Prustamarma, sr

200
A Study On Prushtha Marma W.S.R. To Stabdha Bahuta In Amsa Marmabhighata By Dr.Shivasharanayya M.Swamy A dissertation submitted to the R R R a a a j j j i i i v v v G G G a a a n n n d d d h h h i i i U U U n n n i i i v v v e e e r r r s s s i i i t t t y y y o o o f f f H H H e e e a a a l l l t t t h h h S S S c c c i i i e e e n n n c c c e e e s s s , , , K K K a a a r r r n n n a a a t t t a a a k k k a a a , , , B B B a a a n n n g g g a a a l l l o o o r r r e e e . In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI - M.D (AYURVEDA) In RACHANA SHAREERA Guide Dr.N.G.Mulimani MD (SR) Co-Guide Dr.Shelly Divya M.D.(SR) darshan Post Graduate Department Of Rachana Shareera N.K.J. Ayurvedic Medical College & PG Centre, Bidar. 2010

description

Prushtha Marma W.S.R. To Stabdha Bahuta In Amsa Marmabhighata, Shivasharanayya M.Swamy, RACHANA SHAREERA, N.K.J. Ayurvedic Medical College & PG Centre, Bidar

Transcript of Prustamarma, sr

Page 1: Prustamarma, sr

“ A Study On Prushtha Marma W.S.R. To Stabdha Bahuta In Amsa Marmabhighata ”

By 

Dr.Shivasharanayya M.Swamy A dissertation submitted to the

RRR aaa jjj iii vvv GGG aaa nnn ddd hhh iii UUU nnn iii vvv eee rrr sss iii ttt yyy ooo fff HHH eee aaa lll ttt hhh SSS ccc iii eee nnn ccc eee sss ,,, KKK aaa rrr nnn aaa ttt aaa kkk aaa ,,, BBB aaa nnn ggg aaa lll ooo rrr eee .

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI - M.D (AYURVEDA)

In 

RACHANA SHAREERA

Guide Dr.N.G.Mulimani

MD (SR)

Co-Guide Dr.Shelly Divya M.D.(SR)

darshan

Post Graduate Department Of Rachana Shareera N.K.J. Ayurvedic Medical College & PG Centre, Bidar. 

2010 

Page 2: Prustamarma, sr

 RRR aaa jjj iii vvv GGG aaa nnn ddd hhh iii UUU nnn iii vvv eee rrr sss iii ttt yyy ooo fff HHH eee aaa lll ttt hhh SSS ccc iii eee nnn ccc eee sss ,,,

KKK aaa rrr nnn aaa ttt aaa kkk aaa ,,, BBB aaa nnn ggg aaa lll ooo rrr eee .

Declaration by the candidate

I, hereby declare that this dissertation/thesis entitled “A

study on Prushtha marma W.S.R. to Stabdha bahuta in Amsa

marmabhighata” Is a bonafide and genuine research work carried

out by me under the guidance of Dr.N.G.Mulimani,M.D.(SR)

Professor Department of Rachana Shareera.

Date: Signature of the candidate Dr.Shivasharanayya M.Swamy Place: Bidar

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RRR aaa jjj iii vvv GGG aaa nnn ddd hhh iii UUU nnn iii vvv eee rrr sss iii ttt yyy ooo fff HHH eee aaa lll ttt hhh SSS ccc iii eee nnn ccc eee sss ,,, KKK aaa rrr nnn aaa ttt aaa kkk aaa ,,, BBB aaa nnn ggg aaa lll ooo rrr eee .

Copyright

Declaration by the candidate

I here by declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall declare the rights to preserve, use and

disseminate this dissertation/thesis in print or electronic format for

academic/research purpose.

Date:

Place: Bidar

© Rajiv Gandhi University of Health Sciences, Karnataka

Signature of the candidate Dr.Shivasharanayya M.Swamy

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RRR aaa jjj iii vvv GGG aaa nnn ddd hhh iii UUU nnn iii vvv eee rrr sss iii ttt yyy ooo fff HHH eee aaa lll ttt hhh SSS ccc iii eee nnn ccc eee sss ,,, KKK aaa rrr nnn aaa ttt aaa kkk aaa ,,, BBB aaa nnn ggg aaa lll ooo rrr eee .

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A study on

Prushtha marma W.S.R. to Stabdha bahuta in Amsa

marmabhighata” is a bonafide research work done by Dr.

Shivasharanayya M.Swamy, in partial fulfillment of the

requirement for the degree of Ayurveda Vachaspathi - M.D.

(Ayurveda).

Signature of the Co-Guide Dr.Shelly Divyadarshan

M.D.(SR) Lecturer,

Department of Rachana Shareera NKJ Ayurvedic Medical College & P G Centre

Bidar – 585403

Signature of the Guide Dr. N.G.Mulimani

MD (SR) Professor,

Department of Rachana Shareera NKJ Ayurvedic Medical College & P G

Centre Bidar – 585403

Date: Date: Place: Bidar Place: Bidar

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EEENNNDDDOOORRRSSSEEEMMMEEENNNTTT   BBBYYY   TTTHHHEEE   HHHOOODDD,,,   PPPRRRIIINNNCCCIIIPPPAAALLL///   HHHEEEAAADDD   OOOFFF   TTTHHHEEE   IIINNNSSSTTTIIITTTUUUTTTIIIOOONNN   

This is to certify that the dissertation entitled “A study on

Prushtha marma W.S.R. to Stabdha bahuta in Amsa

marmabhighata” is a bonafide research work done by Dr.

Shivasharanayya M.Swamy under the guidance of

Dr.N.G.Mulimani. Prof department of Rachana Shareera.

Seal and signature of the Principal/Dean

Dr.K.V.L.N Acharyulu. M.D. (Ayu)

Principal & Dean N.K.J. A.M.C. & PG Centre, Bidar – 585403 Karnataka.

Seal and signature of H.O.D. Dr .N.G.Mulimani MD (SR) Prof & H.O.D Dept. Of Post Graduate Studies In Rachana Shareera N.K.J. A.M.C. & PG Centre, Bidar – 585403 Karnataka.

Date: Date: Place: Bidar. Place: Bidar.

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Acknowledgements

This is the greatest moment to me to acknowledge the respected personalities who 

has given this opportunity and helped in doing my dream work of dissertation. 

First  and  foremost  I  have  to  acknowledge  to my  parents  Sri Mallayya  Swamy  and  Smt 

Mallamma swamy& my brother in law Sri Shivmurthy G & my brother Shivamurthy .Swamy. 

I  am  very  much  indebted  to  my  esteemed  and  cherished  Guide  Prof

Dr.N.G.Mulimani MD (SR) H.O.D   P.G.Department  of  Rachana  Shareera  for 

providing an opportunity to carry out this work under his proficient guidance. I will be ever 

grateful  for  his  invaluable  guidance,  constructive  suggestions,  thought  provoking  ideas  in 

every stage of this work to achieve this milestone. 

  It  is a great privilege to record my esteemed & deepest sense of gratitude to my 

Co‐guide   Dr.Shelly Divyadarshan   MD (SR)             P.G.Department of Rachana Shareera   for 

his able guidance,  all time support, generous help & affection throughout my work. 

I consider  it a great privilege to record my deepest sense of gratefulness to our 

Professor.  Dr.S.B. Kotur M.D (SR)  for his all time support, during this work. 

I also express my sincere gratitude  to and offer my sincere  thankfulness  to my 

mentor Professor Dr Ashwinikumar. M.D (SR)  who is my well wisher and generous help during 

my dissertation work. 

I wish to extend my heartiest thanks to the Principal Prof Dr.K.V.L.N Acharyulu.

 N.K.J Ayurvedic Medical College & P.G. Centre for providing the necessary facilities in 

the college for conducting research work. 

I

Any  amount  of  thankfulness  will  be  inadequate  for  all  the  department  teachers 

namely Sanjeevkumar jyoteppa for providing all possible guidance and support. I am highly 

indebted to my beloved senior and lecturer Dr.Anup. B for his constant enthusiastic and 

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affectionate pushes in my thoughts in time and again. I take an opportunity to be grateful to my

teacher Dr.vijay Biradar. M.S (shalya)   for his cooperation in his service.  

On this occasion I give my deepest gratitude to my teacher  Dr.Brahmanand. Swamy 

. M.S  (shalya).  I take this opportunity to convey my thanks to Vidwan P.G.Bhatt for his proper 

guidance during my dissertation work.  

I  also  express my  sincere  gratitude  to  and  offer my  sincere  thankfulness  to 

Dr.Manik kulkarni M.D (Panchakarma) and all Panchakarma dept staff. 

I wish to extend my heartiest thanks to the vice‐ Principal Dr. Prasanna V. Savanur for 

his active guidance during my dissertation work.  

Sri. Vinod Bagali office supdt. , Sri. Lakshmikanth Reddy accountant, Shri Vidyanand 

kulkarni,  Mr.Ramesh  Chidre,  Mr  Chandrakant,  Mr  Kaddi,  Sri.  R.J.  Kadam  Librarian,Mr 

Rajkumar and Smt. Sakubai. Department  assistant Mr.  Sabeer, Mr. Abdul  and  all  the  other 

technical and non technical staff of the college for their cooperation and help. 

In addition this I am also very grateful to my batch mates Dr Vivek Kulkarni Dr

Sukhesh, Dr.Rajshekhar Tokare, Dr.Satyamma, Dr.Geeta Dolli, Dr.Satish Jalihal , Dr

Pradeepraju,Dr Sameer, Dr Jyoti Hullale, Dr Jyoti Rajole.,Dr Sanjeev Trivedi

,Dr.Baslingappa,Dr Omprakash, And I Extend My Regards To My Seniors Dr Santosh

Dixit, Dr Bapu Desai,Dr.Praveen Shegedar And, All My Seniors & Juniors Dr.Mohan.G,Dr

Mallikarjun,Dr.Nagendra,Dr.Sujit.

I  pick  up  this  precious moment  for  appreciation  of my  Friend  Dr  Vijay  Bulgundi 

Orthopedic Surgeon who helped me in modern aspect of my dissertation. 

Lastly  I acknowledge my  thanks  to  those who have directly or  indirectly extended 

their support for completion of my work. 

 

 Date:                                                                                                 Signature of the candidate 

II

Place:  Bidar              Dr.Shivasharanayya. M.swamy  

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ABBREVIATIONS

 

LIST OF ABBREVIATIONS

ACCORDING TO REFERENCE BOOKS (AYURVEDIC)

A.H › Ashtanga Hridaya.

A.S › Ashtanga Samgraha.

Ch.S › Charaka Samhita.

K.S › Kashyapa Samhita.

Su.S › Sushruta Samhita.

ACCORDING TO STHANA OF SAMHITA

Chi › Chikitsa Sthana.

Sha › Shareera Sthana.

Su › Sutra Sthana.

U › Uttar Sthana.

VI › Vimana Sthana.

A study on Prushtha marma W.S.R.to Stabdhabahuta in Amsamarmabhighata  Page III 

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ABBREVIATIONS

 

LIST OF ABBREVIATIONS (MODERN)

F › Female

Fig. › Figure

G › Grade

Gr. › Group

M › Male

Min › minute

No › Number

O.P.D. › Outdoor patient department

Sl. › Serial

Yr › year

A study on Prushtha marma W.S.R.to Stabdhabahuta in Amsamarmabhighata  Page IV 

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ABSTRACT  

“A study on Prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata”  Page 1   

ABSTRACT:-

Marma is described as the vital spots in our body, injury to which ends in

various dangerous crises. The marma are 107, they are classified in various groups based

on their location like-: Shakhagata, udara uarahgata, Prushthagata & Jatrudwagata.

Prushtha marma are 14 in number those are katikataruna, Kukundara, Nitamba,

parshvasandhi, Brahati, Amsaphalaka and Amsamarma each two in number.

Although the gross regional and the viddha laxanas are available in samhitas, but

detail description of particular structures present in Prusthamarma region are lacking in

ancient texts.

Objectives of the study were complete literary review on prushtha marma and

applied anatomy of prushtha marma with special reference to clinical & structural

assessment of Amsamarmabhighata.

METHODS:-

The subject of this dissertation is both literal and observational study, data related

to Prushtha marma were collected from various classics, objective and subjective

parameters and observations of 30 patients of stabdhabahuta (Amsamarmabhighata) were

collected and anatomical variations were noted.

All patients had the structural changes in Amsa pradesha in the form of fracture,

dislocation, rupture of the ligaments, rotator cuff tear, frozen shoulder etc... But we have

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ABSTRACT  

“A study on Prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata”  Page 2   

only included the soft tissue injuries which hold all the structure together and supports

the shoulder.

OBSERVATIONS:-

Subjective and objective parameters were taken to analyze the severity of the

trauma and range of signs & symptoms in each patient. As it is an observational study

based on clinical diagnosis, the student’s t-test was not used. Only the percentage of each

finding was mentioned.

INTERPRETATION & CONCLUSION:-

Interpretation will be done on controversial points and conclusion drawn after

completion of observations.

Key words:-

Prishtha marma, Amsa marma & Stabdhabahuta.

 

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Index

Sl. No. Contents Page No.

1 Introduction 1-2

2 Aims & Objectives 3

3 Review of literature

1. Historical review:

2. Ayurvedic review:

a) Concept of marma shareera

b) Classification of marma

c) Prushtha marma

3. MODERN REVIEW:

a)Katikataruna,Kukundara &Nitamba b)Parshwasandhi marma c)Brahati marma d)Amsaphalaka marma e)Amsa marma f)Modern review of amsa marmabhighata g)Sports medicine & Biomechanics

4-6

7-60

7-11

12-13

14-60

61-86

61-65

65

66

67

68-76

76-83

83-86

4 Photo plates 86-98

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5 Methodology 99-104

6 Observations 105-116

7 Discussion 117-134

8 Conclusion 135-137

9 Summery 138-139

10 Reference Shlokas 140-149

11 Bibliography 150-164

12 Annexure 1-5

13 Master chart 1

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LIST OF TABLES

S.No Name of the table

Page no

1. Classification of marma based on the structure 12

2. Classification of marma based on effect of injury 12

3. Classification of marma on location 13

4. Classification of marma based on numbers 13

5. Classification of prushtha marma 14

6. Bones of Nitamba marma 25

7. Muscles acting on shoulder girdle 75

8. The distribution of patients based on age 105

9. The distribution of patients based on sex 106

10. The distribution of patients based on occupation 107

11. The distribution of patients based on diet 108

12. The distribution of patients based on shoulder pain 109

13. The distribution of patients based on restricted movement 110

14. The distribution of patients based on Tenderness 111

15. The distribution of patients based on visible deformity 112

16. The distribution of patients based on numbness 113

17. The distribution of patients based on Arm drop sign 114

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LIST OF FIGURES

S.No Name of figure Page No

1

Limitations of amsa marma

59

2

Assesment for the joint mobility 102

3

Prushtha marma Photo plate 86

4

Bones & Joints of pelvic cavity Photo plate 86

5

Muscles of the gluteal region Photo plate 87

6

Nerves of pelvic cavity Photo plate 88

7

Ligaments of pelvic cavity  Photo plate88

8

vessels of pelvic cavity Photo plate88

9

Viscera of pelvic cavity Photo plate88

10

Scapula & Ribs Photo plate89

11

Muscles of the scapular region

Photo plate89

12 Brachial plexus

Photo plate89

13 Vessels of the axilla Photo plate89 14

Shoulder girdle articular surfaces Photo plate89

15 Muscles & bursae

Photo plate90

16 Ligaments

Photo plate90

17 Bursae & Rotator cuff muscles

Photo plate91

18 Movements of the shoulder joint

Photo plate91

19 Muscles acting on shoulder girdle

Photo plate92

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20  Causes of Supraspinatus

Photo plate93

21 Painful arch syndrome Photo plate93

22 Rotator cuff Muscles Photo plate93

23 Shoulder joint diagram Photo plate94

24 USG of Shoulder Normal

Photo plate94

25 Shoulder Diagram transeverse view Photo plate95

26 USG of Shoulder Normal transeverse view Photo plate95

27 Supraspinatus tendon full tear Photo plate96

28 Supraspinatus tendon full tear & Bursitis Photo plate96

29 Complete tear of Supraspinatus Photo plate97

30 Radiological Finding of Shoulder Photo plate98

31 Shoulder MRI;Rotator cuff injuries Photo plate98

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LIST OF GRAPHS

Graph

No.

Description Page No.

01 Incidence of Age 106

02 Incidence of Sex 107

03 Incidence of Occupation 108

04 Incidence of Diet 109

05 Incidence of Shoulder pain 110

06 Incidence of Restricted movement on abduction 111

07 Incidence of Tenderness 112

08 Incidence of visible deformity 113

09 Incidence of Numbness 114

10 Incidence of Arm drop sign 115

11 Incidence of modern diagnosis 116

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LIST OF FLOW CHARTS

Flow

chart

No.

Description Page no.

1 General Patho-physiology of marma 9 

2 Mechanism 11 3 Structure of Katikataruna marma 16 4 Patho-physiology of katikataruna marma 18 5 Structure of Kukundara marma 23 6 Patho-physiology of Kukundara marma 24 7 Structure of Nitamba marma 27

8 Patho-physiology of Nitamba marma 30 9 Structure of Parshvasandhi marma 32 10 Patho-physiology of Parshvasandhi marma 36 11 Structure of Brahati marma 38 12 Patho-physiology of Brahati marma 40 13 Structure of Amsaphalaka marma 43 14 Patho-physiology of Amsaphalaka marma 45 15 Structure of Amsa marma 47 16 Patho-physiology of Amsa marma 50

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INTRODUCTION  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 1 

INTRODUCTION

The human anatomy (shareera rachana) is an important for allied health sciences. It is one

of the fundamental subject to the health science.

The ayurvedic life science is also based on the human anatomy and physiology (rachana

& kriya), without the knowledge of shareera rachana and kriya, the physician cannot become

perfect in the profession.

So the ancient Acharyas like Sushruta, Charaka and Vagbhata were given importance to

the knowledge of rachana shareera. The acharya sushruta was mentioned in the shareera sthana

of sushruta samhita, other acharyas are also explained about the human anatomy in their

samhitas. The human body dissection was described in sushruta samhita.

Even though no descriptive anatomy of organ or structure is available in any samhita

granthas but our ancient have treated various diseases and performed the surgery perfectly and

precisely.

If we gone through the marma shareera, These are vital points of the body. They

are situated at various regions of the body. If any injury to the Marma points that leads to

deformity of the structures, produces the severe pain, loss of movements, and even some times

there may be a death. The Marma are still holding the power of anatomists and surgeons in high

amount. It seems that Acharyas have described the regional anatomy in relation to the surface

anatomy of Marma. Every Marma holds its own clinical importance and significant scientific

values, while on research none can ignore this.

 

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INTRODUCTION  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 2 

Marma are vital areas regarded as conglomeration of mamsa, sira, snayu, asthi, and

sandhi and named after their individual predominant structure.

Prushtha Marma are 14 in number those are Katikataruna, Kukundara, Nitamba,

Parshwasandhi, Brahati, Amsaphalaka and Amsa and the structures related to shoulder

region are the most exposed area to common injuries. The activities like weight lifting,

swimming, cricket, fall on the outstretched arm causes the rupture of ligaments and muscles of

shoulder joint, leads to disability of the Amsa sandhi and bahu. Therefore selecting out this topic

for study will be a needful exercise for the subject Shareera Rachana.

Symptomology like stabdhabahuta or bahukriyahara is almost an uncovered area of

study. Hence the surgical and anatomical evaluation of stabdhabahuta symptom under Amsa

Marma will be need for research.

Looking into the above feature though no study has yet been conducted on the vital

points of back especially on Amsa Marma with its degenerative process following on injuries,

hence it is understood that still critical study is needed. 

