Conceptual Study of Marma and Pain Management in Avabahuka by Marma Chikitsa

Abstract

Ayurveda, which focuses on the prevention and treatment of illnesses, offers a variety of strategies for leading healthy lives. The notions of the anatomical and physiological aspects of the body were offered by Ayurveda. One of the topics of Ayurveda is Marma, which is regarded as one of the locations in the body where Prana exists. According to anatomical placements and other structures around them, 107 Marma points were listed in various Ayurvedic scriptures. Marmas points in the body are mostly made of groupings of muscles, ligaments, arteries, tendons, and bones, among other things. Since Marma points are connected to Tridosha, Bhutatma, and Triguna, any trauma or damage to the Marma might result in excruciating manifestations that occasionally have the potential to be fatal. The pioneer of Indian surgery, Acharya Sushruta, was the first to recognize the value of the Marmas in terms of anatomical knowledge and surgical procedures for everyday practice and dangers in life. Currently, Marma Chikitsa is quite well-liked for its all-natural, non-invasive method of therapy. Marma treatment is the manipulation of subtle energy (prana) in the body with the goal of promoting the healing process. This involves stimulating the body\'s meridian points to clear blockages, promoting both physical and psychological strength and relaxation. Avabahuka is a disorder that affects the shoulder joint and is quite similar to frozen shoulder. The major role of Avabahuka, a vata vyadhi and Amsa sandhi, is in sickness. Amsa Marma and Kakshadhara Marma are chosen for the Marma Chikitsa for this reason.

Introduction

I. INTRODUCTION

Marma are the body's critical points. These are the numbers 107. The patriarch of Indian surgery, Acharya Sushruta, recognised the anatomical and surgical relevance of the Marmasin day-to-day practise and risks of life. These are mAmsa, sira, snayu, asthi, and sandhi combined.[1]

These are the seats of the Pranas, according to Acharya Sushruta. Any harm to these results in death or incapacity.[2] As a result, understanding Marma is critical in treatment. Marma stimulation stimulates the pranas, resulting in a healthy body and mind since these are the locations where pranas exist. Marma Chikitsa is currently quite popular due to its natural and non-invasive therapeutic method.

The objective of Marma treatment is to manipulate the body's subtle energy (prana) in order to aid in the healing process. This involves stimulating Marma points on the body, which clears obstructions from the Marma points and provides physical and psychological strength and calm.

The frozen shoulder can also be treated with Marma treatment. Between 2 and 5 percent of the general population are thought to have frozen shoulder at some point in their lifetime.[3] It could also be connected to Avabahuka. Avabahuka under Vatavyadhi has been detailed by Acharya Sushruta. In the following stage, avabhahuka, discomfort and limited shoulder motions are manifested in Amsashosha, the precursor stage caused by vata vitiation.Vatagets became stuck at the base of the shoulders, restricting a number of channels and causing the arm to become immobile.[4]

II. AIMS AND OBJECTIVES

To evaluating the effectiveness of Marma treatment in Avabahuka

III. MATERIALS AND METHODS

It was an analysis of concepts. The information was gathered from works of traditional Ayurvedic literature, contemporary writings, and earlier study papers.

IV. MARMA

Marma derives from "Mru," a Sanskrit word that meaning "to kill." [5] Soma, Maruta, Teja, Sattwa, Rajas, Tamas, and Buddha live in these areas.[6] Any damage to these areas might result in death or deformity. So, the surgeon should be familiar with the Marmasthana. There are 107 Marma points, which are divided into groups based on how they affect a person's vitality.  One of the distinctive and significant subjects covered in Ayurveda is Marma. It has a significant impact on surgery. To make them easier to grasp, Acharya Sushruta divided these Marmas into Shadanga distribution categories. These include the Prusthagata Marmas, Bahu Marmas, Urdhwajatrugata Marmas,[7] Udara-Uraso Marmas, and Sakthigata Marmas.  Marma are further divided into the following categories: Mamsa, Sira, Snayu, Asthi, and Sandhi Marma.[8] They are classified as Sadyapranahara, Kaalantara_Pranahara, Vaikalyakara, Vishalyaghna, and Rujakara Marmas based on the prognosis.[9]

V. CLASSIFICATION OF MARMA

Marmas are classified on following bases-

1. On the basis of Rachana

a. Mamsa Marma -                                       11

b. Sira Marma-                                             41

c. Snayu Marma-                                          27

d. Asthi Marma-                                            8

e. Sandhi Marma-                                         20

2. On the basis of Shadang-Sharir

a. Exitremities-                                             4

b. Thorax-                                                     9

c. Abdomen-                                                 3

d. Supraclavicular Region -                         37

3. On the basis of Parinam

a. Sadhyapranhara Marma-                        19

b. Kalantarpranhara Marma-                     33

c. Vaikalyakar Marma-                                44

d. Vaishalyaghana Marma-                         3

e. Rujakar Marma-                                       8

VI. AMSA MARMA

According to Acharya Sushruta, Amsa Marmai, which connects Amsapitha and Skandha, is located between the Bahumurdha (arm's point) and Greeva (neck).[10]  There are two of them. It is positioned on each side between the Greeva (neck) and the baahu-shira, which connect the Amsapitha and Skandha, according to Acharya Vagbhatt. Injury to this Marma causes the limb to become stiff and lose its ability to move.[11]  It consists of all the soft tissues, such as muscles, ligaments, tendons, etc., that contribute to the development of the shoulder joint. An injury to these components may result in the muscles and ligaments rupturing, dislocating the joint, and impairing shoulder joint function. Acharya Vagbhatt claims that Amsa Marma injuries result in the loss of upper limb function.[12]

