E-ISSN:2456-3110

Review Article

Contemporary Anatomy

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Exploring Basti as Sadhyopranahara Marma through the Lens of Contemporary Anatomy

Arpitha S1*, Nair VA2, Prasanna S3
DOI:10.21760/jaims.9.8.23

1* Arpitha S, Post Graduate Scholar, Dept of Rachana Shareera, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Vivek A Nair, Post Graduate Scholar, Dept of Ayurveda Samhitha Siddhantha, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Prasanna S, Associate Professor, Dept of Rachana Shareera, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

The concept of Marma in Ayurveda holds profound significance, representing vital points on the body where life force resides. Among these, Sadhyopranahara Marma is particularly critical, capable of causing immediate death if injured. Basti, one of the 19 Sadhyopranahara Marma, is highlighted for its unique properties and significance. This study aims to explore why Basti is classified as a Sadhyopranahara Marma, integrating classical Ayurvedic principles with contemporary anatomical understanding. The study examines the anatomical structure and functional significance of Basti. It elucidates Basti as the seat of Prana, composed of Alpa Mamsa Shonitha and surrounded by multiple Sira and Snayu. Injury to Basti can lead to severe bleeding and hemodynamic instability, ultimately resulting in death. Comparing Ayurvedic insights with modern anatomical knowledge of the urinary bladder, the study finds parallels in the understanding of injury mechanisms and fatal outcomes. Bladder trauma can lead to hemorrhage, peritonitis, organ dysfunction, and electrolyte imbalance, highlighting the critical nature of this region in both traditional and contemporary medical contexts. In conclusion, the study underscores the timeless relevance of Marma Shastra in understanding human anatomy and physiology. By elucidating the unique attributes of Basti as a Sadhyopranahara Marma, this enriches our understanding of Ayurvedic principles and their integration with modern medical practice. As we bridge the gap between tradition and innovation, the study emphasizes the holistic vision of healthcare that transcends temporal boundaries.

Keywords: Basti, Sadhyopranahara Marma, Urinary Bladder

Corresponding Author How to Cite this Article To Browse
Arpitha S, Post Graduate Scholar, Dept of Rachana Shareera, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Arpitha S, Nair VA, Prasanna S, Exploring Basti as Sadhyopranahara Marma through the Lens of Contemporary Anatomy. J Ayu Int Med Sci. 2024;9(8):157-162.
Available From
https://jaims.in/jaims/article/view/3431

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-12 2024-07-22 2024-08-02 2024-08-12 2024-08-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.34

© 2024by Arpitha S, Nair VA, Prasanna 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(8)157
Arpitha S et al. Exploring Basti as Sadhyopranahara Marma

Introduction

Marma is a structural entity where Prana resides[1], making it one of the Pranayatana, hence guarding them against damage is essential. As a Shalyatantra Pradhana Shastra, the Sushrutha Samhitha provides in-depth explanations for each of the 107 Marma points.[2] They are considered as the areas that should be avoided during surgeries by Sushruta Samhitha. Marma are vulnerable points on the human body where any form of injury might result in death or severe disability.[3] It is an area of the body that contains the five anatomical structures Mamsa (muscles), Snayu (ligaments), Asthi (bone) and Sandhi (Joints)[4] which are considered to be made up of three elements Marutha, Teja and Soma, they also include Triguna.[5] Depending on the effect of injury and its prognosis Marma points are classified into following types[6]

  • Sadhyo-Pranahara: Symptoms varies from instant death to death within 7 days.[7]
  • Kalantara Pranahara: Symptoms varies from death within 15 days to 30 days.[8]
  • Vishalyaghna: Death occurs immediately if the Shalya is withdrawn from marma location.[9]
  • Vaikalyakara: Injury will lead to deformity and pain.[10]
  • Rujakara: Injury to this Marma will lead to severe pain.[11]

Here, emphasis will be placed on Sadhyopranahara Marma as it is necessary to pay greater attention to Marma that result in instant death. Basti is one among the 19 Sadhyo-Pranahara Marma[12] and Acharya Charaka also explained Basti as one among Trimarma.[13] Hence here an effort is made to understand why Basti is regarded as one of the Sadhyo Pranahara Marma.