 

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Aims & Objectives   

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 3 

Aims and objectives of the study:

1. Conceptual study of Prushtha Marma Shareera.

2. To study the underlying structures of Amsa marma and to fix its limitations.

3. To study the Stabdhabahuta in Amsa marmabhighata on modern parameters.

 

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HISTORICAL REVIEW  

“A Study on prushtha Marma W.S.R. to Stabdhabahuta in Amsa Marmabhighata ”  Page 4 

HISTORICAL REVIEW

In Vedic Literature:

In Rigveda, a word Marma is found in connection with sharp weapon called

vajra,used by lord ‘Indra’ for the purpose of killing the demon ‘Virata’ by attacking the

Marma sthanas.1

In Atharveda, references to Marma sthanas can be found in connection with the

killing of ‘skanda’ by lord ‘Indra’ and lord ‘Agni’.2

Upanishads:

In, ‘Garbhopanishad’we can find the word Marma reference to a quality of

knife which is capable of cutting the Marma of jaghana pradesha, 107 Marma are referred

along with anatomical structures of the body, 18 sensitive or vital parts or Marma

distributed at various places of the body are described for the practice of dharana, which

is achieved by concentration and withdrawal of mind from one spot to other spot of the

body.3

Epic Literature:

In Ramayana, The king Dasharatha while hunting used shabdabhedhi arrow

capable of hitting the objector a person without even looking at which pierced the Marma

sthana of shravanakumar resulting in death soon after the removal of arrow from the

body.4

 

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HISTORICAL REVIEW  

“A Study on prushtha Marma W.S.R. to Stabdhabahuta in Amsa Marmabhighata ”  Page 5 

During the fight between the ‘Vali’ and ‘Sugreeva’ Sri Rama hits at the Marma

sthana of Vali and he falls down with agonizing pain and died after arrow was removed.

These references points to vishalyagna Marma described in ayurvedic texts.5

Hanuman, while entering into Lanka, happened to confront with a very dreadful

and peculiar rakshasi ‘sinhika’ He carefully observed the Marma of the body and killed

the rakshasi by piercing his sharp and long nails into the Marma sthalas.6

The Meghanatha hits the Marma sthana of Lakshmana and falls down with

agony.7

During the fight, Meghanada hits the Marma sthala of the Rama and Lakshamana

and captivated them and tied them tightly With Nag pasha.7

In Mahabharata also, the use of word Marma can be traced out in

Sauptikaparva and Bhishma parva.During the battle between the Kaurava and pandava,

the Ashwathhama inflicted strong blow with his lion like heels on the vitapa Marma of

the elephant.8

In another place, king Duryodhana cries due to torn and broken thigh, which

pierced the Marma sthana.9

On the above narrations if a close observation is made, it can clearly be pointed

out that the knowledge of Marma vigyana was extensively well known since Vedic

period (4000BC) Later on its progression can be observed in the samhita granthas

especially in sushruta samhita shareer sthana.10

 

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HISTORICAL REVIEW  

“A Study on prushtha Marma W.S.R. to Stabdhabahuta in Amsa Marmabhighata ”  Page 6 

  But later, during Sushruta’s period the knowledge was acquired based on

the dissection of cadavers.

Later the Aristotle never dissected the human body but had a rough idea about the

vessels. Celsius (20BC) though wrote work on medicine but gave too little glimpse of

anatomy. Thus modern anatomy is only four hundred years old. The first public

dissection took place at Vienna on 12 February 1404. In 1565, queen Elizabeth of

England permitted dissection on executed criminals. Thus, the ancient Indian knowledge

on anatomy and dissection was considered superior to any of the anatomy in the world up

to 15th century. But afterwards, no efforts were made to improve the knowledge and

remained dormant and stagnated. However,after 19th century again devoped and made the

branches like Surface antomy, radiological Anatomy,Embryology etc ….

 

 

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AYURVEDIC REVIEW  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 7 

AYURVEDIC REVIEW

CONCEPT OF MARMA SHAREERA

Vyutpatti of word Marma

Mru maneen jeevasthaane, Sandhisthaane taatparye cha10”

Word meaning of Marma is jeevasthaana sandhisthana.

Nirukti of Marma

That which causes death on injury is called Marma or painful condition in which

the patient experiences pain same as death.11

Definition of Marma

“Marmaani naama maamsa siraa snaayu asthi sandhi sannipatah;

teshu svabhaavata eva praanatishtanti”12

Marma consists of aggregate of Mamsa, Sira, Snayu, Asthi, Sandhi in which

particularly Prana by nature stays. That which leads to death or which gives misery to

individual similar to death when injured is called Marma.13

Marma are that part of the body which exhibits a peculiar sensation or unusual

throbbing and causing pain on pressure.14

Marma are so called because they cause death when they are injured and they are

meeting place of Mamsa, Asthi, Snayu, Dhamani, Sira, Sandhi and life entirely resides in

them.15

The place where Mamsa, Sira, Snaayu, Asthi, and Sandhi present as Marma in

which specifically Prana is situated.16,17,18

 

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Marma are jeeva darana places in the body.19

Marma are called a jeevaagaara, that is jeeva takes shelter in Marma.20 The point

of the body which leads to death when injured called Marma.21

Prana

In persons generally Soma (Kapha), Maruta (Vaayu), and Tejas ( Pitta), and

Rajas, Satva, and Tamas along with Atma stays in Marmas, that is why they do not

survive if injury takes place on Marma.22,23 These are said to be Prana according to

Sushruta.

There are said to be 10 seats of Prana that is Dasha Pranayatanas by Acharya

Charaka. Those are two Shankha, Three Marma (Shira, Hrudaya and Basti), Kantha,

Rakta, Shukra, Ojas, and Guda.24 Acharya Charaka again mentioned Pranayatanas in

Shareera sthana as Murdha, Kantha, Hrudaya, Nabhi, Guda, Basti, Oja, Shukra, Shonita,

and Mamsa.25Acharya Vagbhata in both Hrudaya and Sangraha mentioned same as

Acharya Charaka.26 Acharya Kashyapa told Dasha Pranayatana’s as Murdha, Hrudaya,

Basti, Kantha, Shukra, Shonita, two Shankha, Guda, among these he called first three are

MahaMarma.27

General structure of Marma

Marma consists of aggregate of Mamsa, Sira, Snayu, Asthi, Sandhi in which particularly

Prana by nature stays.28 In persons generally Soma(Kapha), Maruta (Vaayu), Tejas

( Pitta), Rajas, Satva, and Tamas along with Atma stays in Marmas, that is why they do

 

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not survive if injury takes place on Marma. By injury Shareerika and Manasika dosha are

aggravated which destroy body and mind and finally Atma leaves the body.29

Flow Chart No.1

 

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General symptoms of Marma Viddha lakshana30

Vishama spandana- Variation in pulsation of vessels in pulsatory places of

particular Marma pradesha is due to Viddha and structural impairment. Vishama ruk-

Deferent type of pain will be felt on putting pressure on Marma Viddha pradesha.

Antah (peripheral region) Viddha and Madhya Viddha lakshana

The structure of the Marma generally includes 2 parts, Madhya and Antah

(peripheral region) parts.

Madhya Viddha (central region) –

Injury to the Madhya (central part) of the Marma occurs, and then cardinal

symptoms related to particular Marma appears.

Example- Shankha Marma Madhya Viddha leads to Marana.

Antah (peripheral region) Viddha-

Injury to the Antah (peripheral region) pradesha of the Marma occurred then

instead of showing cardinal signs; it converted in to successive Marma lakshana

So many times patient came with Marma Viddha lakshana will not exhibit

cardinal symptoms. This is because in injury to peripheral part of Marma Rachana

involved.On observation it is clinically very difficult to demark peripheral and central

part of Marma. But on the basis of symptomatology and also Acharya Sushruta’s concept

of Antah (peripheral region) and Madhya Viddha, will guide us to determine the

prognosis. Example- sometimes Shankha Marma Viddha will not lead to Sadhyo Marana,

 

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patient may die after a month. It means in this condition, only peripheral part of Shankha

Marma injuries

Flow Chart No.231

 

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CLASSIFICATION OF MARMA

Classification of Marma is done depending upon structures involved, effect of Marma

injury, place of situation, measurement of Marma, and number of Marma.

Table No 1: Classification of Marma based on structure32,33,34

Marma Sushruta Vagbhata Bhavaprakasha

Mamsa 11 10 11

Sira 41 37 47

Snayu 27 - 21

Asthi 8 8 8

Sandhi 20 20 20

Dhamani - 9 -

Total 107 107 107

Table No 2: Classification of Marma based on effect of injury35

Sadyopranahara 19

Kalantara pranahara 33

Vaikalyakara 44

Rujakara 8

Vishalyaghna 3

Total 107

 

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Table No 3: Classification of Marma on location36

Shakhagata 44

Udara uraha gata 12

Prushtha gata 14

Jatrurdhvagata 37

Total 107

Table No 4: Classification of Marma based on numbers37

One in number

vitapa, kakshadhara, guda, basti, hrudaya, nabhi, sthapani,

adhipati

Two in number

gulpha, janu, stana moola, stana rohita, apalapa, apasthambha,

Katika taruna, kukundara, nitamba, parshva Sandhi, bruhati,

amsaphalaka, amsa, krukatika, viduara, phana, apanga, aavarta,

Utkshepa, shankha

Four in number

kshipra, talahrudaya, koorcha, koorcha shira, indra basti, ani,

oorvi, lohitaksha, srungataka

Five in number

Seemanta

Eight in number

matruka,

 

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PRUSHTHA MARMA38

Prushtha marma are situated at the back of the trunk. Those are 14 in number are

kateekataruna, kukundara, nitamba, parshwasandhi, brahati, amsaphalaka and amsa, each

2 in number.

Table No 5: Classification of prushtha marma (figure no-1)

MARMA NUMBER SIZE STRUCTURE TRAUMA

EFFECT

Kateekataruna 2 ½ anguli Asthi Vaikalyakara

Kukundara 2 ½ anguli Sandhi Vaikalyakara

Nitamba 2 ½ anguli Asthi Kalantarapranahara

Parswasandhi 2 ½ anguli Sira Kalantarapranahara

Brahati 2 ½ anguli Sira Kalantarapranahara

Amsaphalaka 2 ½ anguli Asthi Vaikalyakara

Amsa 2 ½ anguli Snayu Vaikalyakara

1.KATIKA TARUNA:-

Kati – low back region,39 Taruna – young, Trauma here it refers as it may be the

cartilaginous bone or ossification process is going on. In the low back region the five

small bones are ossified and forms single bone called “Katikpalasthi” (Sacrum). That

region is called “Kati” pradesha

On both sides of the prushtha vamsha (vertebral column) in each shroni kanda

(hip bone), there are kateekataruna marma situated. Injury to them gives rise to pallor,

 

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discoloration of the skin, due to hemorrhage or blood flows, disfiguration of the body and

ultimately leads to death. 40

According to Dalhana, kateekataruna marma are asthi marma structurally, having

kalantara pranahara consequences and covers an area half angula and bilateral.41

It is situated on either side of the vertebral column, on the ear like bones of the

pelvis are the two kateekataruna marma injury to these causes pallor due to loss of blood,

emaciation and death.42

Location

On the both sides of the vertebral column where kati kapaala Asthi meet with

Shroniphalaka Asthi. It means sacro-iliac joint. In this region “Katika taruna is present”.

Pramana

Half Anguli Pramana on both sides of sacro-iliac joint of pelvic cavity. It is

approximately 1cm in diameter circular area on the pelvic cavity.

 

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Flow Chart No.3

 

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Viddha Laxanas:-

1. Samanya lakshana

a. After injury to this Asthi marma leads to rupture of major blood vessels because in this

region Asthi protecting major blood vessels of pelvic cavity with main nerves.

b. Severe bleeding.

2. Vishesha lakshana43

a. Shonita kshaya- loss of blood, this is due to rupture of major blood vessels in pelvic

cavity near to the sacro-iliac joint.

b. Pandu- due to blood loss, pallor is the main symptom. This is the first stage of

bleeding.

c. Vividha varna – this is due to moderate blood loss, means other than pale yellow, little

bit bluish coloration starts to occur. Sometimes it exhibits mixed colour, this is second

stage of bleeding.

d. Heena roopata – this is the third stage of bleeding due to excessive blood loss

&distortion of pelvic girdle, leads to heena roopata.

e. Marana – this is last stage of bleeding, means it leads to death hypovolemia.

f. For this process it may take a month, so Marana may occur in a month.

3. Madhya and Antah (peripheral region) Viddha lakshana.

 

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a. Madhya Viddha lakshana – cardinal signs and symptoms- Kalantara pranahara

b. Antah (peripheral region) Viddha lakshana – It is converted in to Vaikalyakara

Marma.

Flow Chart No.4

 

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It is situated on the back of the body on the both sides of the lower spine. The area

of the hip on both the sides of the sacrum can be included in this and since it is asthi

marma, it may be related bone or bony joint. And because it produces loss of blood,

anaemia, distortion of hip & giving ugly look to the person (i.e deformity of pelvic

girdle).

The possibility of rupture of blood vessels along with the fracture, dislocation of

particularly sacro-iliac joint can be thought of.

In compression injury fracture dislocation of sacro-iliac joint and distortion of

pelvic takes place, accompanied by injury to blood vessels especially common iliac

vessels at its bifurcation giving.we can give the another openion that superior glutial

artery it is direct branch from the internel iliac artery injury to this gives rise to

hemorrhage, leading to panduta, etc.

According to the classics this marma is included under the asthi marma. Injury to

this marma leads posterior weight transmitting segment injury which is important from

the locomotion point of view are more disabling. Katikataruna injury, which produces

fracture and dislocation with severe hemorrhage and distortion of normal shape of pelvis,

suggests the following possibilities. The signs and symptoms of trauma over this marma

point to a possibility of joint involvement which produces instability of a pelvis and

produce sever hemorrhage and result in change of normal shape of pelvis. All these three

symptom complexes are possible if the sacro-iliac joint is taken as kateeka taruna. The

internal iliac vessels which lies in the vicinity, will produce intra pelvic hemorrhage on

 

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trauma and produce obvious distortion of normal contour of pelvis, resulting in ‘HEENA

RUPA’ and ultimately death due to hemorrhage or sepsis & shock.

Based on these the kateeka taruna marma seems to be anatomically situated on

the back adjacent to the both the sides of the lower spine where both the hip bone joints

with the sacrum. Dalhana mentioned this marma as asthi marma, satisfies the bony

structures or joints found in the area concerned. But while considering the loss of blood,

pale and distortion of hip arises ugly look to the person, the possibility of rupture or

dislocation of the bony structures usually caused by crush injury, inturn blood vessels and

nerves are damaged producing loss of blood (anaemia) and ultimately leading to death.

The important anatomical structures lie in the sroni pradesha are inferior &

superior gluteal arteries and nerves, internal pudendal artery & the sciatic nerve. If in

case any damage to any arteries may leads to excess bleeding and consenquently death

takes place after some time. Any injury to the sciatic nerve produces loss of sensation and

the movements of the muscles innervated with the nerve.

According to the Vd RR Pathak, the posterior aspect of the ilium, bifurcation of

common iliac artery opposite lumbosacral articulation, in to the external iliac and the

hypogastric arteries the corresponding iliac veins and sacroiliac ligaments should be

taken as the anatomical structures involved in the kateek taruna marma, Dr. V.S Patil also

stands with the same view.

Dr. B.G Ghanekar enumerated the anatomical structures involved in the area of

this marma as sciatic notch, but the description does not justify because the sciatic notch

is deeply situated.

 

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Dr Avinash Lele, in the secrets of marma accounted the anatomical structures

involved in this marma as posterior aspect of the ileum, sacro-iliac ligament, superior

gluteal artery, and vein draining common iliac lymph gland, sacral plexus, gluteus

maximus muscle, and as per their view this marma is not accepted as asthi marma.

According to P.V. krishnarao the important anatomical structures corresponding

to kateekataruna marma are the posterior aspect of the ileum, bifurcation of the common

ilac artery, opposite to the lumbo-sacral articulation.

Astthi marma viddha laxana:

When asthi marma are injured there is discharge of thin fluid mixed with bone

marrow and intermittent pain.44

The learned surgeon well versed in the scripture should diagnose the patient who

has severe pain day and night and who gets no relief in any posture as suffering from an

injury to bone.

2. KUKUNDARA MARMA

Kukundara marma is situated on both sides of prushtha vamsha and the lateral

sides of the outer part of the jaghana asthi and an injury to this marma causes loss of

sensation and movements in lower part of the body.45

It is a sandhi marma in nature, vaikalyakara in consequence and extends over an

half angula area (Dalhana)46

According to chakrapani there are two deviated parts over the sphik47

 

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According to Haranachandra the word kati means jaghana, the marma are situated on the

both sides of vertebral column and they are in whirl in shape.48

Location:

On the two flanks, outside the buttocks and on either sides of the vertebral column

are the two kukundara, injury to this leads to loss of sensation and the movements of the

lower parts of the body.

Pramana:

½ Angula Pramana, outside the buttocks and on either sides of the vertebral column. It is

approximately 1cm in diameter circular area on the pelvic cavity.

According to the Gananathsen , the kukundara marma counted as ischial

tuberosity .Vd.R R pathak counted this marma as to the sacro-iliac articulation over

which the sacral nerves arising from the sacral plexus and passes and emerges out the

pelvis through the greater sciatic foramen.

As per the openion of Dr.Avinash Lele the anatomical structures under the

marma as ischial bone, inferior gluteal artery and vein, inferior pudendal artery and vein,

gluteus maximus muscle and levator ani muscles.

 

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Flow Chart No.5

 

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Flow Chart No.6

 

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Sandhi marma viddha laxana:

Progressive (muscular) atrophy, severe pain, decrease of strength, oedema all

around and a loss of all movements are the features of an injury to the movable and the

immovable joints49. Injury to the sandhi marma the site injury feels as though full of

thorns, even after healing of wound there is a shortening of the arm, lameness, decrease

of strength, movements and emaciation of the body and swelling of the joints.50

.. 3.NITAMBA MARMA:

Nitamba marma is situated above the sroni kanda (hip bone), which covers the

ashaya and connects the lateral part of the vertebral column. An injury to this marma

leads to shosha (atrophy) in the lower extremity and weakness, which ultimately causes

death.51

Table No:6 Shroni phalakasthi

Nitambasthi Hip bone 2

Bhagasthi Pubic symphysis (both together)

1

Trikasthi Sacrum 1

Gudasthi Coccyx 1

 

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According to Acharya Dalhana it is an asthi marma in nature,in consequences cause

kalantara pranahara marma.52

According to vagbhata this marma is located above the ear like bones of the

pelvis, concealing the visceral organs and composed of cartilages. Any injury to this

marma leads to swelling and debility of the lower part, and and lastly leads to death.53

Dr . R. R Pathak has accounted floating ribs, the lumbar plexus along with the

other important structures as the anatomical contents of the nitamba marma.

In the context of Shroni panchaka, Acharya Sushruta told two Nitambasthi. So the

shroni panchaka is nothing but the union of five bones in pelvic region.

So hip bone, specifically ilium and ischium are considered as Nitambasthi, and

the region is called “Shroniphalaka” region.

Location

Above the Jaghana karna of pelvic bone is covering pelvic organ. It is located interior to

the pelvic cavity on the both sides of lateral aspect of the iliac bone. This is nothing but

location of lumbo- sacral plexus and its branches in interior of the pelvic cavity.

Pramana

Half Anguli Pramana on both sides of the interior of the pelvic cavity. It is

approximately one cm diameter circular area of the pelvic cavity.

 

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Flow Chart No.7

 

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Viddha lakshana

1. Samanya lakshana

a. After injury, Sthanika dhatu kshaya; due to dhatu kshaya, Vata prakopa, it may leads to

sarva Shareera dhatu kshaya or specific rakta dhatu kshaya.

b. Vividha vedana – due to involvement of sensory nerves.

2. Vishesha lakshana54

a. Adhah kaaya shosha – Adhah kaya shosha means loss of sensory and motor activity or

atrophy of lower limb.

b. Daurbalya - General debility or lower limb debility. Due to rakta dhatu kshaya and

Vata prakopa, general debility may occur otherwise involvement of the motor and

sensory nerve leads to debility in lower limb only.

c. Marana – involvement of the major blood vessels severe bleeding may occur that leads

to hypovalemia, it may be end up with Marana.

