E-ISSN:2456-3110

Case Report

Insomnia

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

Role of Marma Chikitsa in the management of Anidra (Insomnia) - A Single Case Study

Chouhan A1*, Marwaha R2, Gupta P3, Bhalerao N4, Kumar Chourasia S5
DOI:10.21760/jaims.9.4.44

1* Aayushi Chouhan, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

2 Rita Marwaha, Professor HOD, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

3 Pankaj Gupta, Associate Professor, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

4 Nisha Bhalerao, Associate Professor, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

5 Swatantra Kumar Chourasia, Assistant Professor, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

Marma is the vital area of the body. The word Marma comes from the Sanskrit origin word ‘Mri’ meaning death. The Sanskrit phrase ‘Marayanti Iti Marmani’, also means death or serious damage to the body or health after infliction to the point of their situation. Hence these areas are called Marma. Marma Chikitsa focuses on energizing the body to relieve occupational illness and stress-related diseases. Hence the complete knowledge of the basic principles of Marma and its clinical application can play an important role in treatment modalities. Ahara, Nidra, and Brahmacharya are the three factors that play an important role in the maintenance of a living organism. This study focuses on the effectiveness of Marma Chikitsa on Anidra. A 40-year-old female came to the OPD of Pt. Khushilal Sharma Government Ayurvedic College and Hospital, Bhopal (MP) with a complaint of disturbances in the sleep-wake cycle. In this case study effect of Marma Chikitsa in the management of Anidra (insomnia) is evaluated. The patient was treated with Marma Chikitsa for 10 days. The study suggested that Marma Chikitsa may be used for relieving symptoms of Anidra; however, a study on a large population was suggested.

Keywords: Anidra, Marma, Nidra, Insomnia

Corresponding Author How to Cite this Article To Browse
Aayushi Chouhan, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.
Email: 		Chouhan A, Marwaha R, Gupta P, Bhalerao N, Kumar Chourasia S, Role of Marma Chikitsa in the management of Anidra (Insomnia) - A Single Case Study. J Ayu Int Med Sci. 2024;9(4):275-278.
Available From
https://jaims.in/jaims/article/view/3203

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-14 2024-02-24 2024-03-04 2024-03-14 2024-03-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 19.20

© 2024by Chouhan A, Marwaha R, Gupta P, Bhalerao N, Kumar Chourasia Sand 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].

J Ayu Int Med Sci 2024;9(4)275
Aayushi Chouhan et al. Role of Marma Chikitsa in the management of Anidra (Insomnia)

Introduction

Ahara, Nidra, and Brahmacharya are the three factors that play an important role in the maintenance of a living organism. In Ayurvedic literature, these factors i.e. Ahara (diet), Nidra (sleep), and Brahmacharya (celibacy) have been compared with the three legs of sub-support and have been termed as the three Upastambhas.[1] According to Acharya Kashyapa, getting good sleep at the proper time is one of the characteristics of a healthy man.[2] Thus, Nidra is a harmonious feature gifted by nature. The man of this techno-world is trying to get overcome such harmonious features by elaborating on his mental dimensions. But the biological clock which is mandatory for the well-being of human life’s rhythm, is not ready to recognize these upsetting created by him. If once this harmony is violated, of course, health as well as sleep of a person will be hampered, because sleep exactly runs according to the biological clock. That’s why Ayurveda stresses sleep and describes it as one of the primary tripods of life.[3] Charaka has described Anidra as one of the Vataja Nanatmaja Vikara.[4] Various psychic traits like anger, fear, worry, anxiety, etc. are responsible for the vitiation of Doshas and cause Anidra (Insomnia). Insomnia has a great impact on the social, occupational, and other functioning areas of the individual. Sleep is the periodic state of rest in which there is a diminution of consciousness and activity is termed as sleep.[5]

Case Study

A 40-year-old female Patient School teacher by profession consulted in the outpatient department of Pt. Khushilal Sharma Government Ayurvedic College and Hospital, Bhopal (MP) with a complaint of inability to sleep well for more than 2 years. She regularly goes to bed at 11 pm but is unable to sleep the whole night. She experiences about 4-5 awakenings every night and with each awakening, unable to sleep again.