Objectives

  • To comprehend what constitutes a Sadhyopranahara Marma
  • To determine what defines Basti as Sadhyopranahara Marma

Materials and Methods

For the conceptual study of Basti as Sadhyopranahara Marma following materials were utilized:

  • Sushruta Samhitha
  • Charaka Samhitha
  • Textbooks of Modern Anatomy
  • Various Medical Journals

Review of Literature

Anatomy of Basti Marma as Per Classics:

Basti Marma is also called as Mutrashaya as it functions as the reservoir for urine and also this marma is considered to be the Uttama Sthana for Prana to reside. This Marma is made up of Alpa Mamsa Shonitha[14] and is completely covered by multiple Sira and Snayu.[15]

Location: Inside Kati Pradesha[16] Basti Marma measures upto 4 Angula.[17]

Anatomical relation of Basti Marma as per Sushrutha Samhita, it is surrounded by Nabhi, Prushta, Kati, Mushkha, Sthula Gudha, Vankshana and Shepha.[18]

Effect of Injury:

Any kind of injury that causes the Basti to break on both/multiple sides of the Basti, will lead to Sadhyomaranam, except to those injuries that are caused by Ashmari and also when injury is only on one side.[19]

Modern Anatomy of Urinary Bladder:

The urinary bladder is a muscular reservoir of urine, which lies in the anterior part of the pelvic cavity. The bladder varies in its size, shape and position according to the amount of urine it contains. When empty, it lies entirely within the pelvis; but as it fills it expands and extends upwards into the abdominal cavity, reaching up to the umbilicus or even higher.[20]

The urinary bladder receives its blood supply from branches of the internal iliac artery. Here is a detailed overview of the blood supply of the urinary bladder:

Arterial Supply:

  • The superior vesical arteries: These arise from the anterior division of the internal iliac artery and supply the upper part of the bladder.[21]
  • The middle vesical arteries: These also arise from the anterior division of the internal iliac artery and supply middle part of bladder.[22]

J Ayu Int Med Sci 2024;9(8)158
Arpitha S et al. Exploring Basti as Sadhyopranahara Marma
  • The inferior vesical arteries: In males, these arise from the anterior division of the internal iliac artery and supply the base of the bladder and the seminal vesicles. In females, the equivalent arteries are the vaginal arteries, which supply the base of the bladder and the vagina.[23]
  • The obturator artery: This artery may contribute small branches to supply the inferolateral aspects of the bladder.[24]

Venous Drainage:

  • The veins accompanying the arterial supply form a vesical venous plexus, which drains into the internal iliac veins.[25]

Discussion

The words Sadhyo and Pranahara make up the phrase Sadyopranahara; Sadyo means immediately, and Pranahara implies taking away Prana. Marma are regarded as Pranaadhisthana, as previously mentioned in the introduction. So, we must understand exactly what Prana is; only then can we comprehend what influences Pranaharana.

The five sense organs, Vayu, Pitta, Shleshma, Satva, Raja, Thama and Bhoothatma are together referred to as Prana.[26] Now the question arises what causes a Marma to lose its Prana instantly. We learn that the Sadyopranahara marma are the Marma points with Agni Guna predominance and that they bring death through the Ashu (rapid) Ksheenatha of Agni Guna[27], which is one among the 12- Prana mentioned prior. Agni Guna is shown to be nothing beyond the Ushma of Pancha-Pitta[28], Pancha-Bhootha[29] and Sarva-Dhathu[30], and we are also informed that Arthava and Shonitha both has Agneyatva[31] within them.

Compiling these two pieces of information in the context of Shonitha being Ashraya for Pitta reveals that Shonitha is the most important aspect that must be considered. The assertion that Chaturvidha Sira are nourishing/sustaining Snayu, Asthi, Mamsa and Sandhi provides evidence to this.[32]

Consequently, all Sadhyopranahara Marma such as Shrungataka, Adhipathi, Shankha, Ashtamatrika, Guda, Hridaya, Basti and Nabhi are ideally Agni Guna (Shonitha) Pradhana; yet, how can Basti being Alpa Mamsa Shonitha, become Sadhyopranahara?

