉÒ®úªÉxÉÂ** iÉäVɺiÉnÖùrùiÉÆvÉkÉä iÉÞ¹hÉɶÉÉä¹É¨Énù§É¨ÉÉxÉÂ* (A.H.Sa. 4/63 – 65)

48. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 35 Sandhichedana ´ÉrÇùªÉäiÉ ºÉÎxvÉiÉÉäMÉÉjÉÆ ¨É¨ÉÇhªÉʦɽþiÉä pÖùiÉÆ* UäônùxÉÉiÉ ºÉÎxvÉnäù¶ÉºªÉ ºÉÆEÖòSÉÎxiÉʺɮúÉÁþiÉ:** VÉÒÊ´ÉiÉÆ |ÉÉÊhÉxÉÉÆiÉjÉ ®úHäò Êiɹ`öÊiÉ Êiɹ`öÊiÉ* (A.H.Sa. 4/66 – 67)

49. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 36 Prognosis of Marma injury is variable Small wound in marma or roga involved in marmasthana is difficult to treat/ no good result in treatment ¨É¨ÉÉÇÊiÉPÉÉiɺº´É±{ÉÉä%Ê{É |ÉɪɶÉÉä ¤ÉÉvÉiÉäiÉ®úɨÉÂ* ®úÉäMÉÉ ¨É¨ÉÉǸɪÉɺiÉuùiÉ |ÉGòÉxiÉÉ ªÉixÉiÉÉä%Ê{É SÉ** (A.H.Sareera4/70)

50. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 37 Common symptoms of maŕmaghata (injury to vital spots). > Giddiness > Delirium > Fainting > Delusion > Loss of activity > Semi- consciousness > Increase of body temperature > Weakness of limbs > Increased expirations > Severe pain caused by vata > Blood resembling like meat washed fluid flowing out > Cessation of activity of all sense organs > Imbalance of Tridoshas. > Dhatukshaya > Vatakopam

51. MARMAGATA HYPOVOLEMIC SHOCK Giddiness Delirium Fainting Delusion Loss of activity Semi- consciousness Increase of body temperature Weakness of limbs Increased expirations Severe pain Imbalance of Tridoshas. anxiety or agitation Confusion Decreased or no urine output General weakness Pale skin color (pallor) Rapid breathing Sweating, moist skin Unconsciousness 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 38 Dehaprasupthiguruthasammohaseethakamata Swdamurchavamidahamarmaviddasyalakshana AS

53. Extreme weakness of the body.

54. Vertigo.

55. Persistent Tremors.

56. Tachypnoea

57. Heart burn.

58. Restlessness.

60. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 41 The gate control theory of pain Nerve fibers are large bundles of various size- some are thick and some are thin. Thin transmit the sensation of pain while the thick carry the tactile sensation. Thus if the thick impulse is increased this selectively blocks the conduction of thin fibers. This is called the gate control theory.

61. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 42 Other Theories. The very small electrical changes that occur at the marma points is found to be capable of producing effects far in excess of the tiny electrical change at the point responsible for triggering the desired effect.

62. 43 Trigger Point Injection (TPI) for Pain Management  Trigger point injection (TPI) treating pain for some patients.  TPI is used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax.  Many times, such knots can be felt under the skin.  TP may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body. http://www.webmd.com/pain-management/guide/trigger-point-injection 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay)

64. 1-May-11 45 Acupuncture treatment  acu-points are near nerves.  stimulated, these nerves cause a dull ache or feeling of fullness in the muscle.  stimulated muscle sends a message to the CNS - release endorphins (morphine - like chemicals produced in our own bodies during times of pain or stress) along with other neurotransmitters (body chemicals that modify nerve impulses), block the message of pain from being delivered up to the brain  AT useful as an accompanying treatment for many pain-related conditions, including: headache, low back pain, menstrual cramps, carpal tunnel syndrome, tennis elbow, fibromyalgia, osteoarthritis and myofascial pain.  Acupuncture -acceptable alternative - as part of a comprehensive pain management program. Dr.Jalaludheen.MS(Ay),PhD(Ay)

65. Maŕmakshatasamanyachikiťsa (maŕmaghata) Maŕma therapy is based on the panchabhuta and tridoshã theory of ayurveda. These are practically divided in to two. Primary management and secondary management. But Athreyaparambara and Danwanthariyaparampara not mention of the primary managements involving immediate manipulations. Only the subsequent management of maŕmagata in the light of tridoshã theory which constitutes the secondary management seems to have been mentioned by them. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 46

66. Primary management  Taking a cue out of AcharyasSusrutas advice it would be apt to adopt the principles and practice of maŕmachikitsa from the tradition of ‘siddhamaŕma’.  Ayurvedic maŕmachikitsa had been transferred orally rather than in a textual manner.  ‘The siddha’ maŕma / varma has well designed treatment protocols can implemente with our treatment protocols after attaining good practical knowledge and experience in the same.  Explained land mark of each varma (maŕma), different characteristics of its injury and different techniques to be applied to relive the symptoms are dealt in details. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 47

