E-ISSN:2456-3110

Research Article

Marma

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 8 September
Publisherwww.maharshicharaka.in

A comprehensive study on Regional Anatomy of Adho Shaakhaagata Maamsa Marma by Cadaver Dissection and their Applied Anatomy

H Savanur R.1*, Kumar N.2, Rashmi N.3
DOI: http://dx.doi.org/10.21760/jaims.7.8.2

1* Rajath H Savanur, Post Graduate Scholar, Department of PG Studies in Shareera Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Udupi, Karnataka, India.

2 Nithin Kumar, Guide, Associate Professor, Department of PG Studies in Shareera Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Udupi, Karnataka, India.

3 NR Rashmi, Co-Guide, Assistant Professor, Department of PG Studies in Shareera Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Udupi, Karnataka, India.

Marma is the meeting point where Mamsa, Sira, Snayu, Asthi and Sandhi along with Prana resides which on injury produce death or death like miseries. Maamsa Marma is one such category based on predominant Marma Vasthu. They are eleven in number. Among them four are present in Adho Shakhaa i.e., two Talahrudaya and two Indrabasthi. Talahrudaya Marma is located in the middle of Paada in the line of middle finger, which on injury causes Ruja and Marana. Indrbasthi Marma is located in the middle of Janghain the side of Paarshni and it causes death due to Shonitha Kshaya. Both of them are Kaalantarapraanahara Marmas. Methods: Literature regarding Marma and its Viddhalakshana were collected from various sources and its Viddha Lakshanas are analysed scientifically. Anatomical structures found in the region of Adhoshakhaagata Maamsa Marmas were confirmed with the help of cadaveric dissection in five bodies. Results: Muscles of 1st, 2nd, 3rd and 4th, layer of the sole, Medial & lateral plantar nerves, deep plantar arch, shielded by thick layer of skin, superficial facia and plantar aponeurosis are the important structures present in the Talahrudaya Marma Sthaana. Superficial & deep calf muscles, posterior tibial vessels, peroneal vessels, tibial nerve and short saphenous nerve are the important structures present in the Indrabasthi Marma Pradesha. The Viddha Lakshanas are analyzed with applied aspects of these regions. Conclusion: Centre of the sole along the line of middle finger can be considered as the region of Talahrudaya Marma which on injury results in Ruja & Marana. Indrabasthi Marma is located in the middle of the Jangha (calf) in the side of Paarshni (heel) about 12 Angula above heel, which on injury results in Shonitha Kshaya & Marana.

Keywords: Marma, Talahrudaya, Indrabasthi, Maamsa

Corresponding Author How to Cite this Article To Browse
Rajath H Savanur, Post Graduate Scholar, Department of PG Studies in Shareera Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Udupi, Karnataka, India.
Email: 		Rajath H Savanur, Nithin Kumar, NR Rashmi, A comprehensive study on Regional Anatomy of Adho Shaakhaagata Maamsa Marma by Cadaver Dissection and their Applied Anatomy. J Ayu Int Med Sci. 2022;7(8):8-12.
Available From
https://www.jaims.in/jaims/article/view/2022

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-07-30 2022-08-01 2022-08-08 2022-08-15 2022-08-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Rajath H Savanur, Nithin Kumar, NR Rashmiand 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(8)8
Savanur R et al: Regional Anatomy Adho Shaakhaagata Maamsa Marma Cadaver Dissection

Introduction

The science of Marma was more developed in war fields, as enemies were targeted by hitting arrow in vital areas by the warriors. Knowledge of Marma is being adapted in field of health, spiritual practices, wound management and diseases.

Marma is a vital spot where Maamsa, Sira, Snayu, Asthi, Sandhi along with Prana unites. Marma on injury produces death or death like miseries.[1] Acharya Sushruta gave detailed information of Marmas by classifying them based on location, predominant Marmavasthu, Pramana, effect on injury.[2]

Based on predominant Marmavasthu, Marmas are classified into Maamsa, Sira, Snayu, Asthi and Sandhi Marmas.[3] Maamsa Marmas are 11 in number[4] and among them Talahrudaya and Indrabasthi Marma are located in Adhoshaakha.

Adhoshaakha is one among Shadanga which helps in the locomotion, postural balance, as well as for bearing weight and it is an area which is more prone for injury while walking, sports, war etc. Hence it is highly essential to have an idea about vital spots present in Adhoshaakha.

In this study an effort is made to study the regional anatomy of Adhoshaakhagata Maamsa Marma with the help of cadaver dissection and their Viddha Lakshanas based on clinical anatomy for their better understanding.

Aims and Objectives

1. To study the literature on Adhoshaakhagata Maamsa Marma and their applied anatomy.

2. To identify the regional anatomy of Adhoshaakhagata Maamsa Marma by cadaver dissection.

Materials and Methods

Literature regarding Adhoshaakhagata Maamsa Marma was collected from various books, journals, previous work done and it was analyzed scientifically. Anatomical structures found in the region of Adhoshaakhagata Maamsa Marma were identified with the help of cadaver dissection in five bodies. Photographs were collected. The observations were then correlated with Ayurvedic and contemporary views.