Basti is a structure that resembles Alaabu[33] and is encircled by Sira, and Snayu serves as the seat of Prana. This reference on the anatomy of Basti clears this query of whether Basti being a Snayu Marma has Agneya Guna as Pradhana.

Since Basti is wrapped by multiple Sira and Snayu damage to this Marma can lead to damage of those Sira which could further lead to excess bleeding and then causing death of an individual. This also gives us the insight that Marma told in Sushruta Samhitha are not merely the organs it could also be the surface landmarks for the Marma points.

Though influence of Agni Guna, Soma Guna and Vayu Guna will be present in all types of Marma, the specific mentioning of particular Guna to particular type of Marma suggests the Pradhanyatha in the loss / hampering of those specific Guna in a Marma.

As an example, we can consider that while Sadhyopranahara Marma and Kalanthara Pranahara both have the involvement of Agni Guna in them, the death gets delayed in Kalanthara Pranahara Marma as the Pradhanyatha was given to the loss soma Guna than Agni Guna suggesting gradual blood loss thus Agni Guna loss occurs followed by loss of soma Guna from the body.

Contemporary View of Urinary Bladder as Fatal Location

Immediate Death from Urinary Bladder Injury Can Occur Due to Several Reasons, Including:

  • Hemorrhage: Damage to the blood vessels supplying the bladder, such as the vesical arteries, can lead to rapid and severe bleeding, causing hypovolemic shock and death.[34]
  • Peritonitis: If the bladder rupture leads to the spilling of urine into the peritoneal cavity, it can cause peritonitis, a severe inflammation of the abdominal lining. Peritonitis can further lead to septic shock and death.[35]
  • Infection: Urine is normally sterile, but if it spills into the abdominal cavity due to a bladder injury, it can lead to a severe infection that spreads rapidly and can be life-threatening.[36]
  • Organ Dysfunction: Severe trauma to the bladder can also lead to dysfunction or damage to surrounding organs, such as the ureters, and major blood vessels, which can result in rapid deterioration and death.[37]

J Ayu Int Med Sci 2024;9(8)159
Arpitha S et al. Exploring Basti as Sadhyopranahara Marma
  • Electrolyte Imbalance: The release of urine into the abdominal cavity can disrupt the body's electrolyte balance, leading to cardiac arrhythmias and other life-threatening complications.[38]

Surgical procedure called Suprapubic Cystostomy[39] is carried out when there is obstruction to the normal urinary flow, in this, a connection is surgically created between skin and urinary bladder. In this operation, the bladder is distended with about 300ml of fluid; as a result the anterior aspect of the bladder comes in direct contact with the anterior abdominal wall & can be approached without entering peritoneal cavity. Here bladder is approached from one side and only one incision was made. This is same as mentioned earlier that any kind of injury that causes the Basti to break on both/multiple sides of the Basti, will lead to Sadhyomaranam, except to those injuries that are caused by Ashmari and also when injury is only on one side[19] All the above-mentioned explanations indicate that even in contemporary science blood or blood circulation is a factor, either directly or indirectly involved in deaths due to bladder injury which supports the conceptual hypothesis that Basti Marma Abhighatha is not merely an injury to the tissues (Snayu) of urinary bladder but it is the injury to Hemodynamics over the bladder which is used as the surface marking by our Acharya.

Conclusion

Based on the comprehensive exploration of Basti as Sadhyopranahara Marma through the integration of classical Ayurvedic principles and contemporary anatomical understanding, it becomes evident that Basti holds profound significance in both traditional and modern medical contexts. Through the lens of Ayurveda, the Basti Marma emerges as a vital locus of life force, intimately linked to the sustenance and manifestation of Prana. Its classification as a Sadhyopranahara Marma underscores its critical nature, as any injury to this site can result in immediate loss of life. Moreover, a comparative analysis with modern anatomical knowledge of the urinary bladder elucidates the physiological complexities underlying injuries to this region. From hemorrhage to peritonitis and organ dysfunction, the potential consequences of bladder trauma mirror the ancient understanding of Basti as a site vulnerable to life-threatening outcomes.

In essence, the convergence of ancient wisdom and contemporary science reaffirms the timeless relevance of Marma Shastra in understanding the intricate dynamics of human anatomy and physiology.

