E-ISSN:2456-3110

Review Article

Kakshadhara Marma

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 6 July
Publisherwww.maharshicharaka.in

Anatomical Interpretation of Kakshadhara Marma and its Clinical Importance

Chandrappa Mangalore V.1*, Byalihal H.2, Kanavi N.3
DOI:

1* Vidya Chandrappa Mangalore, Post Graduate Scholar, PG Department of Rachana Sharira, Rajiv Gandhi Educational Society’s Ayurvedic Medical College and Hospital, Ron, Karnataka, India.

2 Harshavardhan Byalihal, Professor, PG Department of Rachana Sharira, Rajiv Gandhi Educational Society’s Ayurvedic Medical College and Hospital, Ron, Karnataka, India.

3 Niyazahmed Kanavi, Assistant Professor, PG Department of Rachana Sharira, Rajiv Gandhi Educational Society’s Ayurvedic Medical College and Hospital, Ron, Karnataka, India.

The term Marma indicates the sense of vital parts of the human body and injury to these spots leads to the death and death like miseries. The Knowledge regarding location and sites of the Marma in the body have great importance in Traumatology. Marmas are grouped separately on the basis of the structural classification, based on the injury consequence, based on the Pramana & based on the location in the body. Marma Viddha Lakshanas are explained in detail by the Acharya Sushruta. Kakshadhara Marma is Vaikalyakara Marma in the Urdhwa Shakha it is Snayu Marma according to the Sushruta which causes Vaikalyata once injured. The main of the study is to explore the structures present in the Kakshadhara Marma and to study its clinical importance.

Keywords: Marma, Vaikalyakara Marma, Kakshadhara Marma, Pakshaghata

Corresponding Author How to Cite this Article To Browse
Vidya Chandrappa Mangalore, Post Graduate Scholar, PG Department of Rachana Sharira, Rajiv Gandhi Educational Society’s Ayurvedic Medical College and Hospital, Ron, Karnataka, India.
Email: 		Vidya Chandrappa Mangalore, Harshavardhan Byalihal, Niyazahmed Kanavi, Anatomical Interpretation of Kakshadhara Marma and its Clinical Importance. J Ayu Int Med Sci. 2022;7(6):122-126.
Available From
https://jaims.in/jaims/article/view/1885

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-25 2022-05-27 2022-06-03 2022-06-10 2022-06-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Vidya Chandrappa Mangalore, Harshavardhan Byalihal, Niyazahmed Kanaviand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(6)122
Mangalore V et al: Anatomical Interpretation of Kakshadhara Marma

Introduction

Marma Shareera is one of the important topics discussed in Ayurveda. The term is also appeared in Vedic period and dictionaries. It is illustrated as the Vital points in the Human body where the Mamsa, Sira, Snayu, Asthi and Sandhi along with the Prana resides.[1]

Based on the injury consequences there are five types as Sadyah Pranahara, Kalantara pranahara, Vaishalyaghna, Vaikalyakara and Rujakara Marma.[2]

Kakshadhara Marma is vital region in Human anatomy It is explained as Vaikalyakara Marma situated in the Urdhwa Shakha.[3]

It is Snayu Marma according to Acharya Sushruta and Sira Marma according to Acharya Vagbhata.[4] It is located between Kaksha and Vaksha.[5]

According to the Amarkosha the meaning of the word Kaksha is Bahumoolam. An injury to the Kakshadhara Marma results in Pakshaghata.

Hence the study is aimed to analyze the anatomical structures of the Kakshadhara Marma and its Viddha Lakshana. Present work is been taken up in updating early concepts of better understanding of Kakshadhara Marma in accordance with the modern and applied anatomy. And to explore Viddha Lakshana of Kakshadhara Marma in relation to Pakshaghata.

Review of Literature

Kakshadhara Marma: Kakshadhara Marma are two in number.[6]

It is located in Urdhwa Shakha. It is situated between Kaksha and Vaksha.[7]

The word Kakshadhara means part of body where the upper arm is connected with the trunk i.e., Shoulder joint.

Kaksha means Bahumoolam which are two in number. Vaksha is the region above the Hridaya and below the Kantha.

As per description Kakshadhara Marmasthana lies between the Kaksha and Vaksha but as the name indicates it is more related to Kaksha, any injury to this particular Marmasthana will lead to Pakshaghata.


Name Kakshadhara
Number 02
Site (At Axilla)
Type (acc. to Pramana) 01 Angula
Type (acc. to Rachana) Snayu
Type (acc. to Aghataj Parinaam) Vaikalyakara
Structures involved Subscapularis, Pectoralis minor, Brachial plexus, axillary artery, Axillary vain, Axillary lymph node
Signs if injured Pakshaghata

Fig 1: Showing Kakshadhara Marmasthana

Materials and Methods

  • Ayurvedic literature related to Kakshadhara Marma was studies from various sources like Brihattrayee and Laghutrayee.
  • Modern literature related to shoulder joint was studied.
  • Materials from the electronic media and journals were reviewed.