3. Antah (peripheral region) and Madhya Viddha lakhana

a. Madhya viddh lakshana – cardinal signs and symptoms (Adhah kaya shosha,

Daurbalya and Marana).

b. Antah (peripheral region) Viddha lakshana – it is converted in to Vaikalyakara Marma,

it means if the Marana not occur, it may end up with deformity of the lower limbs.

Daurbalya due to general Dhatu kshaya or Rakta dhatu kshaya. After injury the

person may die after a month. This depends on the nature of the patho-physiology.

 

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Within this period if Chikitsa Chatushpada’s are available, the person may survive or end

up with sensory and motor loss of lower limb as a deformity.

 

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Flow Chart No.8

 

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4. PARSWA SANDHI MARMA:

Location:55

It is situated inferior to and in the middle of the lateral flanks being attached to it.

They are obliquely placed of conjoined together in order and attached to the lateral sides

of bony part hidden by it.

Pramana:56

Half anguli Pramana on both sides of the Poster-interior part of the Abdomino-

pelvic cavity. It is approximately one cm diameter circular area of the Abdomino-pelvic

cavity. Injury at this site fills up koshta with blood leading to death.57 It is kalantara

pranahara, sira marma structurally.

Dr.sharma has considered iliac artery and its branches regarding this marma. He

has reached this idea by considering filling of koshta (pelvic cavity) with hemorrhage.

Dr. Pathak has given his own comments, The structures responsible for this marma are

renal arteries and veins. Dr patil has located the site of marma between the highest point

of kati and the subcostal region. The possibility of probable structures involved in the

injury could be the lower part of liver on right side or spleen on the left side inferior

venacava and descending aorta, it is ardhangula in pramana measured by all classical

books. Dr.pathak has measured half an inch. This marma is situated in pelvic

region(shroni guha).

 

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Flow Chart No.9

.

 

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Regarding its surface anatomy, it is situated in between the jaghana parswa

obliquely and superiorly,It is sira marma and injury to this causes delayed death(kalantara

pranahara). Due to bleeding filling up the pelvis with blood. Sharma and Ghanekar have

suggested common iliac arteries responsible for this marma. It is to be recalled here that

Vagbhata has confirmed about the marma lying inside the pelvis placed obliquely from

below upwards at the joint where the five pieces of parshuka conjoined together in an

order and attached to the lateral side where the bony part is situated .This vascular marma

lying in the iliac fossa near the sacroiliac joint in the pelvis. The iliac vessels rarely

present isolated uncomplicated wounds. Such wounds are usually complicated by

fracture of the pelvis or by a perforating wound of the abdominopelvic cavity. In other

words they are observed only in connection with extensive traumatic lesions such as

usually in death on the battle field. The immediate and formidable hemorrhage followed

by death.

The external iliac and its companion vein have been injured by bullet traversing the iliac

fossa either obliquely or front to back or by spent shell fragments arrested by contact

with the vessels. Tuffier has reported a case of this description to the “The societe De

chirurgic” which was observed by Letoux. A fragment of a bomb extend at the level of

anterior superior iliac spine, the opening wound did not reveal the vascular injury which

was manifested 15 days later by the appearance of the secondary diffuse hematoma .The

external iliac artery was ligated ,death followed ,however as the result of secondary

hemorrhage. Soubbotitch has reported two cases of hematoma resulted from a wound of

external iliac, one recovered and other died after double ligature of the vessels.

 

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Wounds of the gluteal region leading to injury of gluteal vessels and nerves are

more frequently observed at field ambulences then wounds of external iliac .They usually

result from shell wounds, rarely bullet wounds of the buttock. On one occasion it was

seen that shell fish traversed the buttock and penetrated the iliac fossa into the pelvis.

These extensive injuries are extremely serious and their gravity is enhanced by the

presence of co-existing vascular lesions.

Wounds of the gluteal and pudendal arteries rarely give rise to serious external

hemorrhage therefore they are more attractive to trauma surgeons. The external iliac

artery and vein may together be severed in gunshot wound or may be intermittently or

accidentally divided during pelvic operation. A challenging problem facing the trauma is

the gunshot wound to the pelvis which may generate secondary missiles of bomb and

cause multiple injuries to branches of the venous plexus; The mortality of 50% has been

reported. Attempts at suture, ligation, cautery and clipping are all made difficult by the

rapidity with which the relatively small pelvic cavity of male fills with blood, despite the

employment of multiple suction units. Ligation of major vessels rarely helps.

The discussion suggests that there are two regions, which seems to be responsible

for this marma they are pelvic cavity and gluteal region. The vessels of extremities are

iliac vessels and their external branches.The bleeding from gluteal region also not

apparent but manegable.However ligation or control of bleeding of pelvic vessels are

very difficult rather unmanegable.Therefore these vessels are suggestive for

parswasandhi marma.

 

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The common iliac artery bifurcates into external and internal iliac artery at the

point superior 1/3rd (2 inch) of the imaging line drawn on the surface of the abdomen

joining the point of aortic bifurcation (3/4th inch below the umbilicus ) and mid inguinal

point.the diameter of the aorta and inferior venacava are approximately 1 inch each.The

course of these vessels are also comparable with the description of sushruta’s

parswasandhi marma. The gunshot wound to the pelvis involving the pelvic vessels by

missiles of bone or pallets is a challenging problem for the trauma surgeon even though

the fatality is quite high.

 

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“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 36 

Flow Chart No.10

 

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5.BRAHATI MARMA:

Location:58

Just opposite the stanamula bilaterally on the back are brahati marmas. The injuries of the

region has high tendency of severe bleeding resulting to complications and terminates

into death.It is kalantara pranahara, sira marma structurally.

This word derived from the Sanskrit root Brahat means huge. The region of this

marma is back of the thorax. Its surface anatomy is the area on the surface of the back

corresponding to nipples. The anatomical structure responsible for the traumatic result is

sira (vessels)and the delayed death (kalantara pranahara).

Pramana:59

Half Anguli Pramana on both sides of the Poster-interior part of the Thoraco-

abdominal cavity. It is approximately 1cm diameter circular area of the Thoraco-

abdominal cavity.

 

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Flow Chart No.11

Dr. H.P Sharma has translated this marma into anastomoses around the scapula. Dr.R.R

pathak has discussed for the vessels at the hilum of the liver at right side and vessels at

the hilum of spleen at left side.

 

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Etymologically the word brahati denotes symbolic number 36, or part of the body

between the breast and back. Hence the base of the lungs, diaphragm and the bare area at

the inferior angle of scapula with sub scapular artery or intercostals vessels behind the

pleura in the intercostals space may be included in this marma. An injury to this marma

may produce the excessive bleeding leading to serious complications. It has been

measured ardhangula in pramana by all classical books. Dr Pathak has mentioned it is

half an inch.

Dr Sharma and Ghanekar opines that anastomosis around the scapula. May

correlated to this marma. Dr. V.S Patil has included base of the lungs, bare area at the

inferior angle of the scapula, diaphragm or intercostals muscles behind the scapula are

responsible for this marma.

The triangle of auscultation lies behind the scapula bounded above by trapezius,

below by latissimus dorsi and laterally by the vertebral border of scapula and the exposed

part of the rhomboideus muscle, However the triangle of auscultation is the area of

choice where sixth inter costal artery lies in the sixth intercostal space within the triangle

of auscultation in its approach from below upwards oblique to run in the sixth costal

groove at the angle of the rib. If this artery ruptures leads to intrathoracic hemorrhage

complications leading to death. The penetrating injury on the back of the chest usually

complicates due to uncontrollable bleeding. The fracture of the lower part of the scapula,

bullet or fractured rib usually produces complications.

 

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Flow Chart No.12

 

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6.AMSA PHALAKA MARMA:

On the dorsal aspect of the body the marma is associated with trika.60It is asthi

marma . Injury to this leads to muscular atrophy and loss of sensation or numbness to

related area.

Location:61

It is located in prushtha ( posterior aspect of thorax) on both sides of the prushtha

vamsha(vertebral column) related to the “Trik”.

Pramana 62

Half Anguli Pramana near to the superior angle of the scapula, a circular area is

made with 1cm diameter. Below this cervical enlargement of spinal cord is situated.

According to Prof. J.N Mishra this marma considered,The amsaphalaka marma is

somewhere in the superior part of the back, It lies in both lateral sides of the vertebral

column, This marma is in the close relationship with scapula.

The nerve supplying the upper extremity is an essential part of the marma,

because any injury to this marma may cause atrophy of muscles those are attached to the

amsaphalaka and numbness of the upper extremity. Therefore this can be taken as the

site of the suprascapular notch is the anatomical site where all the above said conditions

can be found with this fact.

According to sushruta the marma is an asthi marma. This statement is doubtful

because traumatological effect of this marma cannot be correlate with this. The wasting

 

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and numbness is possible only after the involvement of nerve supplying to the upper

extremity. Probably the above said version of sushruta was based on the presence of the

scapula in the close relationship with this marma. Sushruta has said that any injury to this

marma causes numbness (swapa) and wasting (shosha ) of the upper extremity.63This is

reliable because an injury to this marma may damage to the branches of the brachial

plexus along with the damage of supraclavicular nerve and artery the damage may

follow-

If foreign body penetrates the deeper parts severe damage of the brachial plexus is

possible this will lead to paralysis of the upper extremity.

If foreign body penetrates the deeper parts leaving light impact, moderate damage

of brachial plexus is possible.

If foreign body penetrates to the superficial part damage to the suprascapular

nerve and artery will be resulted. This will cause paralysis of abductor muscles of the

shoulder joint along with wasting of the same.

 

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Flow Chart No.13

 

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Viddha lakshana

1. Samanya lakshana64

a. Patient will not die after injury to the Amsaphalaka Marma, but leads to vikalata.

b. Pain due to increased Vata.

2. Vishesha lakshana65

a. Bahu shosha – Bahu means arm region, but Dalhana commentary gives the idea as

upper limb. This is because depend on the involvement of Brachial plexus branches.

b. Bahu shopha – As arm atrophy. This is due to involvement of all the upper limb motor

nerves ( Radial, Ulnar, Median, Musculo cutanious nerves).

3. Antah (peripheral region) and Madhya Viddha lakshana.

a. Madhya Viddha lakshana – cardinal symptoms, means bahu shosha as a deformity.

b. Anth Viddha lakshana- converted in to Rujakara Marma, the person feels pain for

long duration. This will cause numbness and wasting due to partial loss of functions.

 

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Flow Chart No.14

 

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7. AMSA MARMA:-

It is situated between the root of the arm on one side and the neck on the other.

This ties shoulder and amsapeetha together. Here there are ligaments binding the scapula

with the clavicle. Injury to this marma, results in stiffness of the limb with loss of

function66. It includes all the soft tissues like muscles, tendons,ligaments etc, which take

part in the formation of shoulder joint with scapula. An injury to these structures may

cause rupture of the muscles, ligaments resulting in dislocation of joint,that leads to loss

of function of the shoulder joint.

According to vagbhata the injury to Amsa marma leads to bahukriyahara i.e loss

of function of upper limb.67 Amsa marma includes the structures related to shoulder

region are the most exposed area to common injuries. The activities like weight lifting,

swimming, cricket, fall on the outstretched arm causes the rupture of ligaments and

muscles of the shoulder joint, leads to the disability of the amsa sandhi and

bahustabdhata.

 

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Flow Chart No.15

 

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Definition of Stabdhabahuta:

This term is mentioned in Su.Sa. Sha.6/35, while explaining about the

Amsamarmabhighata, he says injury to the Amsa marma leads to the Stabdhabahuta,Here

the broad meaning of stabdhabahuta is “Bahukriyanasha”according to Ayurveda

Shabdakosha,that means loss of functions of the upper limb.Accoding to A.Hru. Sha

traumatological effect of Amsa marma is ‘Bahukriyahara’ means same as that of the

meaning of stabdhabahuta. Lastly we can consider the Stabdhabahuta is the impairment

of the upper limb.

Causes for the stabdhabahuta:

Mainly due to the abhighata to the Amsa pradesha, in modern era the injuries

like,

1. Sports injuries

2. Heavy weight lifting

3. RTA (Road traffic accidents)

4. Fall on the outsretched arm

5. Over exertion

Samprapti of Stabdhabahuta:

Here the Stabdhabahuta is not a disease, it is a symptom where the

Amsamarmabhighata takes place.According to Gayadas in Nyayachandrika of Su.sa Ni

1/82 The major structural impairment in the conjoined structure of shoulder or Amsa is

 

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due to Amsastha shleshma or shleshaka kapha. Vitiation of the shleshma leads to the

dryness of the Amsabandhana and lastly emaciation of Amsa pradesha takes place-

ultimately it leads to deformity of the shoulder, However the samprapti of stabdhabahuta

is shown in the flow chart 16.

Clinical features of Stabdhabahuta:

Samanya marmabhighata laxana are:67(1)

1. Vicheshtana

2. Urdhvavata

3. Vayukruta tivra ruja

4. Stabdhata

5. Kriyanasha

Amsa marma is a snayu marma structurally, it measures about half anguli, if injury to the

Snayu marma leads to the following laxanas-67(2)

1. Koubjyam (Shortening)

2. Shareeravayavasaada (svakarmanyaasamrthyam)-loss of functions

3. Kriyasvashaktiriti (Loss of movements like Abduction, Adduction, Flexion

extension etc,)

4. Ruja (Pain)

 

 

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Flow Chart No.16

 

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AMSA PRADESHA:-

Before dealing with the Amsa marma let us know the shoulder & scapular region

according to Ayurvedic scholors.

In amsa pradesha includes nine structural complexes are present. Those are as

followes–Amsa,amsakuta,

amsadesha,amsapinda,amsapeetha,amsaphalaka,amsabandhana,Amsamul & amsasandhi.

These are described according to different Ayurvedic scholors. These terms has been

explained in the sushruta samhita-sutra, shareera, nidana,chikitsasthana, charaka vimana

sthana,vagbhata shareera & nidana sthana.

The dictionary meaning of amsa term is Bhuja,shira,and skandha, “Asyate

samahanyate bharadina”functionally this region is responsible for the weight bearing

part.

This site consists of certain important structures-bones, ligaments, vessels and

nerves.

Bones: Parts of the scapula,clavicle,and upper part of the humerus.

Joints: Shoulder joint

Acromioclavicular joint

 

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Ligaments & muscles:

(1) Coracoacromial ligament

(2) Capsular ligament

(3) Glenoid labrum

(4) Transverse humeral ligament

(5) Bursae-8

(6) Rotator cuff muscles & associated muscles

By observing these structures we can consider that this site is vital one, because injury to

this leads to loss or deformity of the upper limb i.e nothing but the stabdhabahuta or

Bahukriyahara. Based on their references we will come to know that Amsa marma is the

complex structure.

Let us discuss one by one, among the nine terms as according to ayurvedic

scholors.

1. Amsa

Amsa is included under the prushtha marma 68

Among them amsaphalaka is an Asthimarma, but the amsa marma is snayu marma. 69

Amsa marma is a snayu marma structurally, If we discuss about snayu based on

many references (shastracharchaparishad) we can call it as ligament, somewhere it is

considered as nerve or tendon. But depending upon the situations we can name it to

 

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different structures as above said, traumatic effect on amsa marma (snayu) leads to the

functional deformity so, it is known as VAIKALYAKARA MARMA.

Vaikalyakaramarma kalantaram kleshayati rujaam cha karoti.70

All the vaikalyakara marma are later converted into rujakara one. By this reason

this marma can neigther be considered as nerve or tendon,but this may be considered as

complex structures like ligaments, muscles, tendons, bursae & nerves, Hence amsa

marma is the CORACOACROMIAL ARCH or ACROMIOCLAVICULAR JOINT or

SUBACROMIAL BURSA. Based on these observations without any disputs, we can

confine it to SHOULDER REGION, ACROMIAL REGION & SCAPULAR

REGION(PRATYKSHA SHARIR).

According to Kashyapa samhita sutrasthana laxanadhyaya, The amsa term is

mentioned, as -“shushkamsah daridra….. snigdhamsah krushaka,peenamsa adhya,

kathinamsah shura, shithilamsoashakta, unnatamsah puman prashasyate, brashtamsa

kanya.”71

Based on this explaination of Kashyapa we can consider it as shoulder and

acromial region.

According to Charaka vimana sthana while explaining the pramana sharira he

mentioned “ ashthangulou skandhou shadangulou amsou.”72

8 Angula-skandha

6 Angula-amsa

Based on this anthropometry

 

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Skandha kshetra is scapular region

Amsa kshetra is Acromial region.

2. Amsakuta

This term can be seen in the sushruta shareera 6 chapter

In A. Hru.sha-4/16

Apalapa is one of the sira marma, traumatic effect of this marma fills the blood in

the thoracic cavity later is converted into pus formation lastly leads to death. Here,

Anatomically the Apalapa is the beginning part of lungs or pleural sac, Exactly above the

apalapa is the AMSA KUTA or ACROMION REGION73,74.

The kuta is considered as Acromion process of the scapula which is very

prominent structure in the shoulder region.

3. Amsadesha

Here Desha means place or region.“Amsa desha” is that area where the amsa has

spreaded its vicinity.This term has been mentioned in the sushruta Nidanasthana 1st

chapter.Here in Amsa desha – emaciation of structure which bind the amsa i.e

AMSABANDHANA takes place.and constriction of the siras related to Amsa takes

place.This clinical feature is known as Avabahuka.75According to Dalhana the definition

of amsadesa is

“Amsasameepopalakshito deshoamsadesha”76

The area which is superior to Amsa is Amsadesha. Due to the effect of aggravated

vata over conjoined structures of Amsa and related vessels and nerves has been said to be

 

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the cause for the manifestation of Avabahuka. We can compare to the brachial plexus

palsy to the Avabahuka. Where the compression of brachial plexus and related blood

vessels takes place.

Here the amsabandhana is the conjoined structures of shoulder joint (Amsasandhi)

related ligaments and muscles of the shoulder region i.e Rotator cuff.

Hence area occupied by the Rotator cuff muscles, axillary vessels and ligaments

related to the shoulder joint and injury to this leads to loss of functions of Bahu is known

as Avabahuka or were the amsa marma is also present. Overall that area is Amsa desha or

shoulder region.

4. Amsapinda

In Sushruta shareera 5th chapter,whIle explaining “SHODASHA KANDARA” he

described the praroha and he named Amsapinda as Agrapraroha, and Dalhanacharya

clearly explained this term as77

“Hastagatanaam chatusrunamuparigatanamamsapindo bahushiro agrapraroha iti.”78 Here

Bahushira is the synonyme of amsa. No doubt here amsa panda is rounded structural

area and above that area kandaras or prarohas are converged,Bahushira (Part of Amsa) is

the spherical shaped structure containing muscles.

The area over the greater tuberosity of humerus which is attached with the deltoid

muscle is called deltoid prominency. So it bears spherical shape i.e Amsapindika.

 

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5. Amsapitha

According to Gananathsen saraswati,glenoid cavity is compared to the Amsapeetha.

Again this term has been explained in Sushruta sutrasthana and sharir sthana-

(1) While explaining the Anga-pratyanga measurement, Sushruta has quated.

(2) While explaining the types of sandhi-he quated “Amsapeethagudabhaganitambeshu

saamudgah.” 79

By observing these quotations the anthropometry inbetween Amsa peetha and

kurpara is 16 angula,and here we can consider amsapeetha as a exterior border of the

scapular and shoulder region.80 We can give another openion; Inbetween Amsapeetha

sandhi and kurpara sandhi 16 angula length. But Dalhanacharya commentated Amsa

peetha as Bahushira i.e

“Amsapeetho Baahushirah;” and amsapeetha sandhi as one of the type of ‘Saamudga

sandhi’ But the dictionary meaning of peetha is Aasanam & Saamudga is Samputaka, 81

However the area of amsapeetha is accomodates in the area of Amsa.

Hence, By observing above said explaination we can consider Amsapeetha as

scapula and Amsapeetha sandhi as Acromioclavicular joint, because it is one of the

Saamudga sandhi and it is situated just above the shoulder joint.

