E-ISSN:2456-3110

Case Report

Cadaveric Study

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

Amsaphalaka Marma - A Cadaveric Study

V Kori O1*, Thomas A2
DOI:10.21760/jaims.9.5.38

1* Omkumar V Kori, Post Graduate Scholar, Department of Sharira Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda Kuthpady, Udupi, Karnataka, India.

2 Anju Thomas, Associate Professor, Department of Sharira Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda Kuthpady, Udupi, Karnataka, India.

There are total of 107 Marma which are vital points where there is a Sannipata of Mamsa, Sira, Snayu, Asthi, Sandhi along with the Prana resides. Among them Amsaphalaka Marma is Prusthagata Asthi Marma, two in number and Vaikalyakara type of Marma, located on Pristhavansa Ubhaya to (both side of vertebral column) and is related to Trika. Trauma to Amsaphalaka Marma results in Baahuswapa and Shosha. Here Marmabhighata Lakshan can act as predictors of the structures involved. In this study, an attempt is made to find out exact location of Amsaphalaka Marma and its relations with other anatomical structures with the help of cadaveric dissection. The study concludes that the location of Amsaphalaka Marma may be considered as just above the superior border of the spine of the scapula on either side of the vertebral column.

Keywords: Marma, Amsaphalaka, Baahuswapa, Shosha, Trika

Corresponding Author How to Cite this Article To Browse
Omkumar V Kori, Post Graduate Scholar, Department of Sharira Rachana, Shri Dharmasthala Manjunatheshwara College of Ayurveda Kuthpady, Udupi, Karnataka, India.
Email: 		V Kori O, Thomas A, Amsaphalaka Marma - A Cadaveric Study. J Ayu Int Med Sci. 2024;9(5):228-232.
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https://jaims.in/jaims/article/view/3225

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-17 2024-03-27 2024-04-06 2024-04-15 2024-04-22
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© 2024by V Kori O, Thomas Aand 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].

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Omkumar V Kori et al. Amsaphalaka Marma - A Cadaveric Study

Introduction

The term breath is emphasized in equivalence to the subtle life force energy for the existence of mankind. This vital energy is termed as prana, which paves way in understanding different structures in the human body. Term Atma Swaroopa is coined for prana due to existence all over. Concept of Marma was first introduced in Samhita Kala. There are 107 Marma[1] described, as these are the Sannipata of Mamsa, Sira, Snayu, Asthi, Sandi where Prana resides.[2] These are classified into 5 variety on the basis of predominant of structure involved, effect of injury, location on the body[3] and also detail about the each Marmabhighata

Lakshana[4] are explained.

Totally 8 Asthi Marma are explained in classics and accepted by various authors unanimously irrespective of any discrimination as evident in other types of Marma which quotes its uniqueness.

Table 1: Classification of Marma based on structure[5,6,7]

MarmaSushrutaVagbhataBhavaprakasha
Mamsa Marma111011
Sira Marma413747
Snayu Marma27-21
Asthi Marma888
Sandhi Marma202020
Dhamani Marma-9-
Total107107107

Amsaphalaka is Asthi Marma and 2 in number, Ardha Angula[8] in Pramana and Vailakyakara.

Materials and Methods

The study has been conducted in two parts:

1. Conceptual study - Classical literature, modern literature, books, thesis, journal articles, and internet materials were reviewed and related information and references were collected and analyzed scientifically to determine the location and anatomical aspects of Amsaphalaka Marma.

2. Cadaveric study - A thorough dissection of shoulder region and back was carried out on embalmed human male cadavers in the dissection hall of Rachana Sharira department and anatomical structures found in this region was confirmed.

Conceptual Study

Etymology

The word Amsaphalaka is formed by the union of the two words i.e., Amsa and Phalaka.