By elucidating the unique attributes of Basti as a Sadhyopranahara Marma, this study not only enriches our knowledge of Ayurvedic principles but also highlights the enduring relevance of traditional concepts in informing modern medical practice. As we continue to bridge the gap between tradition and innovation, the exploration of Marma Shastra serves as a testament to the holistic vision of healthcare that transcends temporal boundaries.

References

1. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 15, p.371.
2. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 3, p.369.
3. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 42, p.376.
4. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 15, p.371.
5. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 35, p.375.
6. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 8, p.370.
7. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 23, p.372.


J Ayu Int Med Sci 2024;9(8)160
Arpitha S et al. Exploring Basti as Sadhyopranahara Marma

8. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 23, p.372.
9. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 16, p.371.
10. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 16, p.371.
11. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 16, p.371.
12. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 9, p.370.
13. Agnivesha, Charaka, Dridhabala. Charaka Samhita. Ayurveda Deepika commentary by Chakrapanidatta. Edited by Vaidya Jadavaji Trikamji Acharya. Chaukhambha Orientalia, Varanasi; 2009. Reprint. Chikithsa Sthana, Chapter 16, Shloka 3, p.597.
14. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 25, p.373.
15. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Nidana Sthana, Chapter 3, Shloka 20, p.279.
16. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 25, p.373.
17. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 29, p.375.

18. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Nidana Sthana, Chapter 3, Shloka 18, p.279.
19. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 25, p.373.
20. Chaurasia BD. Human Anatomy: Regional and Applied Dissection and Clinical Lower Limb, Abdomen and Pelvis. 6th ed. Vol 2. New Delhi: CBS Publishers & Distributors Pvt Ltd; 2013. Reprint 2015:372.
21. Drake RL, Vogl W, Mitchell AWM. Gray's anatomy for students. Churchill Livingstone; 2014.
22. Standring S. Gray's anatomy: The anatomical basis of clinical practice. Elsevier Health Sciences; 2016.
23. Moore KL, Dalley AF, Agur AMR. Clinically oriented anatomy. Lippincott Williams & Wilkins; 2013.
24. Netter FH. Atlas of human anatomy. Elsevier Health Sciences; 2014.
25. Sinnatamby CS, Last RJ. Last's anatomy: Regional and applied. Churchill Livingstone; 2011.
26. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 4, Shloka 3, p.354.
27. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 16, p.371.
28. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 4, Shloka 3, p.354.
29. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 4, Shloka 3, p.354.
30. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 4, Shloka 3, p.354.


J Ayu Int Med Sci 2024;9(8)161
Arpitha S et al. Exploring Basti as Sadhyopranahara Marma

31. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Sutra Sthana, Chapter 14, Shloka 7, p.59.
32. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Shareera Sthana, Chapter 6, Shloka 18, p.372.
33. Sushruta Samhitha. Sanskrit Commentary by Sri Dalhanacharya. Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhambha Sanskrit Sansthan; 2021. Reprint edition. Nidana Sthana, Chapter 3, Shloka 20, p.279.
34. Top of FormSantucci RA, McAninch JW. Bladder injuries: evaluation and management. Brazilian Journal of Urology. 2001;27(4):392-399.
35. Breyer BN, McAninch JW, Elliott SP. Mastering the evaluation and management of bladder injuries. The Journal of Trauma and Acute Care Surgery. 2007;63(2):321-326.
36. Pereira BM, de Andrade JM. Bladder injuries in traumatic pelvic fractures: a single-centre experience. Canadian Urological Association Journal. 2018;12(3): E109-E114.
37. Mikolajczyk KJ, Gornik W. Bladder injuries in patients with multiple injuries: A single-centre experience. Central European Journal of Urology. 2018;71(3):295-300.
38. Mundy AR, Andrich DE. Urology. In: Bladder injuries (pp. 296-307). Springer, London; 2010.
39. Chaurasia BD. Human Anatomy: Regional and Applied Dissection and Clinical Lower Limb, Abdomen and Pelvis. 6th ed. Vol 2. New Delhi: CBS Publishers & Distributors Pvt Ltd; 2013. Reprint 2015:375.


J Ayu Int Med Sci 2024;9(8)162