By discussing all these points based on the quotation of AMSA MARMA in Su.Sa. sha-

6th chapter and A.Hru.Sha 4th chapter we will come to know that all above said structures

like Amsa peetha,bahushira etc…are included under the Amsa marma.

 

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6. Amsaphalaka

In Kashyapa Samhita sharira sthana while explaining the Asthi sankhya,he

mentioned Amsaphalakas are Asthi they are two in number.

“Dwaamsavamsaphalakaavapi dwaveva chakshakou.”82

According to him amsa-2

Amsaphalaka-2

Akshakasthi-2

Here,we should think about the Amsa because he considered these are also asthi and 2 in

number. But these structures or parts we can include under the spines of scapula,

according to sushruta a mass are included under the kapalasthi.

Finally we can consider Amsa as acromion process and Amsaphalaka as scapula.

7. Amsabandhana

This term already we discussed in the Amsadesha topic.

Sushruta nidana vatavyadhi chapter while explaining the Avabahuka vatavyadhi,he

mentioned the term Amsabandhana-

 

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In the area of the Amsa-underground structures impaired by the aggravation of

vata and rakta due to injury to the amsabandhana that leads to the compression of siras

lastly the disease Avabahuka.83

Here the structures which bind the BAHUSHIRA,AMSAPEETHA, GREEVA

inbetween these the amsa marma is present.the amsa which is bounded by the SNAYU &

PESHI i.e the ligaments of the shoulder joint & Rotator cuff muscles, if injury to these

structures that leads to ‘BAHUKRIYAHARA’ 84or STABDHABAHUTA and lastly

vitiation of the vata and rakta takes place that leads to AVABAHUKA.

According to Gayadas-in Nyayachandrika,

By this quotation we will come to know that the major structural impairment in the

conjoined structure of shoulder or Amsa is due to Amsastha shleshma or shleshaka

kapha. Vitiation of the shleshma leads to the dryness of the Amsabandhana and lastly

emaciation of Amsa pradesha takes place-ultimately it leads to deformity of the

shoulder.85 But according to modern science wasting of muscles are due to the injury of

motor nerve paralysis.

By this explaination we can consider that structures underlying the shoulder and

scapular region are effected, mainly due to the trauma, like Rotator cuff injuries, frozen

shoulder,tearing of ligaments etc….these are resulted into the dislocation of shoulder

joint, ultimately that leads to Bahukriyahara or STABDHABAHUTA.

8. Amsamula

 

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According to Shastracharcha parishad, the amsa mula is correlated into apex of

the axilla.where the brachial vessels and brachial plexus are situated. If injury to this

leads to the paralysis of the upper limb takes place i.e STABDHABAHUTA.

By observing this discussion we can approach that apex of the axilla is included in

the area of the AMSA MARMA

9. Amsasandhi

Amsa sandhi rachana shareera vivechana:

This is a major joint of the upper limb. This is one type of chala and ulookhala

sandhi. This joint is formed by the articulation of Pragandasthi, Akshakasthi and

Amsaphalakasthi.

Pratanavati type of Snayu covers this Sandhi. Acharya Sushruta states that

Snayu is binding material of Mamsa, Asthi and Medha. Like a boat made up of planks

and timber, tightened together by means of large number of bindings is enabled to float

on the water and to carry cargo. Similarly in the body all the Sandhis are tightened up by

large number of Snayus, which enables the body to bear the weight.

Sheshmadhara Kala is present in this joint and seceretes shleshaka kapha. this

act as a lubricant for the joint and helps in protection and movements of the Sandhi.

Acharaya Sushruta has described that the rachana of Sandhi as like a wheel having an

axis. When the axis is lubricated by putting oil on it, the wheel can move freely and

friction does not occur. In the same way the bones or joints can move freely in the

presence of Shleshma.

 

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The word Amsa denotes the shoulder; the Amsa Marma is situated within the

line of the area joining head (murdha). Neck (Greeva) and the arm (bahu). This is a

Snayu Marma to a length of half fingers width (1 cm).

The physical matrixes that are present in amsa marma are Mamsa, Sira, Snayu,

Sandhi and Asthi. It is one of Vaikalyakara marma, and trauma to this will produce

disability of the shoulder joint.

Location & Pramana of Amsa marma87

To make the limitations of Amsa marma, we should know about the classical

definition of amsa marma which correlates with the modern science.

• Bahumurdha (Amsapindika)- Deltoid prominency-1st point

• Amsapitha- Upper 1/4th of .Exterior border of the scapular and shoulder

region-2nd point

• Skandha-shoulder joint-3rd point

• Greeva -Root of the Neck-4th point

• Amsabandhana-Soft tissues of shoulder & scapular region which hold the

above said points.

Joining of all these points one by one and make the half angula point at the

centre of all above said structure,that forms the Amsa marma.

 

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Figure No: 1 Limitations of Amsa marma

 

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MODERN REVIEW  

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MODERN REVIEW

Modern review of katikataruna, kukundara and Nitamba marma:

ANATOMICAL REVIEW OF GLUTEAL REGION:

The Gluteal region forms the prominence at the upper posterior parts of lower

limb.Gluteal maximus is the largest muscle of the region which indirectly extends till the

tibia bone, so that it can act simultaneously on both the hip and knee joints.

The ischial tuberosity on which one sits underlies this muscle. The gateway to the

gluteal region, the greater sciatic notch; the thickest nerve of the body, the sciatic nerve,

also lie beneath this huge antigravity postural muscle. One neurovascular bundle formed

by pudendal nerve and vessels just appear into the gluteal region from the sciatic notch to

disappear fast through the lesser sciatic notch to supply anything and everything in the

region of the perineum.

INTRODUCTION:

The gluteal region overlies the side and back of the pelvis,extending from the iliac

crest above to the gluteal fold below. The lower part of the gluteal region which presents

a rounded bulge due to the excessive amount of subcutaneous fat is known as buttock or

natis. The anterosuperior part of the region seen in a side view is called the hip. The

muscles, nerves and vessels emerging from pelvis are covered by gluteus maximus and

buttock.

 

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SUPERFICIAL FASCIA:

It is heavily laden with fat, more so in females, and is tough and stringy over the

ischial tuberosity where it forms an efficient cushion for supporting the body weight in

the sitting posture, It contains cutaneous nerves, vessels and lymphatics.

DEEP FASCIA:

The deep fascia above, and in front of the gluteus maximus i.e over the gluteus

medius, is thick, dense, opaque and pearly white over the gluteus maximus, however, it is

thin and transparent, the deep fascia splits and encloses the gluteus maximus muscle.

MUSCLES OF THE GLUTEAL REGION (Figure no-4)

These muscles are the gluteus maximus, the gluteus minimus, the gluteus

medius,the piriformis, the superior and inferior gemilli, the obturator internus and

externus and the quadrates femoris, the tensor fasciae latae which lies on the lateral side

of the thigh.

ACTIONS OF THE GLUTEAL REGION:

The muscles of the gluteal region form only three functional groups

The gluteus maximus is the chief extensor of the thigh at the hip joint.

The gluteus medius and the gluteus minimus are powerful abductors of the thigh.

Remaining are the lateral rotators of the thigh.

The tensor fasciae latae is an abductor and medial rotator of the thigh and extensor of

knee.

 

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STRUCTURES DEEP TO THE GUTEUS MAXIMUS:-

Muscles:-

(1) Remaining all gluteal muscles.

(2) Origin of the four hamstring muscles from the ischial tuberosity.

(3) Insertion of the pubic fibres of the adductor magnus.

(B) VESSELS (Figure no-6)

(1)Superior gluteal vessels

(2)Inferior gluteal vessels

(3)internel pudendal vessels

(4)Ascending branch of the medial circumflex femoral artery.

(5)Trochenteric anastomoses,formed by the descending branches of the superior

gluteal artery

The ascending branches of the medial and lateral circumflex femoral artery.

(C)NERVES:-(Figure no-5)

Superior gluteal(L4,5, S1)

Inferior gluteal (L5, S1, S2)

Sciatic (L4,5,Si,2,3)

Posterior cutaneus nerve of the thigh(S1,2,3 )

Nerve to the quadrates femoris (L4,5,S1)

Pudendal nerve (S2,3,4)

Nerve to the obturator internus(L5,S1,S2)

 

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(D)BONES & JOINTS (Figure no-2,3)

(1)Ilium (2)Ischium with ischial tuberosity;

(2) Upper end of femur with the greater trochanter;

(3) Sacrum and coccyx

(4) Hip joint and sacroiliac joint

(E)LIGAMENTS:- (Figure no-7)

(1) Sacrotuberous

(2)Sacrospinous and

(3)Ischiofemoral

CLINICAL APPLICATION OF THE GLUTEAL MUSCLES:-

Intermuscular injections are given in the anterosuperior quadrant of the gluteal

region,i.e in the glutei medius and minimus, to avoid injury to large blood vessels and

nerves which pass through the lower part of this region.

When gluteus maximus is paralysed as in muscular atrophy, the patient cannot

stand up from a sitting posture without support. Such patients, while trying to stand up,

rise gradually, supporting their hands first on the legs and then on the thighs; they climb

on themselves.

When the glutei medius and minimus are paralyzed, the patient cannot walk

normally, He sways or waddles on the paralysed side to clear the opposite foot off the

 

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ground, this is known as LURCHING GAIT; when bilateral it is called WADDLING

GAIT.

These all are we can apply to the traumatological effect of lower three paired

marmas of the back i.e kukundara, kateekataruna & nitamba marma

MODERN REVIEW OF PARSHWASANDHI MARMA

The parshwasandhi marma is the area lying inside the abdomino-pelvic cavity at

posterior wall. It is placed obliquely from below upwards at the joint where the five

lumbar vertebrae are arranged together in an order and further sacralized, attached to the

lateral side where the bony part is situated. This marma deeply reaches to the posterior

abdomino-pelvic cavity.

By observing this explanation, the parshwasandhi marma may be considered as

the vessels related to the posterior abdomino-pelvic cavity i.e major vessels are the

common iliac artery which bifurcates into external & internal iliac artery and inferior

vena cava.

The associated structures involved in this marma are:

MUSCLES:

(1) Psoas major

(2) Psoas minor

(3) Iliacus

(4) Quadratus lumborum

NERVES:

(l) Lumbo-sacral plexus

(2) Lumbar sympathetic chain

 

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VESSELS:

(1) Abdominal aorta & its branches

(2) Bifurcation of common iliac artery

(3) Inferior vena cava & its tributaries

Organs of urinary system (Ureter, urinary bladder, etc)

MODERN REVIEW OF BRAHATI MARMA

The brahati marma is the area lying in the triangle of auscultation which lies

behind the scapula, bounded above by trapezius, below by latissimus dorsi and laterally

by the vertebral border of scapula and the exposed part of rhomboideus muscle.

The vessels of this area may be directly correlates to the brahati marma i.e 6th

intercostal vessels,deeply related to the branches of celiac trunk i.e hepatic artery, splenic

artery and portal vein.

The associated structures involved in this marma are:

MUSCLES: (Figure-4)

1. Trapezius

2. Latissimus dorsi

3. Levator scapulae

4. Rhomboideus major

5. Rhomboideus minor

6. Erector spinae

NERVES:

1. Intercostal nerves (6 & 7th )

 

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2. Sympathetic chain

VESSELS ( Figure no-12)

1. Intercostal vessels(6 & 7th )

2. Anastomotic branches of scapula

3. Branches of coeliac trunk

VISCERA:

1. Base of the lungs

2. Liver at right side

3. Spleen at left side.

MODERN REVIEW OF AMSAPHALAKA MARMA

In the posterior part of the thoracic cavity on both sides of the vertebral column,

near to the shoulder joint, flat type of bone is present which is called by the name

“Scapula” and the region is called “Scapular region”.

In the scapular region, predominantly scapula along with the ribs and vertebral

bones forms one Asthi marma, which is by name “Amsaphalaka marma”(Figure no-9)

It extends from C6 vertebral body to T12 vertebral body. In this region- vertebrae,

ribs and angle of the scapula come together. So the location of Amsaphalaka on both

sides of vertebral column is related to the “Trika”.

Structures associated with the Amsaphalaka marma:

MUSCLES: (Figure no-10)

1. Rhomboideus major

2. Rhomboideus minor

3. Serratus anterior

4. Serratus posterior inferior

 

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5. Teres major

6. Teres minor

7. Trapezius

8. Infraspinatus

NERVES (Figure no-11)

Brachial plexus

ARTERIES (Figure no-12)

1. Axillary artery

2. Scapular, circumflex artery

3. Scapular, dorsal artery

MODERN REVIEW OF AMSA MARMA (SHOULDER REGION)

JOINTS OF THE SHOULDER GIRDLE:- (Figure no-13)

The shoulder or pectoral girdle connects the bones of the upper limb with axial

skeleton. The girdle consists of clavicle and scapula. The clavicle meets the sternum at

the sternoclavicular joint,and unites with the scapula at the acromioclavicular joint. The

scapula has no direct connection with axial skeleton, but is attached to the latter only by

the muscles. The glenoid cavity of the scapula articulates with the head of the head of the

humerous to form the shoulder joint.

The joints of the shoulder girdle, strenoclavicular and acromioclavicular, always

permit the movements of the clavicle and scapula. Moreover, they facilitate the

movements of the shoulder joint in raising the arm above the head.

STERNOCLAVICULAR JOINT:-

It is a saddle type of synovial joint.

Bones forming the joint:-

 

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1. Sternal end of the clavicle, which is covered by a fibrocartilagenous; the articular

surface is convex from above downwards and slightly concave from before

backwards.

2. Clavicular notch of manubrium sterni and upper surface of the first costal cartilage

from a continuous articutar surface covered by fibrocartilage.

LIGAMENTS:-

1. The capsular ligament:Envelops the joint and is attached to the peripheral margins of

the articulating bones.The capsule is thickened infront and behind by the anterior and

posterior sternoclavicular ligament;below it is composed of loose areolar membrane.

2. The fibres of anterior and posterior sternoclavicular ligaments slope downwards and

medially and resist medial displacement of clavicle.

3. The articular disc,made of fibrocartilage,intervenes between the clavicle and the

sterna notch. It is attached above to the posterosuperior part of the sterna and of the

clavicle below to the first costal cartilage, and at the periphery blends with the fibrous

capsule.

The disc divides the joint into a supero lateral or meniscoclavicular compartment,and

an infero medial or meniscosternal ciompartment,the around the lateral compartment is

more lax than that of medial compartment.The articular disc prevents medial

displacement of clavicle when a force is applied to the shoulder region.

1. Interclavicular ligament:-stretches across the suprasternal notch and connects the non-

articular upper part of sterna ends of both clavicles. Some fibres gain attachment to

the suprasternal notch of manubrium.

 

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2. Costo-clavicular ligament:- It is attached below to the first costal cartilage and its

rib,and above to a rough impression on the inferior surface close to the sternal end of

clavicle, the ligaments consists of anterior and posterior laminae which fuse laterally;

medially they are separated by a bursa and merge with the capsule.The fibres of the

anterior lamella are directed upwards and laterally,and those of the posterior lamella

upwards and medially. The costoclavicular ligament acts as a fulcrum for the

translator and rotator moements of the scapula.

ARTERIAL SUPPLY:-

From internal thoracic and suprascapular arteries;

NERVE SUPPLY:-

From medial supraclavicular nerve and nerve to the subclavius.

ACROMIOCLAVICULAR JOINT:-

It is a plane synovial joint. Bones forming the joint are the lateral end of the clavicle,and

clavicular facet on the medial margin of the acromial process of scapula.

Both bones possess small, oval articular surfaces which are covered with fibrocartilage.

The clavicular facet laterally and downward to meet the acromial facet which inclined in

opposite direction. Therefore in dislocation of the joint the acromial process is driven

below the lateral end of the clavicle. Sometimes the joint cavity is divided by an

incomplete articular disc(meniscus) which projects from the upper part of the fibrous

capsule.

 

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LIGAMENTS:-

The joint posseses fibrous capsule and coraco-clavicular ligament.

The fibrous capsule envelops the joint and is attached to the periphery of the articular

surfaces of both bones. The capsule is thickened above to form the acromio-clavicular

ligament.

Coraco clavicular ligament:-

The ligament consists of two parts-conoid and trapezoid,

The trapezoid part is attached, below to the upper surface of the coracoid process; and

above to the trapezoid line on the inferior surface of the lateral part of the clavicle.

The conoid part is inverted cone, Its apex is attached to the root of the coracoids process

above the supra-clavicular notch and its base is attached to the conoid tubercle of the

medial 2/3rd and lateral 1/3rd of the bone.

BLOOD SUPPLY:-Suprascapular & Thoraco-acromial arteries.

NERVE SUPPLY:- Lateral supraclavicular nerve.

MOVEMENTS OF THE SHOULDER GIRDLE:-

Movements at the two joints of the girdle are always associated with the movements of

the scapula.The movements of the scapula may or may not be associated with the

movements of the shoulder joint.

The various movements are

 

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(1) Elevation of the scapula

(2) Depression of the scapula(Drooping of the shoulder )

(3) Protraction of the shoulder(as in pushing and punching movements)

(4) Retraction of the shoulder(squaring the shoulders)

(5) Backward movement of the scapula.

Anatomy of the Shoulder Joint:

This is a synovial joint of ball and socket variety.

Articular Surface: The joint is formed by articulation of scapula and head of the

humerus. Therefore, it is also known as Gleno Humeral articulation.

Structurally it is a weak joint; because Glenoid cavity is too small and shallow to hold the

head of the humorous in the place (the head is four times larger than the size of the

glenoid cavity). However this arrangement permits great mobility, stability of the joint is

maintained by the following factors.

1. The coracoacromial arch or secondary socket for the head of the humorous.

 2. The musculotendinous cuff of the shoulder

3. The Glenoid labrum helps in deepening the Glenoid fossa. Stability is also provided

by the muscle attaching the humorous to the pectoral Girdle, the long head of the

biceps, the long head of the triceps and atmospheric pressure.

Ligaments of the Joint: Fig No 15

 

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1. The capsular ligament: It is very loose and permits free movements. It is least

supported inferiorly where dislocation may damage the closely related axillary nerve.

2. The Glenoidal Labrum: It is a fibro cartilaginous rim, which covers the margins of

the glenoid cavity, thus increasing the depth of the cavity.

3. The Coracohurmeral Ligament: It extends from the root of the coracoid process to

the neck of the humerus opposite to the greater tubercle. It gives strength to the

capsule.

4. Transverse humeral ligament: It bridges the upper part of the bicipital groove of the

humerus (between the greater and lesser tubercle). The tendon of the long head of the

biceps brachi, passes deep to the ligament.

Bursae Related to the Shoulder Joint: (Figure no-14,16)

1) The sub acromial (sub deltoid) bursa.

2) The Sub Scapularis bursa, communicates with the joint cavity.

3) The infraspinatus bursa, may communicate with joint cavity.

4) Several other bursae related to the coroco brachialis, teres major, long head of the

triceps, latissimus dorsi, and the coracoid process are persent.

Relations:

Superiorly: Coracoarcomial arch, sub acromial bursa, supraspinatus and deltoid.

Inferiorly: Long head of the triceps.

Anteriorly: Sub Scapularis, corcao brachialis, short head of biceps and deltoid.

 

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Posteriorly: Infraspinatus, teres minor and deltoid within the joint tendon of the long

head of biceps brachii.

Blood Supply:

Anterior circumflex humeral artery

Posterior circumflex humeral artery

Subscapular artery

Suprascapular artery.

Nerve Supply:

Axillary Nerve

Musculocutaneous Nerve

Suprascapular Nerve  

Movements at the Shoulder Joint (Figure no-17)

The shoulder joint enjoys great freedom of mobility at the cost of stability. There

is no other joint in the body which is more mobile than the shoulder. This wide range of

mobility is due to laxity of its fibrous capsule, and large size of the head of the humorous

as compared with the shallow glenoid cavity. The range of movements is further

increased by concurrent movements of the shoulder girdle.