Amsa - अंस् + अच् = अंस

The Word Amsa means Skandha (shoulder)

Phalaka – Nirukti of word Phalaka is “Asthikhandam Iti’’

Table 2: Asthi Marmas[9]

MarmaSushrutaVagbhata
Katikataruna22
Nitamba22
Amsaphalaka22
Shanka22

Location

Amsaphalaka Marmas are located one on either side of the upper part of the Prushta Vamsha (vertebral column).[10]

It is Prustagata Asthi Marma, Vaikalyakara and Ardha Angula in Pramana[11]

They are located in the region of Trika, injury of which causes Bahuswapa and Shosha.[12]

Cadaveric Study

The dissection of back was carried out on human male cadaver by following the guidelines of BD Chaurasia and Cunningham’s practical anatomy.[13,14]

The cadaveric study was carried out as follows

Cadaver was placed in prone position. First Trika region was identified and marked by drawing one line from the Acromioclavicular joint of right side to the left side and a vertical line was drawn from the external occipital protuberance towards the previous line where it intersects with each other.

Region of Amsa Phalaka Marma was marked on scapular region on the line extending laterally from Trika which lies on suprascapular fossa nearer to the medial border of scapula. The Marma point was marked as Ardha Angula Parivistara Pramana (0.9cm) on both the sides of vertebral column and the skin was removed layer by layer gently.


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Omkumar V Kori et al. Amsaphalaka Marma - A Cadaveric Study

The anatomical structures superficial to deep were noted as follows

1. Trapezius muscle

2. Supraspinatus muscle

3. Supraspinous fossa of scapula

4. Suprascapular nerve

jaims_3225_01.JPG
Fig. 1: location of Amsaphalaka Marma
jaims_3225_02.JPG
Fig. 2: Trapezius muscle
jaims_3225_03.JPG
Fig. 3: Dorsal aspect of scapula
jaims_3225_04.JPG
Fig. 4: Suprascapular nerves and vessels with muscles

Discussion

Discussion on location: Amsaphalaka is Prustagata Asthi Marma associated with Trika. Acharya Sushruta stated that the Marma situated in upper part of the Prishtha (back) on both sides of Prishthavansha (vertebral column) and attached or near to Trika are known as Amsaphalaka Marma.

According to Prof. D. G. Thatte, scapular region and supra scapular nerve are representative of Amsa Phalaka Marma injury of which are responsible for atrophy and loss of sensation in the upper extremities.

The following structure found at the site of Amsaphalaka Marma - scapula bone,[15,16] spine of scapula,[17,18] supraspinous fossa,[19] suprascapular nerve[20] and vessel,[21] supraspinatus muscle, trapezius muscle[22]


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Discussion on Marma Vastu

  • Asthi - Supraspinous fossa of scapula.
  • Mamsa - supraspinatus muscle.
  • Sira - suprascapular vessels.
  • Snayu - suprascapular nerve.

Discussion on Marma Pramana

The measurement of Marma is about 0.9cm on either sides of the vertebral column at the supra scapular fossa near the medial border of scapula.

Discussion on Marma Viddha Lakshana

Injury to this Marma cause Swapa[23,24] [numbness] and Shosha[25] [wasting] of the upper extremity.

Numbness and wasting of the arm are usually caused by damage or compression of the suprascapular nerve passing through spinoglenoid notch. Injury to suprascapular nerve causes the wasting of supraspinatus and infraspinatus muscles. Main complaints are pain, weakness in shoulder, numbness in the arm and wasting in the arm.[26]

  • The injury to the spinal accessory nerve[27] leads to severe wasting of trapezius which can lead to drooping of the shoulder, weakness, numbness and wasting in the arm.
  • Injury at the site of spine of the scapula will damage the structure around it. Trauma at this site will cause damage to the suprascapular artery[28] which leads to massive hemorrhage and intraluminal thrombosis that will disrupt blood circulation to the supraspinatus and infraspinatus muscles and cause wasting of muscles, which subsequently causes numbness and wasting of the arm.
  • If foreign body penetrate deeper parts – severe damage to brachial plexus which will lead to paralysis of upper extremity.
  • Moderate damage of these nerves and vessels causes numbness and wasting[29]
  • If foreign body penetrates superficial parts - damage to suprascapular nerves and artery which results in paralysis of abductor muscles (supraspinatus, deltoid, serratus anterior, trapezius) of the shoulder joint along with wasting of the same.