Cadaveric Study: Dissection at the region of the Kakshadhara Marma has been carried out in department of Sharira Rachana. Rajiv Gandhi Ayurvedic Medical College, Ron. and structures related to Marma were identified. Structures were analyzed and compared on the basis of Ayurvedic literature with special reference to Contemporary sciences.

Discussion

The Kakshadhara Marma lies in the Kaksha region. The detailed discussion of these points are as follows:


Journal of Ayurveda and Integrated Medical Sciences 2022;7(6)123
Mangalore V et al: Anatomical Interpretation of Kakshadhara Marma

Location: As per available references from the Samhitas the exact location of Kakshadhara Marma is mentioned as between Kaksha and Vaksha. But as the name indicates it is more related to Kaksha. According to the Amarkosha the word Kaksha means Bahumoolam which refers to the root of the arm i.e., the joint which connects arm to the shoulder is known as Kaksha Sandhi. Vaksha is the region above the Hridaya and below the Kantha it may be considered as the region above the breast. The word Dhara means bearing or holding. Since it is named as Kakshadhara, it is assumed that it holds Kaksha region with the help of Peshi, Snayu etc.

So, the location of the Marma is in between chest and shoulder joint. But nearer to the shoulder joint or Kaksha sandhi as the name indicates. Thus, kakshadhara Marmasthana is to be considered just below the clavicle nearer to Kaksha Sandhi. The muscles ligaments, blood vessels & nerves in the subclavicular and brachial plexus region are related to the Kakshadhara Marmasthana.

Discussion on Marmavasthu

Mamsavastu: Acharya Sushruta has described 10 Peshi in Kaksha region. The sub clavicular and shoulder regions were dissected and observed the muscles and other structures. The following muscles were studied and identified.

  • Pectoralis Major and minor
  • Deltoid
  • Coracobrachialis
  • Bicep brachii
  • Subscapularis
  • Trapezius
  • Supraspinatus
  • Infraspinatus
  • Teres major and minor
  • Tricep brachii

These 10 muscles may be correlated with the concept of Sushrutacharya.

Siravasthu: Acharya Sushruta explains that Siras are present in the Marma they nourish ligaments, bones, muscles and the joints. The following blood vessels were observed in the Marmasthana.

Superior thoracic artery, lateral thoracic artery, thoracoacromial artery, thoracodorsal artery, anterior and posterior circumflex humeral artery. Axillary vein brachial vein, cephalic vein, subclavian vein, suprascapular artery, superficial cervical artery. These blood vessels may be compared with Sira present in Marmasthana.

Snayu: Acharya Sushruta explains the Snayu present in the Shakha and Sarva Sandhi Pradesh is Pratanavati Snayu which spread like a network. so, this may be compared with nerves of brachial plexus which passes through the Kaksha Sandhi or shoulder joint to supply the upper extremities.

Following nerves of the brachial plexus are observed in the subclavicular and shoulder region related to the Marmasthana.

  • Cords of the brachial plexus.
  • Cutaneous branches from axillary nerve.
  • Axillary nerve.
  • Medial and lateral pectoral nerve
  • Median nerve.

According to the modern explanation following ligaments are found during dissection.

  • Superior, middle & inferior glenohumeral ligaments.
  • Coracoacromial ligament.
  • Capsular ligament.
  • Acromioclavicular ligament
  • Transverse humeral ligament.

The fascia that has been observed are deep fascia covering deltoid, Subscapular fascia, clavipectoral fascia. Since Snayu does the Angabhandhan these ligaments and fascia may be compared with the Snayu in the Marmasthana.

Asthi and Sandhi: Acharya Sushruta said that one Asthi is present in Bahu and two in the Amsa phalaka this results in Kaksha sandhi (Shoulder joint). It is a form of the Ulukala Sandhi. According to the modern, articular parts of the humerus scapula and clavicle are observed as the bony parts and the joint formed is Glenohumeral joint which is ball and socket variety of synovial joint. The bony parts are considered as the Asthi in the Marmasthana and glenohumeral joint may be considered as Sandhi in the Marmasthana.



Journal of Ayurveda and Integrated Medical Sciences 2022;7(6)124
Mangalore V et al: Anatomical Interpretation of Kakshadhara Marma

Discussion on Pramana: The measurement of each Marma has been explained in term of definite Pramana in Samhitas. The Pramana of Kakshadhara Marma has been explained as one Angula. It is area occupied by the Marma in terms of own finger’s breath (Svanguli). Acharya Sushruta while explaining about Pramana of Kakshadhara he explained just as one Angula Pramana. Without much explanation about its upper limit and lower limit of the site of the Marma and also regarding length, breadth and depth of the Marma. So here one Angula Pramana is considered equally as length, breadth or as diameter present in the Kaksha region. This helps to determine the location and to assess the structures present in and around the Marma.

Discussion on Marma Viddha Lakshana

The prognosis of the injury depends upon the site of injury, depth of injury, force at which the injury caused. However, the site and structures are involved are the factor which discriminate the severity of the injury.