Movements of shoulder joint are analyzed as follows.

1. Flexion and Extension: During flexion the arm moves forwards and medially and

during extension the arm moves backwards and laterally. The flexion and extension

take place in a plane parallel to the surface of the Glenoid cavity.

 

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2. Abduction and Adduction: This takes place at right angles to the plane of flexion

and extension (i.e.-approximately midway between the saggital and coronal plane).

In Abduction, the arm moves antero-laterally away from the trunk. This movement

is in the same plane as that of the body of scapula.

3. Medial and lateral Rotation are best demonstrated with mid-flexed elbow. In this

position the hand is moved laterally in lateral rotation of the shoulder joint. And

hand moved medially is medial rotation.

4. Circumduction is the combination of different movements as a result of which the

hand moves along the circle.

5. Elevation: Elevation is an upward movement of a part of the body. Here arm is

taken upwards.

The Range of any movement depends on the availability of an area of free articular

surface on the head of the humerous. It may be noted that the articular area on the head

of the humerous is four times larger than that of the Glenoid cavity.

Table No 7: Muscles acting on Shoulder Girdle. (Figure no-18)

Muscles Origin Insertion Action on Shoulder

Pectoralis major Clavicle medial 2/3, sternum and costal

cartilages 1-6.

Humorous, crest of greater tubercle

Flexion & medial rotation. Adduction & medial rotation.

Lattisimus dorsi Lower ribs, iliac crest.

Humorous inter tubercular groove.

Adduction, medial rotation, extension

if flexed.

Deltoid Clavicle lat.1/3,

acromion spine of scapula.

Deltoid tuberosity of humerous.

Abduction, extension, & lat.

Rotation. Biceps brachii

Short head Long head

Coracoid process Supraglenoid

tubercle

Radius Radius

Flexion Stabilization

Coracobrachialis Coracoid process Humerous middle body Flexion

 

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Teres major Inf. 1/3 margin of scapula

Crest of lesser tubercle humerous

Adduction, medial rotation.

Teres minor

Scapula, superior 2/3 lat. margin

Humerous greater tubercle post. surf.

Lateral rotation, stabilization

Supraspinatus

Scapula, supra spinous fossa

Humerous greater tubercle sup.

Surface

Abduction, stabilization

Infraspinatus

Scapula, infra spinous fossa

Humerous greater tubercle

post.surface

Lat.rotation, stabilization

Subscapularis Scapula, subscapularis fossa

Humerous lesser tubercle.

Med.rotation, stabilization

Analysis of abduction at the shoulder occurs through 90 degrees. The movement

takes place partly at the shoulder joint and partly at the shoulder girdle (forward rotation

of scapula round the chest wall). The humerous and scapula move in the ratio 2:1

throughout abduction, for every 15 degree of elevation, 10 degrees occur at the shoulder

joint and 5 degrees are due to movement of the scapula is facilitated by movements at the

sterno-clavicular and acromio-clavicular joint.

The articular surface of the head of the humerous permits abduction of the arm only

up to 90 degrees. At the limit of this movement there is lateral rotation of the humerous

and the head of the bone comes to lie deep to the coraco-acromial arch. Abduction is

initiated by the supraspinatus, but the deltoid is the main abductor. The scapula is rotated

by combined action of the trapezium and serratus anterior.

MODERN REVIEW OF AMSA MARMABHIGHATA:- (injuries around the

shoulder)

(1) Fracture of the clavicle

(2) Injury to the Acromioclavicular joint

 

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(3) Injury to the Sternoclavicular joint

(4) Proximal humerus fractures

(5) Dislocation of shoulder

(6) Fracture of the scapula

(7) Rotator cuff tear

(8) Frozen shoulder

Here we are not including the Fracture and dislocation as the

Amsamarmabhighata, because the predominant structure of Amsa marma is Snayu

marma,but we can consider these are the complications of Amsamarmabhighata,

remaining are the traumatological effect of amsa marmabhighata as above mentioned.

Soft Tissue injuries Around the shoulder joint:-

The painful shoulder:

Shoulder pain is the second most common musculoskeletal problem (Back pain is

the most common) seen by primary care physicians the most common causes of painful

shoulder in adults are disorders of the rotator cuff, particularly the supraspinatus tendon.

Although conditions such as painful arch syndrome, impingement, rotator cuff tears and

cuff tear arithritis are often considered as separate conditions, in reality they are part of a

spectrum of disorders of the supraspinatus tendon. Other causes of shoulder pain include

calcified tendinitis, frozen shoulder and degenerative disease.

SUPRASPINATUS SYNDROME (Figure no-19)

 

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CAUSES:-

(1) Minor tear of supraspinatus tendon

Trauma due to fall

Small strain where a predisposed degenerative tendon.

(2) Supraspinatus tendinitis

Inflammatory reaction due to a trauma with a history of degeneration or not.

(3) Calcified deposite in supraspinatus tendon.

(4) Subacromial Bursitis

Due to mechanical irritation, but bursal wall inflamed and thickened.

(5) Injury of greater tuberosity

Undisplaced fracture of greater tuberosity.

CLINICAL FEATURES:-

Usually young adults between the ages of 25 to45 years are affected.Occasionally older

individuals may be affected.

Symptoms:-

Pain is most important symptom of this condition. Pain is sever in young adults, whereas

pain is dull aching character in old people.

Physical signs:-

 

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The patient holds the arm by the side of the chest in almost immobile position,as

slight movement is painful. Movement of the shoulder joint is very much restricted and is

almost impossible due to pain. Particularly active abduction is very painful.

X-ray shows calcification within the supraspinatus tendon.

The chronicity of the supraspinatus tendinitis, the typical symptom is that patients

get pain in the middle range of abduction, that means in the beginning of abduction there

is no pain,similarly extreme abduction is also painless but the middle of the arc(70 to 120

degree) of abduction is painful and that is why this condition is also called ‘painful

arc’syndrome. (Figure no-20).

SUPRASPINATUS TEAR:-

Supraspinatus tendon may rupture spontaneously or following trivial injury when

this is degenerated with interruption of its blood supply.This usually occurs in the middle

aged or elderly individuals. In case of complete tear, no repair occurs.In case of partial

tear,fibrous repair is possible.Partial tear may ultimately (a) either recover fully or (b)

partly recover with a persistent painful arc of abduction or (c) gradually develop a frozen

shoulder.

Clinical Features: The patients are usually above 45 years of age.

Symptoms:- Following insignificant violence like lifting a weight or even as part of

normal daily activities, such rupture may occur. The patient first complains of sudden

 

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pain in the shoulder, the severity of which varies. After a while pain is relieved

automatically and later on the patient realizes his inability to start abduction of the

shoulder.

Physical signs:-The shoulder looks normal with slight or no tenderness below the tip of

the acromion process.

In case of movement, after some weeks of disappearance of pain, disability varies

according to type of the tear-either complete or partial. With a complete tear the patient is

unable to start active abduction. To rectify this defect the often shrugs his shoulder and

then abducts it. By shrugging the shoulder he creats an angle of 20 degree at the shoulder

joint, after which the deltoid muscle abducts shoulder to its full range. Supraspinatus

muscle is concerned with first 15 degree to 20 degree abduction and the patient is unable

to abduct the shoulder for these initial degrees. Passive abduction of the shoulder, so no

problem and the range is also full and painless. When he lowers the arm, it suddenly

drops-the ‘drop sign’ of complete tear of supraspinatus tendon.

FROZEN SHOULDER:-

This is also known as ‘peri-arthritis’or adhesive capsulitis.

Frozen shoulder is the degenerative process of the supraspinatus tendon following

injury or overuse. The vascular response if this degenerative process gradually involves

the entire tendinous rotator cuff. The cuff becomes thick, vascular and infiltrated with

lymphocytes and plasma cells. Gradually the infra-articular gusset of the capsule

becomes obliterated by adhesion leading to frozen shoulder.

 

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Clinical features:-

This condition affects slightly older individuals than the supraspinatus

tendinitis.Males are more often affected than the females.

Symptoms:-

The patients usually give history of trauma which is often trivial. This is followed

by pain around the shoulder joint.The pain is felt just above the greater tuberosity and

gradually radiates along the outer side of the arm to the back of the forearm and hand.

Gradually the pain increases in severity. Night pain is considerable and often awakes the

patients from fast sleep. Patient also realises stiffness of the shoulder along with the

pain.As the pain gradually subsides after a few months, stiffness increases in severity.

This stiffness continues for a few months and then the movements gradually return

almost to normal. So three phases can be distinguished in the clinical feature-(1)

Increasing pain with slight stiffness;(2) Decreasing pain with increasing stiffness; (3)

Gradual reduction of stiffness to almost normal movement of the joint. Each phase lasts

for about 6 months.

ROTATOR CUFF INJURIES :-

Rotator cuff muscles:- (Figure no-21)

The capsule of the shoulder joint is reinforced by the 4 tendons which form

expansions and blend with the capsule of the shoulder joint.This is known as Rotator cuff

it is called ‘rotator’as these tendons are concerned with rotation of the shoulder joint and

it is called ‘cuff’ as it is like cuff of the shirt covering the capsule of the shoulder

 

Page 101: Prustamarma, sr

MODERN REVIEW  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 82 

joint.The tendon of the supraspinatus superiorly,tendons of the infraspinatus and teres

minor posteriorly and tendon of the subscapularis anteriorly take part in the rotator cuff.

Cause:-

Sudden strain due to trauma

Even mild to moderate injury in an age degenerated tendon.

It is complete tear of tendinous cuff.

Clinical features

Passive movement possible

Men over 60 age

Rarely young patients when trauma is strong

Pain at the tip of shoulder Upper arm

Unable to abduct

Tenderness below the lateral margin of acromion

No initial abduction with supraspinatus

Abduction about 45-60 degree

Able to sustain abduction beyond 90 degree by deltoid action

By all above these conditions we can consider, shoulder pain with immediate trauma or

with a history of trauma.

Many shoulder related post trauma problems are degenerative origin.

 

Page 102: Prustamarma, sr

MODERN REVIEW  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 83 

Such problems are similar to that of post traumatic AMSA MARMA signs.

So This marma correlates to the Snayu marma viddha laxana as mentioned in the Su.Sa.su 25/38

by Dalhanacharya.

Ayama, akshepa, Sthambha, ativedana, bahukriyahara are the signs

NERVE INJURIES RELATED TO SHOULDER REGION:-

The nerves of the shoulder region are mainly the brachial plexus,the lesion of the

brachial plexus may be either complete or partial.

Complete lesion is rare and occurs only after severe injury. It damages all the roots of the

plexus and is often fatal. In this case, there will be anaesthesia of the whole upper limb

except the upper part of the arm which is supplied by C3,4 & 5 and by the

intercostobrachial nerve. There will be complete paralysis of the arm and scapular

muscles.

Incomplete lesion may be due to stabs or cuts and may affect any of the roots. But

the common injury is due to traction or pressure, which affect either the upper or lower

portion of the plexus.

ERB’S PARALYSIS:

Erb’s point is the segment where C5 and C6 roots join to form upper

trunk,suprascapular and nerve to subclaveus are given and ventral and dorsal divisions of

upper trunk start. In injury to this point the abductors and lateral rotators of

shoulder,flexors of elbow and supinators are paralysed.Arm hangs by the side.It is rotated

 

Page 103: Prustamarma, sr

MODERN REVIEW  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 84 

medially extended at elbow joint, pronated at forearm, cutaneous loss on lateral side of

arm and forearm.

KLUMKE’S PARALYSIS:

Damage to C8 and T1 segments is called Klumpke’s paralysis. Small intrinsic

muscles of hand are affected. It leads to ‘complete claw hand’. i.e extension of

metacarpophalangeal joints and flexion of interphalangeal joints, loss of sensation on

medial side of forearm. If T1 is injured proximal to the white ramus communicans to

first thoracic sympathetic ganglion .

SPORTS MEDICINE & BIOMECHANICS:-

Definitions:-

Sports medicine focuses on the physical problems experienced by people whose

tissues are healthy but in whom the level of activity has exceeded the strength of those

tissues.Biomechanics is the study of the physical limits of the human body and is

therefore the basic science underlying sports medicine.

DIAGNOSIS OF SPORTS INJURIES:-

History (onset):

From the history, sports injuries can be grouped according to the type of onset.

• Acute extrinsic injuries are those caused by a direct blow and are commonly cuts

and bruises.

 

Page 104: Prustamarma, sr

MODERN REVIEW  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 85 

• Acute intrinsic injuries are a failure of the human body in response to the ultimate

load of that structue being exceeded. These are commonly ligament strains or

disruptions, dislocations, and fractures with a very different pattern to those seen in

acute extrinsic injuries.

• Chronic injuries have no single moment of onset and are more likely to relate to

fatigue failure of tissues or injury in an area where a previous injury has not yet

completely settled.

Investigations:

The careful clinical assessment of the fuctional stability of an injured muscles

,ligament, tendon etc is far more valuable than expansive imaging techniques, such as

MRI,CT which can be very misleading.

Some disorders related to the sports injuries:

TENDON

Tendons attach muscle to bone and are composed of dense, regularle arranged

fascicle, or groups of collagen bundles.Disorders are:

 

Page 105: Prustamarma, sr

MODERN REVIEW  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 86 

• Paratendinitis

• Paratendinits with tendinosis

LIGAMENTS

Ligaments transmit tensile forces across the joint, define the motion limits of the

bones with respect to each other and guide the relative movements of bones within the

motion limits.The principles of examination of an injured ligament can be applied to any

joint that is readily palpable by direct comparison with the uninjured limb:

• Grade 0: normal ligament , normal joint stability;

• Grade1: tenderness at the site of ligament injury, no detectable increase in joint

laxity while loading the ligament;

• Grade2: Increase in joint laxity but with a solid end point;

• Grade3: significant increase in joint laxity with no end piont.

The stability of joints varies enormously from one individual to the next.women’s joints

tend to be more lax than men’s and all joints become stiffer as we grow older.

BURSAE

Sandwitched between tissues that slide past each other, bursae decrease the

frictional forces present. They are endothelium lined cushions and normally contain little

 

Page 106: Prustamarma, sr

MODERN REVIEW  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 87 

fluid. If they are overloaded they can become inflammed, swollen and very

painful.Althogh the appearance can mimic sepsis,a pathogenic organism is rarely

isolatedin cases of closed injury.

 

 

Page 107: Prustamarma, sr

 PHOTO PLATE NO 86

  

Figure no 3 : PRUSHTHA MARMA 

 

Figure no 4 (BONES & JOINTS) 

 

 

 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 86 

Page 108: Prustamarma, sr

 PHOTO PLATE NO 87

 

 

 

 

Figure no 5 : MUSCLES OF THE GLUTEAL REGION 

 

 

 

 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 87 

Page 109: Prustamarma, sr

 PHOTO PLATE NO 88

Pelvic cavity structures 

 

Figure no 6: NERVES 

 

 

 

Figure no 8: VESSELS 

 

 

 

 

 

 

Figure no 7: LIGAMENTS 

 

Figure no 9: VISCERA 

 

 

 

 

 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 88 

Page 110: Prustamarma, sr

 PHOTO PLATE NO 89

Figure no 10: SCAPULA & RIBS 

 

Figure no 11: MUSCLES OF SCAPULAR REGION 

 

Figure no 12: NERVES 

 

Figure no 13: VESSELS 

 

Figure no  14: SHOULDER GIRDLE‐ ARTICULAR SURFACES 

 

 

 

  Page 89 

Figure no 15: MUSCLES & BURSAE 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

Page 111: Prustamarma, sr

 PHOTO PLATE NO 90

 

 

 

Figure no 16: LIGAMENTS 

 

 

 

 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 90 

Page 112: Prustamarma, sr

 PHOTO PLATE NO 91

 

 

  Page 91 

Figure no‐17: BURSAE & ROTATOR CUFF MUSCLES 

 

 

Figure no 18: MOVEMENTS OF SHOULDER 

JOINT 

 

 

 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

Page 113: Prustamarma, sr

 PHOTO PLATE NO 92

 

  

 

 

  

 

Figure no: 19‐MUSCLES ACTING ON SHOULDER GIRDLE 

  Page 92 

 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

Page 114: Prustamarma, sr

 PHOTO PLATE NO 93

 

 

 

 

Figure no 20: CAUSES OF SUPRASPINATUS TEAR 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 93 

Page 115: Prustamarma, sr

 PHOTO PLATE NO 94

 

 

Figure no 21: PAINFUL ARCH SYNDROME  

  

 Figure no 22: ROTATOR CUFF MUSCLES 

 

Figure no 23: SHOULDER JOINT DIAGRAM:‐

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 94 

Page 116: Prustamarma, sr

 PHOTO PLATE NO 95

 

 

 

Figure no 24: USG OF SHOULDER NORMAL:‐ 

 

 

Figure no 25 : SHOULDER DIAGRAM TRANSVERSE VIEW:‐ 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 95 

Page 117: Prustamarma, sr

 PHOTO PLATE NO 96

 

 

 

Figure no 26: USG OF SHOULDER NORMAL TRANSVERSE VIEW:‐ 

 

 

Figure no 27:  SUPRASPINATUS TENDON FULL TEAR:‐ 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 96 

Page 118: Prustamarma, sr

 PHOTO PLATE NO 97

 

 

 

Figure no 28:  SUPRASPINATUS TENDON FULL TEAR & BURSITIS:‐

.  

Figure no 29:  COMPLETE TEAR OF SUPRASPINATUS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 97 

Page 119: Prustamarma, sr

 PHOTO PLATE NO 98

 

 

  

Figure no 30 : RADIOLOGICAL FINDINGS

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 98 

Page 120: Prustamarma, sr

 PHOTO PLATE NO 99

 

 

Figure no 31: SHOULDER MRI: ROTATOR CUFF INJURIES

 

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ” 

  Page 99 

Page 121: Prustamarma, sr

MATERIALS AND METHODS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 99 

METHODOLOGY

MATERIALS & METHODS:-

(1) Literary study was undertaken by the data, compiled from Brihatrayis, Laghutrayis and

other classical texts including journals, presented papers.previous thesis work done and

correlated,analyzed with the knowledge of contemporary science on the subject.

(2) Observations are analyzed and correlated in the view of ancient description of

structures and traumatological effects of Amsa marma.

(3) A special case proforma was prepared with all the points of Amsamarmabhighata

(stabdhabahuta). Observation of minimum 30 patients will be selected for

study.structural abnormality will be observed with the help of clinical examination of

ARM DROP SIGN.

METHOD OF COLLECTION OF DATA:-

Literary study:-The data for the present work was collected from the samhitas, the text

books of the recent author’s scientific journals and internate. The data obtained was

arranged in the systematic manner.

Clinical study:-Present study is observational study where in the 30 patients diagnosed

as stabdhabahuta are taken from N.K.J Ayurvedic medical college & PG centre teaching

hospital randomly. The patients were subjected for screening of the symptoms, clinical

examination, and data obtained was analysed.

 

Page 122: Prustamarma, sr

MATERIALS AND METHODS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 100 

STUDY DESIGN:-

(a) Clinically diagnosed 30 patients of stabdhabahuta due to the injury to Amsa

marma (Snayu marma) was selected.

HISTORY TAKING AND PHYSICAL EXAMINATION:

Complete history regarding age, sex, occupation, socio-economic status,history of

present illness, family history etc was recorded. Physical examination from general

routine examination to local shoulder joint examination was done.

INCLUSION CRITERIA:-

(1) The patients of either sex irrespective of all ages.

(2) Diagnosed patients of stabdhabahuta due to the injuries to amsapradesha,the

clinical features correlated with snayu marmabhighata laxana and samanya

marmabhighata laxana were taken.

EXCLUSIVE CRITERIA:-

(1) Fracture with dislocation

(2) Tuberculosis of shoulder joint

(3) Sprengel’s shoulder (congenital elevation of the scapula).

(4) Non-traumatic conditions and systemic disorders.

ASSESSMENT CRITERIA:-

 

Page 123: Prustamarma, sr

MATERIALS AND METHODS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 101 

Subjective parameters:

(1) Shoulder pain (Amsa ruja)

(2) Restricted movement. (Chestopaghata).