History of Past Illness - No previous sleep problem

Physical Examination

Mental, neurologic, and physical examination was within normal limits, except for a body mass index of 31 and a blood pressure of 135/92 mm Hg.

Treatment Protocol[6]

The treatment involved the administration of Marma Chikitsa. The present study includes stimulation of 4 Marma points that is Talhridaya Marma Sthapani Marma, Apanga Marma, Seemant Marma these will be stimulated 15 -18 times on average in a single sitting.[3] The details of the administration are as follows.

Duration of study - 10 days
Follow up - 7th day

Table 1: Treatment Protocol

SNMarma NameStimulation TimeFrequencyDuration
1.Talhridaya Marma0.8 sec15-18 TimesTwice a day
2.Sthapani Marma0.8 sec15-18 TimesTwice a day
3.Apanga Marma0.8 sec15-18 TimesTwice a day
4.Seemant Marma0.8 sec15-18 TimesTwice a day

Technique of stimulation of Marma[7]

Talhridaya Marma - Tal means palmar aspect of hand and Hridya means centre so essentially the Marma present at the centre of the palm is termed as Tala Hridaya Marma. Now start touching the palmar aspect of your hand by folding all the fingers, except middle one unfold all other. The point where pulp of finger touches the hand is called as Tal Hridaya Marma. Stimulate this Marma 15-18 times by applying pressure on it, this will surely help you to get rid of insomnia.

Sthapani Marma - The Marma present at Sthapani i.e., the space between the eyebrows where Agya Chakra or third eye exists is designated as Sthapani Marma. Now join your palms and fix fingers of right hand in the web of left hand by keeping both the thumbs straight to make a fist and apply pressure on Sthapani Marma with the base of first metacarpal bone (root of thumbs) which relaxes you.

Apanga Marma -Place your index fingers on the root of eyebrows so that you can easily discover the midpoint of bridge of nose and start massaging the pathway of brows till you reach their outer corners or depressed part of the temples which are just of the size of pulp of index fingers, this specific point is Apanga Marma. Press it 15-18 times to obtain its positive effects.

Seemant Marma - Seemant Marma is present on the skull and is mainly correlated with different sutures such as coronal suture, sagittal suture and lambdoid suture.


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Aayushi Chouhan et al. Role of Marma Chikitsa in the management of Anidra (Insomnia)

a) Place horizontally four fingers of your hand above the bridge of the nose so that it should meet the base of the hairline apply moderate pressure on it. This particular point is Seemant Marma on coronal suture.

b) Place hypothenar area of right hand at the root of nose and stretch your fingers upwards in the partition of hairline, the point where middle finger reach is Seemant Marma on sagittal suture.

c) Situate the base of your both hands at the nape of your neck and the place where your fingers reached is lambdoid suture. Now press this point gently to abolish your headache.

Criteria for assessment

Based on improvement in sign & symptoms reported by the patients, was assessed on the basis of score developed for grading these clinical factors followed by statistical analysis.

Scoring adopted for insomnia

1. Sleeplessness

SNSleeplessnessGrade
1.No complaint0
2.Patient gets sleep at night or awakens early in the morning1
3.Sleep is full of dreams or sleep disturbs due to any other reason during night.2
4.Sleep disturbs at midnight due to any reason and does not get sleep afterwards3
5.Patient doesn’t get sleep after resting in day time/gets sleep late at night and awakens early in the morning4
6.Gets sleep after taking sedatives5
7.Doesn’t get sleep at all

2. Disorders of Sleep-Wake (S-W) Schedule

SNDisorders of Sleep-Wake (S-W) ScheduleGrade
1.Normal (s-w) schedule0
2.Transient change1
3.Frequently changing2
4.Delayed sleep phase3
5.Irregular (s-w) pattern4
6.Non-24 hours (s-w) syndrome5