As per Rachananusara the Kakshadhara Marma is a Snayu Marma according to Sushruta and Sira Marma according to Vagbhata. Based on Viddha Lakshana it is Vaikalyakara Marma. The Snayu Marma Viddha Lakshanas are Ayaama, Akshepaka, Stambha, excessive Ruja in Snayu. Vaikalyatha in Anga. In case of Kakshadhara Marmaviddha the symptom explained is Pakshaghata.

Acharya Sushruta explains that if the injury occurs to the surrounding of Sadyah Pranahara Marma leads to the effect of Kalantara Pranahara Marma. Similarly, an injury to Kalantara Pranahara Marma leads to the effect of Vaikalyakara Marma. Similarly, Vaishalyaghna leads to Vaikalyakara, Vaikalyakara leads to Rujakara effect and Rujakara may not cause severe pain. Acharya Dalhana commented on this as Antheviddha Lakshana of Sushruta.

Based on this since Kakshadhara Marma is Vaikalyakara Marma, whenever injury occurs to the surrounding or peripheral parts of the Marma, effect of Rujakara Marma is observed. symptoms such as severe pain due to which reduced/ altered movements are observed in these conditions.

Acharya Sushruta explains Pratanavati Snayu are network like structures which are present in Shakha and Sandhi Pradesh. Kakshadhara

Marma is situated in Bahumula at Urdhwa Shakha and in Kaksha Sandhi. So, specifically predominance of Snayu Marma at the Kakshadhara Marma Pradesh is Pratanavati Snayu. This may be compared with the Brachial plexus which branch like a network to supply the upper arm and forearm. Whenever an injury occurs to nerves of brachial plexus, the affected parts are situated in between Vaksha and Kaksha region. At this site Acharya Sushruta have stated the site of Kakshadhara Marma. So, whenever an injury occurs to nerves of brachial plexus it results in reduced/ loss of functions of upper arm. Which results in paralysis of affected arm. Which may be compared with Viddha lakshana of Kakshadhara Marma i.e., Pakshaghata.

Any injury structures which are related to Kakshadhara Marma such as compression of the trunk of brachial plexus in aneurysm of axillary artery. Injury to the upper trunk of brachial plexus i.e., Erb’s paralysis. Injury to the lower trunk of Brachial plexus i.e., Klumpke’s paralysis. Axillary nerve injury due to shoulder dislocation, musculocutaneous nerve injury may lead to the following impairments inability of flexion of elbow and depression of shoulder joint. Nerve injury may lead to paralysis and wasting of the muscles of the arm.

The Snayu’s may also be compared with ligaments in relation to the Marmasthana, ligaments observed in this Marmasthana are glenohumeral ligaments, coracoacromial ligament, coracoclavicular ligaments the transverse humeral ligament injury to these ligaments will lead to the disability of the joint. Further these ligaments are also innervated by nerves of brachial plexus.

Acharya Vagbhata highlights importance of Sira in Kakshadhara Marmasthana. The blood vessels such as axillary artery and its branches, axillary vein which accompany the brachial plexus during their course. Injury to these structures results in loss of blood supply and lack of blood and nerve supply to the muscles of the arm results in disability of the arm. The disability of arm in all these occasions refers to Pakshaghata in Ayurveda.

Conclusion

From the above description we can conclude that Kakshadhara Marma can be compared with brachial plexus.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(6)125
Mangalore V et al: Anatomical Interpretation of Kakshadhara Marma

Injury to these may lead to paralysis of upper extremity. Hence, it is considered under Vaikalyakara Marma. These Marma have abundance of Snayu that’s why considered under Snayu Marma by the Acharyas. If the injury occurs directly on Kakshadhara Marma Sthana it results in Pakshaghata, in less severe condition or if injury takes place surrounding of Kakshadhara Marma Pradesh, based on Antheviddha Lakshana of Sushruta effect of Rujakara Marma is observed. Due to excessive Ruja there is altered movements and disability of the arm.

jaims_1885_01.JPG

Reference

1. Sushruta, Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. Varanasi: Chaukhambha Samskrit Pratishtana; 2013. p371.

2. Sushruta, Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibhandha Sangraha of Dalhanacharya.Varanasi: Chaukhambha Samskrit Pratishtana;2013. p370.

3. Sushruta, Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibhandha Sangraha of Dalhanacharya.Varanasi: Chaukhambha Samskrit Pratishtana;2013. p372.

4. Vagbhata, Pt Hari Sadasiva Sastri Paradakara, editor. Asthangahrudaya of vagbhata with sarvangasundari of Arunadatta. Pune: Chaukhamba Sanskrit Sansthan. p413.

5. Sushruta, Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. Varanasi: Chaukhambha Samskrit Pratishtana; 2013. p373.

6. Sushruta, Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. Varanasi: Chaukhambha Samskrit Pratishtana; 2013. p373.

7. Sushruta, Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. Varanasi: Chaukhambha Samskrit Pratishtana; 2013. p367.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(6)126