(3) Motor weakness (kriyahani).

(4) Tenderness (sparshaasahatva)

OBJECTIVE PARAMETERS:

Clinical parameters

Arm drop sign

This test is mainly for the complete tear of rotator cuff muscles.

Stabilising the scapula with one hand, the examiner passively abducts the patient’s

affected shoulder to 90 degree and asks him to sustain it .In case of complete tear, the

patient cannot sustain the abducted arm and it drops by the side of the trunk.

ASSESSMENT OF PAIN:

Measurement of intensity of pain was assessed by medical research council (MRC)

grading recommendation by W.H.O... Patient’s subjective experience of pain is measured

& the grades with numbers show the features of pain such as its intensity & severity.

MRC grading:

G0 : absence of pain.

 

Page 124: Prustamarma, sr

MATERIALS AND METHODS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 102 

G1 : Mild pain – pain that can be easily ignored (those who are having pain &

able to bear it without any drug or medication)

G2 : Moderate pain – pain that cannot be ignored, interferes with daily

activities & needs treatment from time to time (pain which the patients were able to bear

with difficulty & relieved with the use of analgesic drugs.)

G3 : Severe pain – Demanding constant attention (In which the patients were

unable to bear and use of analgesic drugs was essential.)

G4 : Totally incapacitating pain or most excruciating pain.

ASSESSMENT FOR LOCAL TENDERNESS:

The grading for assessment of local tenderness was taken as:

Go : No tenderness

G1 : Patient complains of pain

G2 : Patient complains of pain and winces

G3 : Patient complains of pain and withdraws the joint

G4 : Patient does not allow to touch the joint

ASSESSMENT FOR JOINT MOBILITY OR RANGE OF MOTION -

RESTRICTED MOVEMENT (CHESTOPAGHATA):Figure No:2

 

Page 125: Prustamarma, sr

MATERIALS AND METHODS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 103 

 

The grading for assessment of restricted movement was taken as in degrees, 

For abduction 

Go  :  80‐90 

  G1  :  61‐80 

  G2  :  41‐60 

  G3  :  21‐40 

  G4  :  0‐20 

ASSESSMENT OF MOTOR WEAKNESS:

Here, two things we should remember, muscle power and nerve supply, While

investigating for muscle power, one must have a clear conception about the anatomy as to

which nerve which nerve supplies which muscle. It may so happen that the muscle

 

Page 126: Prustamarma, sr

MATERIALS AND METHODS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 104 

concerned is supplied by more than one nerve. In that case, the clinician will not be able

to assess the severity of the nerve injury by investing the muscle power. To test whether a

particular nerve is injured or not, the muscle which is exclusively supplied by the same

nerve should be examined for muscle power. The patient is asked to carry out the

movement of the joint against resistance which is performed by the same muscle supplied

exclusively by the nerve concerned. Following are the gradations of the muscle power

which has been quoted according to MRC, London.

Gradation of muscle power:

G0 - Complete paralysis

G1 - Flicker of contraction

G2 – contraction with gravity eliminated alone

G3 – contraction against gravity and some resistance

G4 – contraction against opposed force .

 

Page 127: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 105 

OBSERVATIONS

1. Age:

Table No 8: Table showing the distribution of patients based on Age (N=30)

Sl no Age No of Patients %

1. Below 20 0 0

2. 21-30 4 13.33

3. 31-40 7 23.33

4. 41-50 6 20

5. 51-60 6 20

6. 61-70 4 13.33

7. 70 above 3 10

(N = total number of patients, % = Percentage)

Out of the 30 patients, the above observation shows that a maximum number of patients i.e. 7

patients (23.33%) fall in the age group 31-40. Followed by 6 (20%) patients in the age groups

41-50 & 51-60, 4 patients (13.33%) in the age groups 21-30 & 61-70, 3 patients (10%) in the age

group 70 and above.

 

Page 128: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 106 

2. Sex

Table No 9: Table showing the distribution of patients based on Sex (N=30)

Sl no Sex No of Patients %

1. Male 20 66.67

2. Female 10 33.33

(N = total number of patients, % = Percentage)

Out of the 30 patients, 20 patients (66.67%) were male and 10 patients 33.33% were

female. The ratio of male to female was 2:1.

 

Page 129: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 107 

3. Occupation

Table No 10: Table showing the distribution of patients based on Occupation (N=30)

Sl no Occupation No of Patients %

1. Farmer 8 26.67

2. Housewife 5 16.67

3. Teacher 2 6.67

4. Driver 4 13.33

5. Sports 7 23.33

6. Other 4 13.33

(N = total number of patients, % = Percentage)

Out of the 30 patients, maximum no of patients- 8 patients (26.67%) were farmers by occupation

and sportsmen- 7 patients (23.33%), 5 patients (16.67%) were housewife, 4 patients (13.33%)

were drivers and other occupations, 2 patients (6.67%) were teachers.

 

Page 130: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 108 

4. Diet

Table No 11: Table showing the distribution of patients based on Diet (N=30)

Sl no Diet No of Patients %

1. Mixed 17 56.67

2. Vegetarian 13 43.33

(N = total number of patients, % = Percentage)

Out of 30 patients, 13 patients (43.33%) were vegetarian, 17 patients (56.67%) had mixed diet.

 

Page 131: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 109 

5. Shoulder Pain

Table No 12: Table showing the distribution of patients based on Shoulder pain

(N=30)

Sl no Shoulder pain No of Patients %

1. Unbearable 5 16.67

2. Severe 11 36.67

3. Moderate 6 20

4. Mild 2 6.67

5. Absent 6 20

(N = total number of patients, % = Percentage)

Out of the 30 patients, maximum- 11 patients (36.67%) presented with severe shoulder

pain, 6 patients (20%) had moderate pain, 6 patients (20%) had no pain, 5 patients

(16.67%) had unbearable pain and only 2 patients (6.67%) had mild pain.

 

Page 132: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 110 

6. Restricted movement on abduction (in degrees)

Table No 13: Table showing the distribution of patients based on restricted

movement (N=30)

Sl no Restricted movement

(in degrees)

No of Patients %

1. 80-90 0 0

2. 60-80 0 0

3. 40-60 5 16.67

4. 20-40 17 56.67

5. 0-20 8 26.67

(N = total number of patients, % = Percentage)

 

Page 133: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 111 

Out of the 30 patients, maximum patients- 17 (56.67%) had restricted movement of the

shoulder joint on abduction, limited from 20-40 0. 8 patients had restricted movement of

0-20 0 and 5 patients had restricted movement of 40-60 0.

7. Tenderness

Table No 14: Table showing the distribution of patients based on Tenderness (N=30)

Sl no Tenderness No of Patients %

1. Absent 19 63.33

2. Pain 9 30

3. Pain + winces 2 6.67

4. Pain with withdrawal 0 0

5. Does not allow to touch 0 0

(N = total number of patients, % = Percentage)

 

Page 134: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 112 

Out of 30 patients, maximum patients- 19 (63.33%) didn’t have any tenderness over the

shoulder joint. 9 patients (30%) had only pain and 2 patients (6.67%) had pain and

winced.

8. Visible deformity

Table No 15: Table showing the distribution of patients based on Visible deformity

(N=30)

Sl no Visible deformity No of Patients %

1. Visible 0 0

 

Page 135: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 113 

2. Palpable 5 16.67

3. Absent 25 83.33

(N = total number of patients, % = Percentage)

Out of 30 patients, maximum 25 patients (83.33%) had no visible deformity and only 5

patients (16.67%) had palpable deformity. No patients had any visible deformity.

9. Numbness

Table No:16 Table showing the distribution of patients based on Numbness (N=30)

Sl no Numbness No of Patients %

1. Positive 5 16.67

2. Negative 25 83.33

(N = total number of patients, % = Percentage)

 

Page 136: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 114 

Out of 30 patients, maximum 25 patients (83.33%) had numbness and 5 patients

(16.67%) did not have numbness.

10. Arm drop sign

Table No:17 Table showing the distribution of patients based on arm drop sign

(N=30)

Sl no Arm drop sign No of Patients %

1. Positive 17 56.67

2. Negative 13 43.33

(N = total number of patients, % = Percentage)

Out of 30 patients, maximum 17 patients (56.67%) had positive Arm drop sign and 13

patients (43.33%) had negative Arm drop sign.

 

Page 137: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 115 

11. Modern diagnosis

Table No: 18 Table showing the distribution of patients based on Modern diagnosis

(N=30)

Sl no Modern diagnosis No of Patients %

1. Frozen shoulder 19 63.33

2. Erb’s paralysis 2 6.67

3. Klumpke’s paralysis 3 10

4. Rotator cuff injuries 6 20

(N = total number of patients, % = Percentage)

Out of 30 patients, maximum 19 patients (63.33%) were diagnosed suffering from frozen

shoulder, 6 patients (20%) were suffering from rotator cuff injuries, 3 patients (10%) were

suffering from klumpke’s paralysis and 2 patients (6.67%) suffered from erb’s paralysis. All

these conditions fall under the term –“Stabdhabahuta”.

 

Page 138: Prustamarma, sr

OBSERVATIONS  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 116 

 

Page 139: Prustamarma, sr

DISCUSSION  

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 117 

DISCUSSION:

After going through the conceptual literature in detail, the present study entitled as “A

study on Prushtha marma W.S.R to Stabdhabahuta in amsamarmabhighata.” Reveals

some interesting points which are discussed thoroughly to draw the probable conclusions

at various levels.

Discussion on History and concept of Marma:

The origin of marma can be traced back to the vedic period.Its references were

also found in Upanishads, epics like Ramayana, Mahabharata, and as well as the ancient

medical science.The word marma derived from the Sanskrit root ‘mru’ and applies to a

part or a spot of vital importance in the body, which if injured results in serious

consequences it also denotes vital force of life.

The ancient surgery in India primarily associated with warfare. Though the

knowledge of anatomy was not too accurate and was deficit about many important

structures but it is surprising to find the phenomenon growth and excellence of Indian

surgery during the period of sushruta. Surgical operations demanded the accurate

knowledge of anatomy but it seems, the concept of marma has supplied them with the

knowledge of regional anatomy and the structures involved in the region and considered

the knowledge of marma as half the knowledge of surgery and it was the mastery of

knowledge of these marma that might have helped for the growth of surgery in ancient

age.

It is noteworthy that up to 15th century Greek, Roman and Arabians did not

posses much anatomical knowledge. If peep into the history of modern anatomy even the

Aristotle not never dissected the human body but had rough idea about vessels.’ Celsius’

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though wrote book on medicine but we little glimpse of anatomy in it.

Discussion on pathophysiology of marmabhighata

The four types of siras carrying the doshas and Rakta separately are connected

with all the marma as well. In case of trauma, blunt or piercing over the marma there will

be an bleeding leading to dhatukshaya there by resulting into vata prakopa in turn

mobilization of pitta and its vitiation. Thus causing severe pain accompanied by trishna,

shosha, bhrama and later death preceded by excessive sweating. Sushruta emphasis more

on vata prakopa and its role destroying normal physiological function or haemostasis.It is

a reflex vasodilatation and fall in blood pressure, loss of consciousness. And some time

leading to death, if it is irreversible type of shock. It is a systemic effect of mechanical

injury.

In view of modern pathology also the death in marmabhighata is the result of

shock.shock is defined as disparity between volume and space and it is the sudden

derangement of the physiological functions. A mechanical injury at any part of the

produce reflex vaso-dilatation, fallen blood pressure and loss of consciousness and

death.Hence marmabhighata will definitely produce reflex vaso-dilatation unbelievable

amount of blood flows from vascular system to the interstitial spaces.

So it may be considered that after the abhighata siras of affected marma may

produce vasovagal reflexes due to vata prakopa and raktasrava. Thus it is obvious that

marma are susceptible points to traumatic shock especially, which are located in head &

neck,chest and abdomen including pelvis.

Discussion on role of prana

As we understand, marma is reservoir of prana. The prana pervades every cell of the

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body through the innumerable nadis in which it moves or flows. There are Dasha

Pranayatanas told in Ayurvedic Classics, generally Soma (Kapha), Maruta (Vaayu), and

Tejas ( Pitta), and Rajas, Satva, and Tamas along with Atma stays in Marmas, that is why

they do not survive if injury takes place on Marma. That is why named as Prana.

Discussion on Prushtha marma

Prushtha marma are fourteen in number,and let us discuss one by one.

Discussion on katika taruna Marma

It is Asthi Marma Varity which is delayed fatal on injury, it present on the both

sides of the vertebral column where sacrum meet with pelvic bone which is Ardha anguli

in measurement. It means sacro-iliac joint. In this region “Katika taruna is present”.

General symptoms of Katikatruna Marma injury are loss of blood (shonita kshaya ),

Pandu (anemia ) discoloration or produces different colours (vivarna ), disfigure ( heena

roopata) and death (Marma).

After injury to this bone leads to rupture of major blood vessels because in this

region pelvic bone in front of the sacroiliac joint protecting major blood vessels of pelvic

cavity with main nerves.

In front of the sacroiliac joint the terminal branches of common iliac artery

divides in to external and internal iliac artery. Sacroiliac joint is a synovial joint; the

fibrous articular capsule is thickened dorsally and ventrally to form the sacroiliac

ligaments; because of the interlocking nature of the joint surfaces and the strong

sacroiliac ligaments, only limited movement is permitted at the sacroiliac joint. Fracture

of this sacroiliac joint leads to rupture of major vessels inside i.e. iliac vessels, leads to

bleeding. Traumalogist explains injury to internal vessels is always hazardous because

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due to lack of coagulation causes chronic internal bleeding and needs emergency surgical

intervention. Acharya Sushruta explained the stages of internal blood loss very

beautifully as follows.

1. Shonita kshaya- loss of blood, this is due to rupture of major blood vessels in

pelvic cavity near to the sacroiliac joint.

2. Pandu- due to blood loss, pallor is main symptom. This is first stage of

bleeding.

Discussion on Kukundara marma

It is sandhi marma varity which is vaikalyakara on injury, it present on the both

sides of vertebral column and the lateral sides of the outer part of the jaghana asthi and

which is Ardha angula in measurement. Gananathsen counted the kukundara marma as

ischial tuberosity, Vd R.R. Pathak counted this marma as to the sacroiliac articulation

over which the sacral plexus and pass out the pelvis through the greater sciatic

foramen.Injury to this marma leads to loss of sensation and the movements of the lower

limbs.

But on discussion we can confine that the Anatomical structures under the marma

as Ischial bone, inferior gluteal artery and vein, inferior pudendal artery and vein,roots of

the sacral plexus, gluteus maximus muscle and levator ani muscle.

Discussion on Nitamba Marma

Nitamba Marma is Asthi Marma, which lies above the ear like bone (ischium) of

pelvis, covering pelvic organ. It is located interior to the pelvic cavity on the both sides of

lateral aspect of the ishchial bone. This is nothing but location of lumbo sacral plexus,

sciatic notch is present for sciatic nerve, and the Marma is Ardhanguli in pramana, injury

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to which leads to Adhah kaya shosha, Daurbalya and it is vaikalyakara in nature. Context

of Shroni panchaka, Acharya Sushruta told 2 Nitambhasthi. So the shroni panchaka is

nothing but the union of 5 bones in pelvic region. So hip bone, specifically ilium is

considered as Nitambhasthi, and the region is called “Shroniphalaka” region. To cause

Shosha (wasting) and numbness is possible only after involvement of nerves supply to

the extremity. Probably above said version of Sushruta i.e. katikataruna is Asthi Marma

was based on the presence of ischium in the close relationship with Marma. Here the

nerves ashrayee and ischium gives ashraya. Sushruta has said that any injury to this

Marma cause wasting ( Shosha) and debility ( Daurbalya ) of the lower extremity. This is

reliable because an injury at this Marma may damage to the sciatic nerve along with the

superior gluteal, internal pudendal artery.

Adhah kaaya shosha means loss of sensory and motor activity or atrophy of lower

limb. Daurbalya - General debility or lower limb debility. Due to rakta dhatu kshaya and

Vata prakopa, general debility may occurs otherwise involvement of the motor and

sensory nerve leads to debility in lower limb only. Marana is not common but the severity

of injury if involve major blood vessels severe bleeding may occur that leads to

hypovolemia the it may be end up with death.

Discussion on Parshwasandhi marma

It is situated inferior to and in the middle of the lateral flanks being attached to it,

they are obliquely placed of conjoined together in order and attached to the lateral sides

of bony part hidden by it. It is sira marma and injury to this leads to delayed death, this

vascular marma lying inside the pelvis placed obliquely from below upward,and some

modern Ayurvedic authors have suggested common iliac arteries responsible for this

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marma.

The discussion suggests that there are two regions which seems to be responsible

for this marma they are pelvic cavity and gluteal region,the vessels of extremities are iliac

vessels and their exrernal branches.If injury to these regions leads to priorly bleeding,

these are not apperent but manegable.then also very difficult rather unmanegable.

Therefore these vessels may correlate to the Parshwasandhi marma.

The common iliac artery bifurcates into external and internal iliac artery at the

point superior 1/3rd (2 inch) of the imaging line drawn on the surface of the abdomen

joining the point of aortic bifurcation (3/4th inch below the umbilicus) and mid inguinal

point. The diameter of the aorta and inferior venacava are approximately 1inch each, the

course of these vessels are also comparable with the description of Sushruta’s

parshwasandhi marma.The gunshot wound to the pelvis involving the pelvic vessels by

missiles of bone or pallets is a challenging problem for the trauma surgeon even though

the fatality is quite high

Discussion on Brahati marma

The brahati marmas are situated just opposite the stanamula bilaterally on the

back. Structurally this marma is a sira marma injury to this region has high tendency of

severe bleeding resulting into complications and terminates into delayed death.Few

authors says that structures involved in this marma are anastomoses around the scapula,

and R.R Pathak has discussed for the vessels at the hilum of the liver at right side,vessels

at the hilum of spleen at left side.

Dr. V.S Patil has included the base of the lungs,bare area at the inferior angle of

the scapula,diaphragm or intercostals muscles behind the scapulaare responsible for the

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marma.

Lastly the area of triangle of auscultationis the choice where sixth intercostals

artery lies in the sixth intercostal space within this area.If this artey ruptures leads to

intrathoracic hemorrhage,complications leading to death.The penetrating injury on the

back of the chestusually complicates deu to uncontrollable bleeding.bullet or fractured rib

usually produces complications.

Discussion on Amsa phalaka Marma

On the dorsal aspect of the body Marma is associated with Trika (scapula). It is

Asthi Marma and post traumatic condition is muscular atrophy and anesthesia. Following

facts should be essentially may be considered in Amsa phalaka Marma.

1. That Marma is somewhere in the superior part of the back.

2. That Marma is in both lateral sides of the vertebral column.

3. That Marma is close relationship with scapula.

4. That Marma includes the nerve supply to the upper extremity, because an injury to this

Marma may cause wasting and numbness of the upper extremity.

There fore this can be concluded that the site of supra scapular notch is the

anatomical site where all the above said conditions can be found with this fact fertion of

Acharya Sushruta is reliable. According to Acharya Sushruta this Marma is Asthi Marma.

This statement is not acceptable because wasting and numbness is possible only after

involvement of nerves supply to the extremity. Probably above said version of Sushruta

was based on the presence of scapula in the close relationship with Marma. Here the

nerves ashrayee and scapula gives ashraya. Sushruta has said that any injury to this

Marma cause numbness (Swapa) and wasting ( Shosha) of the upper extremity. This is

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reliable because an injury at this Marma may damage to the brachial plexus along with

the damage of suprascapular nerve and artery. The damage may follow as under:

1. If foreign body penetrate the deeper parts- severe damage to the brachial plexus is

possible. This will lead to paralysis of the upper extremity.

2. If foreign body penetrates the deeper parts leaving light impact, moderate damage of

brachial plexus is possible. This will cause numbness and wasting due to partial loss

of function.

If foreign body penetrates to the superficial part – damage to the suprascapular nerve and

artery will be resulted. This will cause paralysis of abductor muscles of the shoulder joint

along with the wasting of the same.