Assessment Criteria

Regional anatomy and Viddha Lakshanas of Adhoshaakhagata Maamsa Marma were studied with the help of cadaver dissection and literature study.

Observation

The dissection of Adhoshaakhagata Maamsa Marma has been carried out in 5 cadavers as per the Cunningham’s manual of practical. Dissection procedure was carried out layer by layer, and the structures were observed and studied thoroughly.

Location of Talahrudaya Marma and Location of Indrabasthi Marma

Talahrudaya Marma[5]

jaims_2022_01.JPG

Fig. 1: Talahrudaya Marma

The plantar aspect of the middle of the foot was dissected in the region of Talahrudaya Marma layer by layer and the following observations were made superficial to deep. Skin, Superficial facia, Plantar aponeurosis, Flexor Digitorum Brevis, Medial Plantar Nerve, Lateral Plantar Nerve, Flexor Digitorum Longus, Flexor Digitorum Accessories, Oblique Head of Adductor Hallucis, Deep Plantar Arch and Tendon of Peroneus Longus.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)9
Savanur R et al: Regional Anatomy Adho Shaakhaagata Maamsa Marma Cadaver Dissection

Indrabasthi Marma[6]

The back of the leg in the region of Indrabasthi Marma region was dissected layer by layer and the following observations were made from superficial to deep. Skin, Superficial facia, Short Saphenous Vein, Sural Nerve, Deep Fascia modified to form intermuscular septa, Gastrocnemius, Soleus muscle containing venous sinusoids, Posterior tibial vessels, Tibial nerve, Flexor digitorum longus, Flexor hallucis longus and Interosseous membrane between the Tibia and Fibula.

jaims_2022_02.JPGFig. 2: Indrabasthi Marma

Discussion

Discussion on Marma

Marma is a vital point in our body where Mamsa, Sira, Snayu, Asthi, Sandhi along with Parna meet. Which on injury produce death or death like misery.

Agni, Soma, Vayu, Satva, Raja, Tama, and Bhutatma are the Prana situated in Marma Pradesha. The Satva, Raja, Tama can be considered as Mano Gunas whereas Agni, Soma, and Vayu can be considered as the Shareerika Doshas. The Bhootatma is the Atma which is present in the Deha. The injury to the Marma Sthana will vitiate

the Shareerika Doshas, which further disturbs the Manasika Gunas and finally they cause the destruction of Bhootatma resulting in Marana.

107 Marmas mentioned in the Samhitas[7] are grouped into different categories[8] based on Pramana as Ekangula Pramana, Dviangula Pramana, Triangular Pramana, Svapaanitala Pramana and Ardhangula Pramana Marma.[9] Based on predominance of Marmavasthu, they are classified as Maamsa Marma, Sira Marma, Snayu Marma, Asthi Marma and Sandhi Marma[10] On the basis of location, Marmas are grouped as Shaakhagata Marma, Udaraurogata Marma, Prushtagata Marma and Urdhwajatrugata Marma.[11]Based on effect of injury they are classified into Sadhyopranahara, Kaalantharapranahara. Vaikalyakara, Vishalyaghna and Rujakara Marma[12]

Talahrudaya Marma

Discussion on location

Talahrudaya Marma is situated in the centre of the sole in the straight line drawn from root of the middle toe or Madhyamanguli.

Pramana of Talahrudayamarma is ½ Angula.

Centre of the sole along the line of middle figure can be considered as the region of Talahrudayamarma.

Discussion on Marma Vasthu

Maamsa Marma Vasthu - flexor digitorum longus, flexor digitorum brevis, flexor digitorum accessories, oblique head of adductor hallucis, peroneus longus.

Sira Marma Vasthu - medial plantar artery, lateral plantar artery, deep plantar arch.

Snayu Marma Vasthu - medial plantar nerve, lateral plantar nerve, plantar aponeurosis.

Asthi Marma Vasthu - navicular and cuneiform bone, cuboid, metatarsal bones.

Sandhi Marma Vasthu - cuboideonavicularjoint, cuneocuboidal joint, tarsometatarsal joints.

Discussion on Marmaviddha Lakshana

As Talahrudaya Marma Sthana contains predominantly muscles, hence it can be considered as Maamsa Marma. Injury to Talahrudaya Marma causes Ruja (severe pain) and Marana.


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Savanur R et al: Regional Anatomy Adho Shaakhaagata Maamsa Marma Cadaver Dissection

The symptoms may be due to following reasons.

1. As Sira, Dhamani are spread inside the Maamsa, whenever Maamasa is injured Rakta Srava will be seen. Due to Dhathukshaya, Vataprakopa will occur which results in severe pain and Marana.

2. As muscle tissue is the best culture media for growth of bacteria, in ischemic muscle the anaerobic bacterial growth particularly clostridium can occur. It may produce severe painful condition and may be fatal as it leads to shock.