A. Avabahuka

Kakshara Marma Sushruta defines Avabahuka as occurring when vitiated vatadosha enters the veins of the Amsa Sandhi (shoulder joint), restricting mobility of the shoulder joint and causing arm muscular atrophy.[20] Joints have some role in every bodily movement. The shoulder joint has the widest range of motion, and when it is injured, everyday activities are limited and the agony is intolerable. Therefore, it is crucial to cure it. Ayurveda describes several methods for treating it.

The term "Avabahuka" in the current text is equivalent to "frozen shoulder" or "adhesive capsulitis."

VIII. PAIN

An uncomfortable sensation is pain. Pain is described by the Ayurvedic terms Vedana, Dukha, Pida, Sula, Ruk, Ruja, Bheda, Sadana, and Avasada. The Susruta Samhita claims that Vata is the primary cause of pain.[21]

A. Pain Management and Marma Chikitsa

There is no specific, universal medication prescribed in Ayurveda for any type of pain. The causal factor or Doshika preponderance that caused the pain determines how it should be managed. There are a number of analgesics and anti-inflammatory drugs used in conventional (allopathic) pain management, but there is still no one medicine that can treat all types of pain. Every person has a unique method of reacting to pain.

So, the goal of Marma treatment is to provide immediate pain relief.  The goals of pain management are to reduce suffering, reduce unease, and enhance quality of life. In terms of Marma Chikitsa, the Ayurvedic technique is the only one that can satisfy this. [22]

Due to the atrophy of the joint and compression of the numerous channels, this is where in Avabahukavayu which is placed at Amsa. As a result, the therapies Amsa Marma and Kakshadhara Marma aid in the management of pain in Avabahuka.

B. Technique of Marma Chikitsa[23]-

A simple and effective method of recovering vital vitality is Marma treatment.

1. Posture-Posture is crucial for good self-Marma treatment practise. For practitioners, a seated position is most practical. Keep your neck and spine in a straight line whether standing or sitting, without becoming rigid or leaning in any one way.

It comprises of the following steps-

a. Complete physical relaxation

b. Practice deep breathing

c. Whole-body perception

d. The perception of psychic centres

e. Understanding of Marma points

f. Gently press the Marma points with your thumb and fingertips.

The actual treatment is applying pressure to the Marma points with the thumb or fingers.

2. Pressure- depend upon the nature of Marma

3. Stimulation Time- 0.8 sec/stimuli

4. Repetition- 15 to 18 times in single sitting.

The patient was seated with its spine straight, and the doctor was standing behind it.

Amsa Marma is located between the Bahumurdha (arm's tip) and Greeva (neck), therefore pressure should be applied there in accordance with the technique described above.

Between the Vaksha and the Kaksha is where the Kakshadhara Marma is located; pressure should be applied here using the technique described above.

a. Inclusion Criteria

Patient diagnosed as Frozen shoulder

Individuals of both sexes

Age group- 20-60 years

b. Exclusion Criteria

As a complication of systemic illnesses, frozen shoulder was reported.

Patients having a history of an upper limb fracture or other abnormality

Patient with additional spinal conditions

Pregnant ladies and nursing mothers

IX. DISCUSSION

A key component of ayurvedic medicine is called Marma Chikitsa, in which pressure or stimulation is applied to certain Marma points to encourage the flow of Prana (life force energy).  Multiple illnesses are treated with Marma Chikitsa. It is also beneficial for easing joint, bone, muscular, and nerve discomfort. The Vata's area of expertise is the regulation of all types of bodily feelings. However, when Vata becomes vitiated, all of these activities get disrupted, and vitiated Vata's excessive activity can result in discomfort.  For its analgesic action, Marmas should be activated in any form of pain.  Working on the neuroendocrine system is Marma Chikitsa. Actually, the intended effect is caused by sending a nerve impulse to the brain as a result of pressure or stimulation. It is recommended to apply pressure or stimulation to the Amsa Marma and Kakshdhara Marma sites.This treatment aids in reducing shoulder joint discomfort, enhancing range of motion, and relaxing the body.

The interpretation of the study's findings suggests that Marma Chikitsa, particularly through the application of Amsa Marma and Kakshadhara Marma, is an effective and safe alternative and complementary therapy for pain management in Avabahuka. The study's results are consistent with previous research on Marma Chikitsa and pain management, emphasizing the importance of a holistic approach to pain management.