Discussion on Amsa marma

The word Amsa denotes the shoulder; the Ama marma is situated within the line

of the area joining head (murdha),Neck (Greeva), and the arm (Bahu).This is the snayu

marma to a length of half finger width.

The physical metrixes that are present in Amsa marma are

mamsa,sira,snayu,sandhi and Asthi.It is one of the vaikalyakara marma, and trauma to

this will produce disability of the shoulder joint.

By observing the above said quotation,we can make it as the basement for the

modern establishment of Ams marma, In modern science there are the muscles and

ligaments binding the scapula with the clavicle,an injury to these structures may cause

rupture of the ligaments resulting in disability of shoulder joint and arm.

The Amsa marma that includes the structures related to shoulder region are the most

exposed area to common injuries.The activities like weight lifting, swimming, cricket ,

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fall on outstretched arm causes the rupture of ligaments and muscles of the shoulder

region leads to the disability of the amsa sandhi and bahustabdhata.

Let us discuss the amsa pradesha where the amsa marma is present,we will try to

approach the underlying structures of amsa marma and fixing its limitations. Based on the

anguli pramana marma vargeekarana, the amsa marma is half angula,we cannot say the

actual limitations of amsa marma, structurally.

Before discussing the anthropometry of Amsa marma, we will discuss the

underlying structures of Amsa pradesha.

Underlying structures of Amsa marma:

According to parishabdartha sharira,there are nine structural complexes are

presentthoseare;Amsa,Amsakuta,Amsadesha,Amsapinda,Amsapitha,Amsaphalaka,amsab

andhana & Amsandhi.

Let us correlate the classical quotation of Amsa marma with modern science.

Bones:(Bahumurdha & Amsaphalaka):

Parts of the scapula,clavicle and upper part of the humerus.

Joints :(Amsa sandhi & Amsapeetha sandhi):

Shoulder joint and acromioclavicular joint.

Soft tissues: (The snayu binding the Amsa sandhi):

Ligaments of the shoulder joint and muscles of the shoulder joint.

Underlying structure of Amsa marma as to Ayurvedic scholors, correlating with the

modern science:

Amsa

Amsa marma is a snayu marma structurally,If we discussed about snayu,based on many

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openion,we can call it as ligament,somewhere it is considered as nerve or tendon.But

depending upon the situations we can name it to different structures as above

said,traumatic effect on Amsa marma (snayu) leads to the functional deformity, so it is

known as Vaikalyakara marma.

Pratanavati type of snayu covers this sandhi,Acharya sushruta states that snayu is

the binding material of mamsa, Asthi and medha.Like a boat made up of planks and

timber, tightened together by means of large number of binding is enabled to float on the

water and to carry cargo.similarly in the body all the sandhis are tightened up by large

number of snayus, which enables the body to bear the weight.

All vaikalyakara marma are later converted into rujakara one.by this

reason this can neigther be considered as nerve or tendon ,but this may be considered as

complex structures like ligaments, muscles, tendons,bursae and nerves. Hence,based on

these observations without any disputs, we can confine it to Shoulder region

(Amsa),Acromion region (Amsa kuta)& scapular region (Amsapitha) and these binds

together by the soft tissues is known as Amsa marma.

Amsakuta

Amsakuta is situated exactly above the Apalapa marma.The kuta is considered as

Acromion process of the scapula which is very prominent structure in the shoulder

region.

Amsa desha:-

The area occupied by the Rotator cuff muscles,axillary vessels,ligaments &

bursae related to the shoulder joint and injury to this leads to loss of functions of Bahu is

known as Avabahuka and where the Amsa marma is also present.Overall that area is

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known as Amsa desha or shoulder region.

Amsa pinda:-

The area over the greater tuberosity of humerus which is attached with the deltoid

muscle is called deltoid prominency.So it bears spherical shape i.e Amsapindika.

Amsapitha:-

According to Gananathsen saraswati,glenoid cavity is compared to the Amsapeetha.

Again this term has been explained in Sushruta sutrasthana and sharir sthana-

1. While explaining Anga-pratyanga measurement, Sushruta has quoted-Su.sa.su-35/12

2. While explaining the types of sandhi-he quated “Amsapeethagudabhaganitambeshu

saamudgah.” (Su.Sa.Sha-5/27)

By observing these quotations the anthropometry inbetween Amsa peetha and

kurpara is 16 angula,and here we can consider amsapeetha as a exterior border of the

scapular and shoulder region.We can give another openion; Inbetween Amsapeetha

sandhi and kurpara sandhi 16 angula length. But Dalhanacharya commentated Amsa

peetha as Bahushira i.e “Amsapeetho Baahushirah;” and amsapeetha sandhi as one of

the type of ‘Saamudga sandhi’. But the dictionary meaning of peetha is Aasanam &

Saamudga is Samputaka, However the area of amsapeetha is accomodates in the area of

Amsa.

Hence, by observing above said explaination we can consider Amsapeetha as

scapula and Amsapeetha sandhi as Acromioclavicular joint, because it is one of the

Saamudga sandhi and it is situated just above the shoulder joint.

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By discussing all these points based on the quotation of AMSA MARMA in

Su.Sa. sha-6th chapter and A.Hru.Sha 4th chapter we will come to know that all above said

structures like Amsa peetha,bahushira etc…are included under the Amsa marma.

Amsaphalaka:-

In Kashyapa Samhita sharira sthana while explaining the Asthi sankhya,he

mentioned Amsaphalakas are Asthi they are two in number.

“dwaamsavamsaphalakaavapi dwaveva chakshakou.”

According to him amsa-2 Amsaphalaka-2 Akshakasthi-2

Here, we should think about the Amsa because he considered these are also asthi

and 2 in number. But these structures or parts we can include under the spines of scapula,

according to sushruta a flat mass are included under the kapalasthi.

Finally we can consider Amsa as acromion process and Amsaphalaka as scapula.

Amsabandhana

In the area of amsa-underground structures impaired by the aggravation of the

vata and rakta due to injury to the amsa bandhana that leads to the compression of siras

i.e blood vessels and nerves, lastly the disease avabahuka.

Here the structures which bind the bahushira,Amsapitha and greeva in between

these the amsa marma is present.The amsa is bounded by the snayu & peshi i.e soft

tissues.if injury to these structures that leads to disability of upper limb.

By this explaination we can consider that structures underlying the shoulder and

scapular region are affected, mainly due to trauma,like rotator cuff injuries,frozen

shoulder,tearing of lagaments etc….these are complicated into disability of the shoulder.

Amsamula:-

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According to Shastracharcha parishad, the amsa mula is correlated into apex of

the axilla.where the brachial vessels and brachial plexus are situated. If injury to this

leads to the paralysis of the upper limb takes place i.e STABDHABAHUTA.

By observing this discussion we can approach that apex of the axilla is included in

the area of the AMSA MARMA.

Amsasandhi:-

This is a major joint of the upper limb. This is one type of chala and ulookhala

sandhi. This joint is formed by the articulation of Pragandasthi, Akshakasthi and

Amsaphalakasthi.

Pratanavati type of Snayu covers this Sandhi. Acharya Sushruta states that

Snayu is binding material of Mamsa, Asthi and Medha. Like a boat made up of planks

and timber, tightened together by means of large number of bindings is enabled to float

on the water and to carry cargo. Similarly in the body all the Sandhis are tightened up by

large number of Snayus, which enables the body to bear the weight.

Sheshmadhara Kala is present in this joint and seceretes shleshaka kapha. this act

as a lubricant for the joint and helps in protection and movements of the Sandhi.

Acharaya Sushruta has described that the rachana of Sandhi as like a wheel having an

axis. When the axis is lubricated by putting oil on it, the wheel can move freely and

friction does not occur. In the same way the bones or joints can move freely in the

presence of Shleshma.

Discussion on limitations of Amsa marma & Amsamarmabhighata:

To make the limitations of Amsa marma, we should know about the classical

definition of amsa marma which correlates with the modern science.

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• Bahumurdha (Amsapindika)- Deltoid prominency-1st point

• Amsapitha- Upper 1/4th of .Exterior border of the scapular and shoulder

region-2nd point

• Skandha-shoulder joint-3rd point

• Greeva -Root of the Neck-4th point

• Amsabandhana-Soft tissues of shoulder & scapular region which hold the

above said points .

Joining of all these points one by one and make the half angula point at the

centre of all above said structure, that form the Amsa marma. Injury to this leads

to Stabdhabahuta, this symptom we can consider in the aghata to the

Amasapradesha, like Rotator cuff injuries, Frozen shoulder, Bursitis, ligament

tear, Erb’s palsy, Klumpke’s paralysis etc..as we know the Amsa marma is a

Snayu marma injury to this, we can correlate to the Samanya maramabhighata &

snayu marma viddha laxanas.

Samanya marmabhighata laxana are:

1. Vicheshtana

2. Urdhvavata

3. Vayukruta tivra ruja

4. Stabdhata

5. Kriyanasha

Snayu marma viddha laxanas are:

1. Koubjyam (Shortening)

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2. Shareeravayavasaada (svakarmanyaasamrthyam)-loss of functions

3. Kriyasvashaktiriti (Loss of movements like Abduction, Adduction, Flexion

extension etc).

4. Ruja (Pain)

By observing all these clinical features we will come to know that all are

comes under the Stabdhabahuta symptom of Amsamarmabhighata,and injuries

according modern science viz Rotator cuff injuries,frozen shoulder, nerve

injuries related to shoulder, ligament tear,etc are also correlates to the samanya

marmabhighata and snayu marmaviddha laxana.

Discussion on clinical observations:

1. Age:

Out of the 30 patients, the above observation shows that a maximum number of

patients i.e. 7 patients (23.33%) fall in the age group 31-40. Followed by 6 (20%) patients

in the age groups 41-50 & 51-60, 4 patients (13.33%) in the age groups 21-30 & 61-70, 3

patients (10%) in the age group 70 and above. So, more number of patients were found in

of 31-40 years (adult age group). This is due to continued exposure to strenuous physical

work and also due to repeated stress over the joints in case of sportsmen.

2. Sex:

Out of the 30 patients, 20 patients (66.67%) were male and 10 patients 33.33% were

female. The ratio of male to female was 2:1. This is obvious because of males in India

being outdoors most of the time span for work.

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3. Occupation:

Out of the 30 patients, maximum no of patients- 8 patients (26.67%) were farmers by

occupation and sportsmen- 7 patients (23.33%), 5 patients (16.67%) were housewife, 4

patients (13.33%) were drivers and other occupations, 2 patients (6.67%) were teachers.

More incidences in farmers may be due to excessive work in the farms and in case of

sportsmen might be due to repeated stress over the joints.

4. Diet:

Out of 30 patients, 13 patients (43.33%) were vegetarian, 17 patients (56.67%) had

mixed diet. Incidences over dietary habits are not convincing to say that the diet plays a

role in the particular clinical study.

5. Shoulder pain:

Out of the 30 patients, maximum- 11 patients (36.67%) presented with severe

shoulder pain, 6 patients (20%) had moderate pain, 6 patients (20%) had no pain, 5

patients (16.67%) had unbearable pain and only 2 patients (6.67%) had mild pain. Most

of the patients in the study presented with muscle inflammation leading to intense pain.

This was found to vary according to the different structural involvement viz. muscle

tendons (increased severity), nerve (numbness), etc. and also upon the friction involved

in between the associated structures.

6. Restricted movement on abduction: (in degrees)

Out of the 30 patients, maximum patients- 17 (56.67%) had restricted movement of

the shoulder joint on abduction, limited from 20-40 0. 8 patients had restricted movement

of 0-20 0 and 5 patients had restricted movement of 40-60 0. Since the patients had much

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pain or limitations of function (in nerve injury), restricted movement might have been

observed on abduction, in this study.

7. Tenderness:

Out of 30 patients, maximum patients- 19 (63.33%) didn’t have any tenderness over

the shoulder joint. 9 patients (30%) had only pain and 2 patients (6.67%) had pain and

winced. This might be due to the involment of softer structures involved in the shoulder

joint as compared to the other traumatic pathologies of bone.

8. Visible deformity:

Out of 30 patients, maximum 25 patients (83.33%) had no visible deformity and only

5 patients (16.67%) had palpable deformity. No patients had any visible deformity. As

the inclusion criteria for the study included only of the injuries of the soft tissues, no

patients were included with conditions like fractures, dislocations, etc. which often

present with visible deformity. As compared to those conditions, it was found in this

study that there was no visible deformity in maximum number of patients.

9. Numbness:

Out of 30 patients, maximum 25 patients (83.33%) had numbness and 5 patients

(16.67%) did not have numbness. This might be due to less nerve involvement cases

being observed in this particular study.

10. Arm drop sign:

Out of 30 patients, maximum 17 patients (56.67%) had positive Arm drop sign and 13

patients (43.33%) had negative Arm drop sign. Upon the assessment parameters being

observed in the study, the patients obviously had difficulty in normal functioning of the

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upper limb. So, the Arm drop sign was found to be positive in most of the shoulder soft

tissue injuries.

11. Modern diagnosis:

Out of 30 patients, maximum 19 patients (63.33%) were diagnosed suffering from

frozen shoulder, 6 patients (20%) were suffering from rotator cuff injuries, 3 patients

(10%) were suffering from klumpke’s paralysis and 2 patients (6.67%) suffered from

erb’s paralysis. All these conditions fall under the term –“Stabdhabahuta”. The incidence

of Frozen shoulder is found to be maximum in the study, than other conditions. This

might be due to involvement of only capsular ligament of the shoulder joint. Whereas in

case of the other conditions observed (rotator cuff injuries/ erb’s paralysis/ klumpke’s

paralysis), there is involvement of other structures along with the capsular ligament

which may or may not have preceded with Frozen shoulder.

Page 157: Prustamarma, sr

                    CONCLUSION 

 

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 135  

Conclusion:

1. If a close observation is made, we will come to know that the knowledge of

marma vijnana was extensively well known since vedic period (4000BC). Later

on its progression can be observed in the Samhita granthas especially Sushruta

samhita shareera sthana.

2. The various classical texts of Ayurveda have defined marma as a reservoir of

prana, the seat of tridosha and triguna, atma, chetana, a conglomeration of mamsa,

sira, snayu, asthi, sandhi making the place vulnerable to injury.

3. The marma of the back are studied in relation to anatomical locations, structures

involved and their patho-physiology as shown in the flow charts.

4. Symptoms produced after marmabhighata are to that of traumatic complications

viz shock, Functional deformity, if not treated properly lastly leads to death.

5. The Prushtha marma are the physio-anatomical vital areas on the back of the body

surface. Injury to these vital areas leads to vata vyadhi, associated with rakta

dosha, sometimes kalantara pranahara and vaikalyakara effect on the body.

6. The Prushtha marma are 14 in number they are lower three marma are situated in

the gluteal region, structural correlation of these marma are:

i. Katikataruna marma can be correlated as the cartilaginous bone or

ossification process is going on. In the low back region the five small

Page 158: Prustamarma, sr

                    CONCLUSION 

 

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 136  

bones are ossified and forms single bone called “Katikpalasthi” (Sacrum).

That region is called “Kati” pradesha.

ii. Kukundara marma can be correlated as sacro-iliac articulation over

which the sacral nerves arising from the sacral plexus and passes and

emerges out the pelvis through the greater sciatic foramen.

iii. Nitamba marma can be correlated as hip bone, specifically ischeal

tuberosity, considered as Nitambasthi,

7. Parshwasandhi marma can be correlated as the iliac vessels and its branches.

8. Brahati marma can be correlated as the triangle of auscultation is the area of

choice where sixth inter costal artery, and deeply the branches of coeliac trunk is

present.

9. Amsaphalaka marma can be correlated as the Scapular region where the muscles,

vessels and nerves are related to the scapula bone.

10. The Amsa marma limitations can be concluded by joining the following points as

the root of the neck, deltoid prominancy, Shoulder joint and upper 1/4th of exterior

border of scapular region and make the half anguli point at the centre of all above.

11. The underlying structures of Amsa marma are the muscles, ligaments, bursae,

vessels and nerves related to shoulder region.

12. The Amsamarmabhighata leads to Stabdhabahuta,this symptom can be seen in

following diseases:

A. Rotator cuff injuries

Page 159: Prustamarma, sr

                    CONCLUSION 

 

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 137  

B. Frozen shoulder

C. Bursitis

D. Ligament tear

E. Erb’s paralysis

F. Klumpk’s paralysis

The observational study helps us to take the traumatological cases based on

the marma shareera illustrated as per Ayurvedic literature. The specific ill effects

produced due to the injury caused over a precise location of the body, explained

as viddha laxanas in classics is tried to be justified hypothetically on the basis of

modern anatomy, Physiology & surgery in the present study.

As I have taken observational study on the living subjects, the study is

more precise and effective. On the basis of this observational study we can better

study the radiological findings on the particular marma sthana in the form of

surgical anatomy and traumatology in future, as per Ayurveda.

Page 160: Prustamarma, sr

SUMMERY  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 138 

SUMMARY

The dissertation entitled “A STUDY ON PRUSHTHA MARMA W.S.R.TO

STABDHABAHUTA IN AMSAMARMABHITA” comprises of 8 chapters namely

Introduction, Objectives, Review of literature, Methodology, observation, Discussion,

Conclusion and Summary.

Chapter 1:

general idea regarding Rachana shareera, Marma and Prushtha Marma along

with the needs of the study has been covered in the introduction part of dissertation

along with need of this study in the present scenario is been highlighted.

Chapter 2:

Gives an idea about aims and objectives of the study.

Chapter 3:

Review of literature is subdivided into Historical review, Ayurvedic review,

Aghata laxana and Modern review Historical review section comprises of references

pertaining to Marma. In Ayurvedic review, location, measurement, classification, effect

of injury of Marma Pradesha explained in detail. In the first part of modern review detail

regional and correlative anatomy of Gluteal region, upper back region, shoulder region

and injuries related shoulder region has been explained.

 

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SUMMERY  

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 139 

Chapter 4:

Methodology chapter explains about method of data collection, and study Pattern and

modern parameters for the observational study has been taken.

Chapter 5:

Observational study reveals that, 30 patients has been taken and complaining of

Symptoms under the marmabhighata laxana presents the stabdhabahuta laxana correlated

with the injuries of shoulder region according to modern science.

Chapter 6:

In the discussion part, discussed in detail on Prana, definition,

classification and detail discussion has been done on individual Prushtha marma and

on their Viddhalakshanas. Special observational study has been taken on

Amsamarmabhighata, correlates with the modern conditions.

Chapter 7:

Conclusions drawn from various sections of the work are given.

Chapter 8:

Summarizes the entire work. 