3. Traumatic shock is the shock caused by some external trauma which occurs due to damage of muscles and bones common in battlefields and road accidents. Myoglobin and some toxic substances are released from damaged muscles will damage the renal tubular cells leading to degeneration of renal tubules. Stimulation of somatic afferents from damaged muscles causes constriction of renal blood vessels resulting in renal failure.

Indrabasthi Marma

Discussion on location: Indrabasthimarma is located in calf region of leg in the side of heel. It is situated about 12 Angula from heel in calf region.

Discussion on Marma Vasthu

Mamsa Marma Vasthu - gastrocnemius muscle, soleus muscle, flexor digitorum longus, flexor hallucis longus, tibialis posterior.

Sira Marma Vasthu - Small saphenous vein, deep veins, venous sinusoids, posterior tibial artery, peroneal artery.

Snayu Marma Vasthu - tibial nerve, crural interosseous membrane

Asthi Marma Vasthu - tibia and fibula.

Sandhi Marma Vasthu - middle tibiofibular joint

Discussion on Viddha Lakshana: As Indrabasti Marma Sthana contains predominantly muscles, it can be considered as Mamsa Marma. Injury to Indrabasti Marma causes Raktakshaya and Marana.

The symptoms may be due to following reasons.

1. As Sira, Dhamani are spread inside the Maamsa, whenever Maamasa is injured Raktasrava will be seen. Due to Dhathukshaya, Vataprakopa will occur which results in severe pain and Marana.

2. Soleus is considered as peripheral heart as it contains venous sinusoids within it, which is responsible for venous blood return. Deep to soleus posterior tibial vessels are situated. When calf region is injured, there may be profuse bleeding due to the rupture of venous sinusoids or posterior tibial vessels.

3. In myositis caused by anaerobic bacteria particularly clostridium, pain, swelling, edema, and toxemia usually develops within 48 hours which may further affect adrenals and can cause hypotension and death.

4. Traumatic shock is the shock caused by some external trauma which occurs due to damage of muscles and bones common in battlefields and road accidents. Myoglobin and some toxic substances are released from damaged muscles will damage the renal tubular cells leading to degeneration of renal tubules. Stimulation of somatic afferents from damaged muscles causes constriction of renal blood vessels resulting in renal failure.

Conclusion

Marma is the meeting point where Maamsa, Sira, Snayu, Asthi, Sandhi along with Prana resides which on injury causes death or death like misery or pain. Prana here refers to the Agni, Soma, and Vayu i.e., Shareerika Doshas, Satva Raja, and Tama i.e., Manasika Gunas and Bhootatma. So, Marma is Nivasa for Shareera Doshas and Manasika Gunas which are Adhara for Bhutatma. Marma is classified into various types based on predominant Marma Vasthu, effect of injury, location and Pramana. Maamsa Marma is one such type based on predominance of Marma Vasthu. There are 11 Maamsa Marmas. Among them four are located in Adhoshaakha i.e., two Talahrudaya and two Indrabasthi (one on each limb). Centre of the sole along the line of middle finger can be considered as the region of Talahrudaya Marma. It is a ½ Angula Pramana, Kalantarapranahara Marma. Muscles of 1st, 2nd, 3rd and 4th layer of the sole, Medial & lateral plantar nerves, deep plantar arch, shielded by thick layer of skin, superficial facia and plantar aponeurosis are the important structures present in the middle of the sole. This thick shield as well as bulk of muscles justifies the reason of classifying it as Maamsa Marma. Injury to them results in Ruja & Marana as a consequence of Rakthadhatu Kshayajanya Vata Prakopa.


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Savanur R et al: Regional Anatomy Adho Shaakhaagata Maamsa Marma Cadaver Dissection

Indrabasthi Marma is located in the middle of the Jangha (calf) in the side of Parshni (heel) about 12 Angula above heel. It is a ½ Angula Pramana, Kaalantarapranahara Marma. Superficial & deep calf Muscles, posterior tibial vessels, peroneal vessels, tibial nerve and short saphenous nerve are the important structures present in the Indrabasthi Marma Pradesha. Bulk of calf muscles justifies the reason of classifying it as Maamsa Marma. Injury to these calf muscles which is considered as peripheral heart along with the vessels lying deep to these muscles results in Shonitha Kshaya & Marana.

Reference

1. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p371.

2. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p369.

3. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p369.

4. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p367.

5. B D Chaurasia’s Human Anatomy, Vol 1. 5th edition. New Delhi: CBS Publishers & Distributors Pvt Ltd; 2020,Pp466, p123-32.

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7. Agnivesa. Vaidya Yadavji Trikamji Acharya, editor. Charaka Samhita revised by Charaka and Drdhabala with Sri Chakrapanidatta Ayurvedadipika commentary in Sanskrit. 5th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2008. Pp738, p697.

8. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p369.


9. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p375.

10. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p369.

11. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p370.

12. Sushruta. Yadavji Trikamji Acharya, editor. Sushruta Samhita with Nibandha Sangraha of Dalhanacharya. 8th ed. Varanasi: Chaukhambha Orientalia; 2008. Pp824, p370


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