X. ACKNOWLEDGEMENTS

We are sincerely thankful to Dr. Navneet Dadhich (Asst. Professor, P.G. Department of Rachana Sharir, PGIA, Jodhpur, Rajasthan (India), Dr. Amit Gehlot (Asst. Professor, P.G. Department of Rachana Sharir, PGIA, Jodhpur, Rajasthan (India), Dr. Rajendra Meena (Principal Ayurved Medical Officer, Govt. District Ayurved Hospital, Baran, Rajasthan (India), Dr. Girdhar Gopal Malav (Ayurved Medical Officer, Govt. District Ayurved Hospital, Baran, Rajasthan (India) and Dr. Dinesh Verma (Senior Ayurved Medical Officer, Govt.Of Rajasthan (India) for their valuable guidance and supports.

Conflicts of Interests: None.

Conclusion

In conclusion, the present study provides valuable insights into the mode of action of Amsa Marma and Kakshadhara Marma in pain management for Avabahuka through Marma Chikitsa. The study has established the importance of a holistic approach to pain management, which takes into account the physical, emotional, and spiritual aspects of the individual. The effectiveness of Marma Chikitsa has been demonstrated in the study, particularly through the application of Amsa Marma and Kakshadhara Marma. By stimulating these Marma points, Marma Chikitsa restores the flow of vital energy and promotes healing at the cellular level, leading to significant pain relief. The findings of this study have significant implications for the use of Marma Chikitsa as a safe and effective alternative and complementary therapy for pain management in Avabahuka. However, further research is needed to establish the scientific validity of Marma Chikitsa and to explore its full potential in pain management. Overall, the present study emphasizes the potential of Marma Chikitsa in pain management, particularly through the application of Amsa Marma and Kakshadhara Marma. The study adds to the existing body of knowledge on Marma Chikitsa and highlights its importance in the management of Avabahuka.

References

[1] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirsthana 6/16 pg-69 [2] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirstahna 6/16 pg-69 [3] https://www.ncbi.nim.nih.gov [4] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Nidansthana 1/82 pg-304 [5] Vaidya Jadavji Trikamji Acharya Editor of Sushrutasamhita Of sushruta with the Nibandhasangraha commentary of Sri Dalhanacharya, reprint edition,Varanasi;Chaukhambha Sanskruta Samsthana;2010, Shareer Sthana, Ch.6,Ver.3,pg.369 [6] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirstahna 6/37, pg-77 [7] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirsthana 6/6 pg-68 [8] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirsthana 6/7 pg-68 [9] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirsthana 6/8 pg-68 [10] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirsthana 6/27 pg-74 [11] Bhisagacharya harisastri Paradakara Vaidya Editor of Astangahridaya Of vagbhatta with the commentaries sarvangasundara of Arunadatta and Ayurvedarasayan of hemadri,Chaukhambha Orientalia ,Varanasi-2014,shareer Stahna,Ch-4,ver.38,Pg.413 [12] Bhisagacharya harisastri Paradakara Vaidya Editor of Astangahridaya Of vagbhatta with the commentaries sarvangasundara of Arunadatta and Ayurvedarasayan of hemadri,Chaukhambha Orientalia ,Varanasi-2014,shareer Stahna,Ch-4,ver.38,Pg.413 [13] https://www.easyayurveda.com/2017/06/14/Amsa-Marma-components-location-effect-injury/ [14] Secrets of Marma by Dr. Avinash lele, Dr. Subhash ranade, and Dr.David Frawley, chaukhmbha Sanskrit Pratisthan Delhi, Reprinted-2005, pg no-75 [15] Dr. bhaskara Govind Ghanekara, commentator of sushruta Samhita- Ayurvedarahasyadipika, edition-2019, pg no-197 [16] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Sharirsthana 6/25, pg - 72 [17] Dr. bhaskara Govind Ghanekara, commentator of sushruta Samhita- Ayurvedarahasyadipika, edition-2019, pg no-193 [18] https://www.easyayurveda.com/2017/06/07/Kakshadhara-Marma/ [19] Secrets of Marma by Dr. Avinash lele, Dr. Subhash ranade, and Dr.David Frawley, chaukhmbha Sanskrit Pratisthan Delhi, Reprinted-2005, pg no-49 [20] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su. Nidanasthana 1/82 pg-304 [21] Dr. Ambika Dutta Shastri, Editor of Sushrut Samhita, Ayurved Tattva Sanddipika Varanasi, Chaukhamba Sanskrit sansthan Varanasi, Edition-2018, Su.Sutrasthana 17/12, pg-94 [22] Sunil Kumar Joshi. Marma Science and Principles of Marma Therapy. Delhi, Vani Publication. 2019, pg-55 [23] Sunil Kumar Joshi. Marma Science and Principles of Marma Therapy.Delhi, Vani Publication. 2019, pg-71

Copyright

Copyright © 2023 Dr. Hemendra Kumar Verma, Dr. Shyoram Sharma, Prof. Mahendra Sharma. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.