3. Sleep Quality

SNSleep QualityGrade
1Enjoyable sleep0
2Anxious or agitated before and during sleep1
3Feeling un-freshed and unrest after sleep2
4.Sleep experience negative and not enjoyable3

4. Sleep Time

SNSleep TimeGrade
1.Adequate sleep (6 – 8 hours)0
2.Inadequate night sleep (4 – 5 hours) with ½ to 1 hour day nap1
3.Inadequate night sleep (4 – 5 hours) without day nap2
4.Inadequate night sleep (2 – 3 hours)3
5.Gets 1 – 2 hours night sleep with or without day nap4
6.No sleep at night but gets 1 – 2 hours day nap5
7.No sleep at all6

5. After Awakening

SNAfter AwakeningGrade
1.Fresh (Sukhavabodhana)0
2.Sleepy or fatigued1
3.Poor concentration2
4.Poor problem solving3

6. Associated complaints like Akshigaurav, Shirogaurav, Alasya, Jrimbha, Angamarda, Glani, Bhrama, Ajirna, Kshudamanda

SNAssociated complaintsGrade
1.Mild degree (Occasional complaints)1
2.Moderate degree (once or twice in 2 – 3 days)2
3.Severe degree (daily complaints) - 33

Observation

Diagnostic criteriaBefore treatmentAfter treatment
SleeplessnessGrade 5Grade 2
Sleep-Wake (S-W) ScheduleGrade 4Grade 0
Sleep QualityGrade 3Grade 0
Sleep TimeGrade 4Grade 0
After AwakeningGrade 3Grade 1
Associated complaints like Akshigaurav, Shirogaurav, Alasya, Jrimbha, Angamarda, Glani, Bhrama, Ajirna, Kshudamanda etc.Grade 3Grade 1

Discussion

The demanding workload and fast-paced lifestyle, combined with improper dietary habits, can lead to numerous health issues, especially disorders caused by vitiation of Vata known as Vatavyadhi. The practice of Marma Chikitsa can help improve sleep-wake cycle. In a study, participant underwent ten days of Marma Chikitsa treatment which resulted in significant improvements in their symptoms. After the first sitting of Marma Chikitsa, improvement begins and by the tenth day, participants are completely free of their symptoms.


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Aayushi Chouhan et al. Role of Marma Chikitsa in the management of Anidra (Insomnia)

Conclusion

The case report shows significant relief in signs and symptoms within 10 days This indicates that Marma Chikitsa is a prompt and non-pharmaceutical method of treatment that provides immediate pain relief to the patient. These methods are absolutely applicable in our present century and prove to be very beneficial for everyone. Especially Marma Chikitsa i.e., stimulating Marma points pop out your hidden power to give promising results to cure insomnia. Marma Chikitsa is an easy, effortless, effective therapy.

References

1. Agnivesa, Charaka Samhita, Acharya Jadavji Trikamji, Chowkhmbha publication, 2001, Varanasi.Ch.Su. 11/35.

2. Kashyap Samhita, edited by Shri Satyapal Bhishagacharya with hindi commentary Vidyotini, Reprint edition, Choukhmbha Sanskrit Series, Varanasi, khila sthana5/7.

3. Agnivesa, Charaka Samhita, Acharya Jadavji Trikamji, Chowkhmbha publication, 2001, Varanasi.Ch.Su. 11/35.

4. Agnivesa, Charaka Samhita, Acharya Jadavji Trikamji, Chowkhmbha publication, 2001, Varanasi.Ch.Su. 20/11.

5. Blacktons Newgold Medical Dictionary.

6. Joshi SK. Marma Science and Principles of Marma Therapy. 1st ed. Delhi: Vani Publications; 2010. ISBN: 8189221-64-7.

7. Joshi SK. Marma Science and Principles of Marma Therapy. 1st ed. Delhi: Vani Publications; 2010. ISBN: 8189221-64-7.


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