Conclusion

Marma are the physio-anatomical vital areas of the body in which Mamsa, Sira, Snayu, Asthi, Sandhi, Dhamani unite and where the prana resides. Injury to these vital areas leads to Marana or Marana Sadrushya Vedana. Based on the literary and cadaveric studies, it has been concluded that the Amsaphalaka Marma can be considered as the region of supraspinous fossa nearer to the medial border of scapula on either side of the vertebral column which has a measurement of about 0.9cm. Based on Vidhha Lakshana Baahuswapa can be considered as numbness of the arm and Bahushosha as wasting of the arm. Baahuswapa and Bahushosha can be claimed as deformities which uphold Amsaphalaka Marma as Vaikalyakara Marma. Hence it seems appropriate to consider Amsaphalaka as a Prustagata Asthi Marma of Ardha Angula Pramana and Vaikalyakara type of Marma.

References

1. Patil VC, NM Rajeshwari, Editor, 1st edition, English translation on nibhanda sangraha commentry of dalhana on sushruta samhita, sharira sthana, pratyaksha marma nidresha shareera, chapter 6, verse 15, Varanasi, chaukhamba sankrit santhana,2018; 199

2. Patil VC, NM Rajeshwari, Editor, 1st edition, English translation on nibhanda sangraha commentry of dalhana on sushruta samhita, sharira sthana, pratyaksha marma nidresha shareera, chapter 6, verse 3, Varanasi, chaukhamba sankrit santhana, 2018; 194

3. Acharya Y T, Editor, commentary Ayurveda deepika of chakrapani datta on charaka samhita by agnivesha and revised by charaka and dridabala, siddi sthana, trimarmiya siddi adyaya, chapter 9, verse 3, Varanasi, chaukambika orientalia, 2011; 716

4. Vidya B H P, Editor, 10th Edition, commentary sarvanga sundara of arunadatta and commentary ayurveda rasayana of hemadri of astanga hrudaya of vagbhata, shareera sthana, marma vubhaga shareeram adhyaya, chapter 4, verse 40, Varanasi, chaukambika orientalia, 2005; 413

5. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika


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Omkumar V Kori et al. Amsaphalaka Marma - A Cadaveric Study

panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 370

6. Vidya B H P, Editor, 10th Edition, commentary sarvanga sundara of arunadatta and commentary ayurveda rasayana of hemadri of astanga hrudaya of vagbhata, shareera sthana, marma vibhaga shareeram adhyaya, chapter 4, verse 40, Varanasi, chaukambika orientalia, 2005; 413

7. Bhavamishra, Bhava prakasha, 8th Edition, part 1with hindi commentary by pandit sri.brahma Shankar mishra, edited by pandit sri.brahma Shankar mishra, , Varanasi, chaukambika sankrit santhana, 2003; 66

8. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 371

9. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 372

10. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 26, Varanasi, cahukambika orientalia, 2007; 384

11. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 26, Varanasi, cahukambika orientalia, 2007; 384

12. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 26, Varanasi, cahukambika orientalia, 2007; 374

13. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 819

14. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 820

15. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 822

16. uams.org

17. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 846

18. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 847

19. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 849

20. wikipedia.com

21. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 845

22. Rogerwick P L W, Editor, 39th edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 847

23. Vidya B H P, Editor, 9 th Edition, commentary sarvanga sundara of arunadatta and commentary ayurveda rasayana of hemadri of astanga hrudaya of vagbhata, shareera sthana, marma vibhaga shareeram adhyaya, chapter 4, verse 42, Varanasi, chaukambika orientalia, 2005,414

24. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 371

25. Acharya Y T, 9th Edition, commentary of sri dalhanacharya and commentary nyaya chandrika panjika of sri gayadasacharya, on sushruta samhita of sushruta, shareera sthana, pratyeka marma nidresha shareera, chapter 6, verse 5, Varanasi, cahukambika orientalia, 2007; 371

26. Rogerwick P L W, Editor, 39th Edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 811.

27. medical dictionary.com


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28. Rogerwick P L W, Editor, 39th Edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 844

29. Rogerwick P L W, Editor, 39th Edition, grays anatomy, medical division landongroups limited, Great Britain, churchil, livingstone, 1989, 801


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