67. Adankal The techniques for relieving the emergency symptoms of maŕmabhigatha The techniques are usually strikes, hits, blows or presses to certain particular locations in the body. The quantum of measurement of impact to nerve centre is known as ‘mathirai’. The adankal is used to relieve symptoms like unconsciousness, shivering, protrusion of tongue; convulsions etc. 51 adankals out of these 13 are widely used. Egvayullaadankal, unnakkinadiyil, alavil, alavadiputtukal etc. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 48

68. General techniques in adankals“Emergency management” He should be lifted and made to sit. Massage mildly on the chest and back The rib cage is made to expand well by extending both the hands. Stretch the nerves. Massage the feet. Massage in right and left with hands of both side. Etc. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 49

69. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 50

70. Elakkumura The manipulation technique for reviving the patient from a state of marmabhigata is termed as elakkumurai. There are specific elakkumura for every sadyopranaharamarmas. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 51

71. Elakkumura in uchchi varma Patient -laid flat on bed. Holding foot together, the doctor slams/ hits his feet against the sole of the patient thrice, then applying pressure on the uchchi varma and the entire body shook well. If the patient is not revived even after this nasya with lucusaspera juice is advised. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 52

72. Stimulation of Uchichivarma  By regulating the impact on the marma the same can be utilized for obtaining positive health benefit.  This attained by achieving control of prana by measured trauma.  This has identified as point of convergence of 216 nerves and it is a seat of panchabhutas.  It can be optimally stimulated by sidewise to-and-fro movments using the tip of the three middle fingers of the doctor over the site thrice daily. It brings about, Stimulation on endocrine glands Maintain optimal brain temperature. Stimulates sleeping. Cures headache etc. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 53

73. Varma treatments 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 54

74. For neck and shoulder pain Manibandha varma Mudichu + kaakattaikaala + thusumuga varma 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 55

75. For hip & LBA 1. komberikaala+ viruthi+ nonganampoottu 2. komberikaala + viruthukaala + ullangalvelleri varma 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 56

76. Secondary management TAILADRONYA SAYANA Dislocation of any part of the body caused mainly by a fall, or in the event of having been run over or trampled down or of being wounded by a blow , hurt at any of the maŕmas etc the patient should be kept immersed in a large tank of oil and the diet should consist of the soup or essence (rasa) of meat. VASTHI According to AcharyaCharaka; the maŕmas are to be protected from aggravated vayu, because the aggravated vayu is responsible for aggravation of pitha, kapha and the élan vitae is dependent upon this vayu. The vayu is best treated with vasthi so, there is none other than vasthi therapy which can safeguard the vital organs. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 57

77. Manipulation Abyanga Parisheka Najavarakizhi Vasthi Bandage with murivenna 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 58

78. Injury to janumarma “ an abnormal increase in the local swelling, together with an excruciating pain, loss of strength, breaking pain in the joint, and restricted movements of affected part, mark of wound of a flexible or immovable joints11 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 59

79. Marma kashaya Bandage with murivenna Dhara with murivenna Njavarakizhi Exercise / physiotherapy. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 60 shoulder wrist LBA

80. Mustadimarmakwatha 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 61

81. Murivenna Swarasa of Pongamiaglabra Aloe vera Piper betel Moringaoliefera Erythrinaindica Alliumcepa Borreriahispida Kalka – asperagusracemoses Cocusnucifera oil 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 62

82. KASHAYA BALA KWATHA MUSTHADI KWATHA MUTTA KWATHA (EGG) MARMANI KWATHA ELADI KWATHA MARMA KANDI KWATHA 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 63

83. OILS MURIVENNA ASAVENNA KAYATHIRUMENI OIL PURAVENNA BALATAILA ANCHENNA KUKKUDA TAILA MUKKOOT TAILA 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 64

84. GULIKA MARMANI ELADI GRUTHA ASHTAVARGA CHANDANATHI LEHYA ELADI PANCHAMAMSADI KOYI TAILA CHOORNA ELADI THRIKADUKADI CHOORNA 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 65

85. EXTERNAL APPLICATIONS SNEHABYANGA MASSAGE WITH OIL KARSANA-DRY POWDER MASSAGE UDWARTHANA- VIGOUROUS RUBBING WITH HERBAL POWDER PADAGADA- MASSAGE WITH FOOT SARVANGASEKA PINDASWEDA- PPS JPS CPS- KUKKUDANTHA YAKRUT PINDA SWEDA. OTHER SEDATION –THAPA USHMA ROOKSHA VALUKA LEPANA 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 66

86. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 67 Do’s and don’ts…… Don’t ignore Marma Try to avoid Marma Always respect Marma Understand Marma

87. Conclusion  The potential of marmasastra as remained unexploited.  The understanding of marma needs better understanding of the principles of ancient anatomy.  The management can be classified as acute corrective and subsequent management based on tridosha theory. The nature of the subsequent management is rejuvinative in most occasions. Sincere efforts have to be made in documently and incorporating the traditional offshoots of marma therapy scattered over various part of our country. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 68

88. 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 69

89. jalal_ayurveda@yahoo.com 09447232573 www.researchayurveda.org 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 70 THANK YOU

90. Thirumoolarvarmology institute,coimabotre, art research institute (ARI) To know more about siddha varma in clinical practice 1-May-11 Dr.Jalaludheen.MS(Ay),PhD(Ay) 71