 

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cÉ | (xÉÑ. xÉ. zÉÉ 6/26 QûsWûhÉ)

 

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47. MÑüMÑülSUÉæ ÎxTücÉÉåÂmÉËU E³ÉiÉpÉaÉÉæ | (cÉ.xÉ.zÉÉ.7/11

cÉ¢ümÉÉÍhÉ)

48. WûÉUhÉcÉÇSì

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50. uÉxiÉÑ zÉÔMæüUÏuÉÉMüÐhÉïÇ ÃRåû cÉ MÑüÍhÉZÉleÉiÉÉ |

oÉsÉcÉå¹É¤ÉrÉÈzÉÉåwÉÈ mÉuÉïzÉÉåTü¶É xÉÎlkÉeÉå ||

(A.WØû.zÉÉ.4/51)

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mÉɵÉÉïliÉUmÉëÌiÉ;

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qÉUhÉÇ; (xÉÑ. xÉ. zÉÉ 6/26)

52.AÎxjÉqÉqÉÉïÍhÉ AkÉÉïÇaÉÑsÉå MüÉsÉÉliÉUmÉëÉhÉWûUå cÉ |

(xÉÑ. xÉ. zÉÉ 6/26 QûsWûhÉ)

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(A.WØû.zÉÉ.4/20)

AÉzÉrÉcNûÉSlÉÉæ iÉÉæ iÉÑ ÌlÉiÉqoÉÉæ iÉÃhÉÉÎxjÉaÉÉæ |

AkÉÈzÉËUUå zÉÉåTüÉåA§É SÉæoÉïsrÉÇ qÉUhÉÇ iÉiÉÈ ||

(A.WØû.zÉÉ.4/21)

 

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54. iɧÉÉkÉ:MüÉrÉzÉÉåwÉÉå SÉæoÉïsrÉÉŠ qÉUhÉÇ; (xÉÑ. xÉ. zÉÉ

6/26)

55. AkÉÈmÉɵÉÉïliÉUmÉëÌiÉoÉ®Éæ

eÉbÉlÉmÉɵÉïqÉkrÉrÉÉåÎxiÉrÉïaÉÔkuÉïÇ cÉ eÉbÉlÉÉiÉç

mÉɵÉïxÉÎlkÉ |

(xÉÑ. xÉ. zÉÉ 6/26)

56. ÍxÉUÉqÉqÉïÍhÉ AkÉÉïÇaÉÑsÉå MüÉsÉÉliÉUqÉ×irÉÑmÉëSå cÉ |

(xÉÑ. xÉ. zÉÉ 6/26 QûsWûhÉ)

57. iÉ§É sÉÉåÌWûiÉmÉÔhÉïMüÉå¸iÉrÉÉ ÍqÉërÉiÉå; (xÉÑ. xÉ. zÉÉ 6/26)

58. xiÉlÉqÉÔsÉɬeÉÔpÉiÉÈ mÉ׸uÉÇzÉxrÉ oÉ×WûiÉÏ, iɧÉ

zÉÉåÍhÉiÉÉÌiÉmÉëuÉ×̨ÉÌlÉÍqɨÉæÃmÉSìuÉæÍqÉëïrÉiÉå |

(xÉÑ. xÉ. zÉÉ 6/26)

59. xiÉlÉqÉÔsÉÉÌSirÉÉÌS ÍxÉUÉqÉqÉÉïÍhÉ AkÉÉïÇaÉÑsÉå

MüÉsÉÉliÉmÉëÉhÉWûUå cÉ| (xÉÑ. xÉ. zÉÉ 6/26 QûsWûhÉ)

60.̧ÉMüxÉqoÉ®å CÌiÉaÉëÏuÉÉrÉÉ | (xÉÑ. xÉ. zÉÉ 6/26 QûsWûhÉ)

61. mÉ׸ÉåmÉËU mÉ׸uÉÇzÉqÉÑpÉrÉiȨ́ÉMüxÉqoÉ®å AÇxÉTüsÉMåü |

(xÉÑ. xÉ. zÉÉ 6/26)

62. AÎxjÉqÉqÉÉïÍhÉ AkÉÉïÇaÉÑsÉå uÉæMüsrÉMüUÉÍhÉ cÉ | (xÉÑ. xÉ. zÉÉ

6/26 QûsWûhÉ)

63. iÉ§É oÉÉÀûÉæÈxuÉÉmÉzÉÉåwÉÉæ;| (xÉÑ. xÉ. zÉÉ 6/26 QûsWûhÉ)

 

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64. qÉ‹ÉÎluÉiÉÉåAcNûÉå ÌuÉÎcNû³ÉÈxÉëÉuÉÉå ÂMçü

cÉÉÎxjÉqÉqÉÉïÍhÉ | (A.WØû.zÉÉ.4/48)

65. iÉ§É oÉÉÀûÉæÈxuÉÉmÉzÉÉåwÉÉæ;| (xÉÑ. xÉ. zÉÉ 6/26 QûsWûhÉ)

66.

oÉÉWÒûqÉÔkÉïaÉëÏuÉÉqÉ®åÇAÇxÉmÉÏPûxMülkÉoÉlkÉlÉÉuÉÇxÉÉæ

,iÉ§É xiÉokÉoÉÉWÒûiÉÉ;|| (xÉÑ. xÉ. zÉÉ 6/26)

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(A.WØû.zÉÉ.4/25)

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MüÉæoerÉÍqÉirÉÉÌS MüÉæoerÉÍqÉÌiÉ AliÉoÉïÌWûUÉrÉÉqÉeÉÇ

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Ì¢ürÉÉxuÉzÉÌ£üËUÌiÉ xÉÉqÉÉlrÉålÉ xÉuÉïzÉUÏUxrÉ,

 

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Ì¢ürÉɶÉɧÉÉåi¤ÉåmÉhÉÉmɤÉåmÉhÉmÉëxÉÉUhÉMÑülcÉlÉsɤÉhÉ

É:| (xÉÑ. xÉ. xÉÔ.25/37 QûsWûhÉ)

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üÉlrÉÉÇxÉÉæ cÉåÌiÉ |

(xÉÑ. xÉ. zÉÉ 6/6)

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zÉÉ 6/26 QûsWûhÉ)

70. uÉæMüsrÉÇ MüsÉÉliÉUåhÉ YsÉåzÉrÉÌiÉ ÃeÉÉÇ cÉ MüUÉåÌiÉ | (xÉÑ.

xÉ. zÉÉ 6/22)

71. zÉÑwMüÉÇxÉÈ.........pÉë¸ÉÇxÉÉ MülrÉÉ | (MüÉ.xÉ. xÉÑ.

sɤÉhÉÉ®ÉrÉ-)

72. A¹ÉÇaÉÑsÉÉæ xMülkÉÉæ wÉQÇûaÉsÉÉæ AÇxÉÉæ | (cÉ.xÉ. ÌuÉ.

8/117)

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mÉɵÉÉåïmÉËUpÉÉaÉrÉÉåUmÉsÉÉmÉÉælÉÉqÉ,iÉ§É U£åülÉ mÉÑrÉpÉÉuÉÇ

aÉiÉålÉ qÉUhÉqÉç |

(xÉÑ. xÉ. zÉÉ 6/25)

74. mÉ׸uÉÇzÉÉåUxÉÉåqÉïkrÉå iÉrÉÉåUåuÉ cÉ mÉɵÉïrÉÉåÈ |

AkÉÉåAÇxÉMÑüOûrÉÉåÌuÉïSèkrÉSmÉsÉÉmÉÉZrÉ qÉqÉïÍhÉ

 

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iÉrÉÉåÈMüÉå¸åAxÉ×eÉÉmÉÔhÉåï lÉzrÉå±É iÉålÉ mÉÔrÉiÉÉqÉç ||

(A.WØû.zÉÉ.4/16)

75. AÇxÉSåzÉÎxjÉiÉÉå uÉÉrÉÔ: zÉÉåwÉÌrÉiuÉÉAÇxÉoÉlkÉlÉqÉç ||

ÍxÉUɶÉÉMÑülcÉrÉ iɧÉxjÉÉå eÉlÉrÉirÉuÉoÉÉWÒûMüqÉç || ( xÉÑ.

xÉ.ÌlÉ.1/82 )

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77. iÉ§É WûxiÉmÉÉSaÉiÉÉlÉÉÇ MühQûUhÉÉÇ lÉZÉÉ AaÉëmÉëUÉåWûÉÈ |

(xÉÑ. xÉ. zÉÉ 5/11)

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AaÉëmÉëUÉåWûÉ |(xÉÑ. xÉ. zÉÉ 5/11QûsWûhÉ)

79. AÇxÉmÉÏPûaÉÑSpÉaÉÌlÉiÉqoÉåwÉÑ xÉÉqÉѪÉÈ| (xÉÑ. xÉ. zÉÉ 5/27)

80.

CÇSìoÉÎxiÉmÉËUlÉÉWûÉÇxÉÌmÉPûMÑümÉïUÉliÉUÉrÉÉqÉ:wÉÉåQûzÉÉÇaÉÑsÉÈ |

(xÉÑ. xÉ. xÉÔ 35/ç12)

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zÉÉ 5/27 QûsWûhÉ)

82. ²ÉuÉÇxÉÉuÉÇxÉTüsÉMüÉuÉÌmÉ ²uÉåuÉ cɤÉMüÉæ | (MüÉ.xÉ.zÉÉ.)

 

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83. AÇxÉSåzÉÎxjÉiÉÉå uÉÉrÉÔ: zÉÉåwÉÌrÉiuÉÉAÇxÉoÉlkÉlÉqÉç ||

ÍxÉUɶÉÉMÑülcÉrÉ iɧÉxjÉÉå eÉlÉrÉirÉuÉoÉÉWÒûMüqÉç || ( xÉÑ.

xÉ.ÌlÉ.1/82 )

84. aÉëÏuÉÉqÉÑpÉrÉiÉÈ xlÉÉruÉÏ aÉëÏuÉÉoÉWÒûÍzÉUÉåliÉUå ||

xMülkÉÉÇxÉmÉÏPûxÉqoÉlkÉÉÇxÉÉæ oÉÉWÒûÌ¢ürÉÉWûUÉæ||

(A.WØû.zÉÉ.4/25)

85. zÉÉåwÉrÉåSÇxÉoÉlkÉlÉÍqÉÌiÉ zÉÉåwÉxrÉ

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uÉiÉïliÉå xÉÇÎzsɹÉ: zsÉåwqÉhÉÉ iÉjÉÉ;

iÉjÉÉ-aÉÑhÉÉÈ MüÉsÉÉiÉç mÉUçÇ zsÉåwqÉÉ oÉlkÉlÉå

A¤hÉÉåÈÍxÉUÉrÉÑiÉÈ ||

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xjÉÉlÉÎxjÉiÉÇ cÉ oÉÎklÉrÉÉiÉç xuÉÎxiÉMåülÉ ÌuÉcɤÉhÉÈ ||

(xÉÑ.xÉ.ÍcÉ.3/31)

87.

oÉÉWÒûqÉÔkÉïaÉëÏuÉÉqÉ®åÇAÇxÉmÉÏPûxMülkÉoÉlkÉlÉÉuÉÇxÉÉæ,iɧÉ

xiÉokÉoÉÉWÒûiÉÉ;|| (xÉÑ. xÉ. zÉÉ 6/26)

 

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aÉëÏuÉÉqÉÑpÉrÉiÉÈ xlÉÉruÉÏ aÉëÏuÉÉoÉWÒûÍzÉUÉåliÉUå ||

xMülkÉÉÇxÉmÉÏPûxÉqoÉlkÉÉÇxÉÉæ oÉÉWÒûÌ¢ürÉÉWûUÉæ

|(A.WØû.zÉÉ.4/25)

oÉÉWÒûqÉÑkÉÉï oÉÉWÒûÍzÉU:,aÉëÏuÉÉ iÉÑ MülkÉUÉ,iÉrÉÉåqÉïkrÉå

AÇxÉTüsÉMüpÉÑeÉÍzÉZÉUrÉÉåoÉïlkÉlÉÉæ AÇxÉÉæ,

xlÉÉrÉÑqÉqÉÉïhÉÏ AkÉÉïlaÉÑsÉå uÉæMüsrÉMüÉUÏÍhÉ cÉ || (xÉÑ. xÉ. zÉÉ

6/26 QûsWûhÉ)

aÉëÏuÉÉrÉÉ EpÉrÉÉå: mÉɵÉïrÉÉå: xlÉÉruÉÏ ²å AÇxÉÉuÉÑcrÉåiÉå| YuÉ

ÎxjÉiÉÉæ?

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CuÉ mÉÏPåû,-mÉëÌiɸÉlÉå,

rɧÉÉÇxÉÉæ ÌiɸiÉÈ | xMülkÉÉæ cÉÉÇxÉmÉÏPåû cÉ, iÉåwÉÉÇ xÉqoÉlkÉ:-

mÉërÉÉåeÉlÉÇ,

rÉjÉÉåxiÉÉuÉåuÉÇxÉÉæ ÌuÉ®Éæ oÉÉÀûÉæ: Ì¢ürÉÉ-

AÉMÑülcÉlÉmÉëxÉÉhÉÉïÌSMüÉ, iÉÇ WûUiÉÈ,iÉÉæ oÉÉWÒûÌ¢ürÉÉWûUÉæ

 

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OûÏMüÉ)

 

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23) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 358

24) Agnivesha, Charaka samhita with Ayurveda dipika of commentary of

Chakrapanidatta; Edited by Vaidya Jadavji Trikamji Acharya;

Chaukambha Orientalia; Varanasi; Reprint 2007; Pp: 738; Page No.: 181

25) Agnivesha, Charaka samhita with Ayurveda dipika of commentary of

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Chaukambha

Orientalia Varanasi; Reprint 2007; Pp: 738; Page No.: 338

26) Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of

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Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

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31) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

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And Ayurveda Rasayana commentary of Hemadri; Edited by

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33) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

34) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 37

 

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35) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

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36) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

37) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 370

38) Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of

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Orientalia; Varanasi; Reprint 2005; Pp:956; Page No.: 413

39) Bhavamishra, Bhavaprakasha Part I with Hindi commentary by Pandit

Sri. BrahmaShankar Misra; Edited by Pandit Sri. Brahma Shankar Misra;

8th edition;

 

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“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 158 

Chaukambha Sanskrit Sansthan; Varanasi; 2003; Pp: 960; Page No.: 66.

40) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edite by Vaidya Jadavji Trikamji Acharya and Narayana

Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi; 2007; Pp:

824; Page No.: 371

41) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Editedby Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

42) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Editedby Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

43) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Editedby Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 374

44) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

 

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“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 159 

Dalhanacharya and Nyaya Chandrika Panjika commentary of

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Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 374

45) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

46) Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of

Arunadatta andAyurveda Rasayana commentary of Hemadri; Edited by

Bhisagacharya HarisastriParadakara Vaidya; 9th edition; Chaukambha

Orientalia; Varanasi; Reprint 2005; Pp:956; Page No.: 414

47) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

48) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

 

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BIBILIOGRAPHY   

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 160 

2007; Pp: 824; Page No.: 371

49) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 366

50) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

51) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

52) Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of

Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by

Bhisagacharya HarisastriParadakara Vaidya; 9th edition; Chaukambha

Orientalia; Varanasi; Reprint 2005; Pp:956; Page No.: 414

53) Sushruta, Sushruta samhita with Nibandha sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

 

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“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 161 

Gayadasacharya; Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition;Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 374

54) Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya;Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th

edition; Chaukambha Orientalia; Varanasi; 2007; Pp: 824; Page No.: 371

55)Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of

` Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya;

Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya;

9th

edition; Chaukambha Orientalia; Varanasi; 2007; Pp: 824; Page No.: 366

55) Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya;Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 374

 

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BIBILIOGRAPHY   

“A Study on prushtha marma W.S.R. to Stabdhabahuta in Amsa marmabhighata ”  Page 162 

56)Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya;Edited by Vaidya Jadavji Trikamji Acharya and

Narayana Ram Acharya; 9th edition; Chaukambha Orientalia; Varanasi;

2007; Pp: 824; Page No.: 371

56) Vagbhata, Astanga Hrdayam with Sarvanga Sundara commentary of

Arunadatta and Ayurveda Rasayana commentary of Hemadri; Edited by

BhisagacharyaHarisastri Paradakara Vaidya; 9th edition; Chaukambha

Orientalia; Varanasi;Reprint 2005; Pp: 956; Page No.: 414

57) Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya;

Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya;

9th edition; Chaukambha Orientalia; Varanasi; 2007; Pp: 824; Page No.:

374

58) Sushrutha, Sushrutha Samhitha with Nibandha Sangraha commentary of

Dalhanacharya and Nyaya Chandrika Panjika commentary of

Gayadasacharya;

Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya;

9th edition; Chaukambha Orientalia; Varanasi; 2007; Pp: 824; Page No.:

371

 

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59) Secrets of marma, prof.dr.avinash lele,prof. Dr.subhash Ranade,Dr David

frawley,chaukambha Sanskrit pratishthan, Delhi, First edition-2002;

Pp:109; Page No.:69-75.

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edition-2006,Chaukambha Amarabharati prakashana Pp:109; Page no.77.

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chauhan,chaukambha Orientalia Varanasi Pp:254; Page no: 169

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commentary by- Dr.B.G.Ghanekar,publishedMeharchand Lachhmandas

publications,New Delhi,14th edition, 1999

63) A critical and correlative study on marma & marmabhighata W.S.R. to

pelvic region in relation to anatomy & patho-physiology,by

Dr.N.G.Mulimani,M.D. Thesis,N.K.J.Ayurvedic Medical college Bidar-

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64) B D Chaurasia’s Human Anatomy, volume-1,4th edition-2005, CBS

Publishers & Distributors New Delhi Pp:288; Page No:59,75.

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Publishers & Distributors New Delhi Pp430; Page No:313,387.

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culcutta, third edition-2001, Pp:1324 ; Page No:452.

 

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68) Bailey & Love’s short practice of Surgery;Publisher:Arnold international

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Diagnosis-2nd Edition-2002 JP Brothers Medical publishers (P) Ltd., New

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72) Shoulder region injuries (Marma-2009) presented paper by Dr

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Page 192: Prustamarma, sr

                                                                                                    ANNEXURE  

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 1 

SHRI SIDDHARUDHA CHARITABLE HOSPITAL

TEACHING HOSPITAL ATTACHED TO

N.K.J. AYURVEDIC MEDICAL COLLEGE AND P.G. CENTRE

BIDAR – 585403  

P.G. DEPARTMENT OF RACHANA SHAREER  

TITLE ‐  “A  study  on  prushtha  marma  w.s.r  to  stabdhabahuta  in  amsa marmabhighata.” 

 

Name of the P.G. Scholar – Dr. shivasharanayya M. swamy

O.P.D No – Bed No –

I.P.D No – Ward –

Diagnosis – Duration –

Date –

Name – Age / Sex –

Address –

Occupation – Religion –

Date of Admission –

Date of Discharge –

 

Page 193: Prustamarma, sr

                                                                                                    ANNEXURE  

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 2 

1. Chief complaint with Associated Sign & Symptom with duration :

a. Pain(Ruja)

b. Swelling(shotha)

c. Tenderness

d. Loss of function (Bahu kriyahara)

e. Morning stiffness(stabdhata)

f. Inability to move the upper limb

g. Others

2. History of present illness :

a. Fall from a height

b. Accident

c. Strike by a hard object

d. Twisted

e. Crushing injury

f. Others

3. History of past illness :

a. H/O – related to operation

b. H/O – Diabetes

c. H/O – Tuberculosis

d. H/O – Rheumatic/ Rheumatoid diseases

e. Others

 

Page 194: Prustamarma, sr

                                                                                                    ANNEXURE  

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 3 

4. Family History :

5. General Examination :

Body built – Temp. – 0 F

Nutrition – Pulse –

Appearance – B.P. –

Pallor – Respiration –

Lymphadenopathy – Weight –

Oedema –

6. Local / Regional examination :

a. Deformity – Visible ⃞ / Palpable ⃞ / No Deformity ⃞

Specification: __________

b. Swelling – Yes ⃞ / No ⃞ in Cm ________

c. Visible bruising – Yes ⃞ / No ⃞ area in measurement ________

d. Tenderness over the shoulder areas – mild ⃞ / moderate ⃞ / severe ⃞ / absent ⃞

e. Function of the upper limb – impaired ⃞ / limitation ⃞ / intact ⃞

f. Movement of the upper limb – abnormal movements ⃞ / crepitus ⃞

Specification :__________

 

Page 195: Prustamarma, sr

                                                                                                    ANNEXURE  

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 4 

7. Additional Clinical Examination :

a. Skin wound : Communicated with fracture

i. Position –

ii. Nature of wound –

b. State of circulation in distal part :

i. Colour – Pink ⃞ / Blue ⃞ / Gray ⃞ / White ⃞

ii. Warmth – Warm ⃞ / Cold ⃞

iii. Arterial Pulsation –

iv. Capillary return – on digital pulp –

Pink flush / Sluggish / Absent

c. State of spinal cord and peripheral nerve :

d. Involved joint :

i. Joint mobility in degree –

ii. Extension ⃞ / Flexion ⃞ / Lateral rotation ⃞ / Medial

rotation ⃞ / Adduction ⃞ / Abduction ⃞ / Circumduction

⃞ / Protraction ⃞ / Retraction ⃞

8. Radiological examination :

a. Type of Dislocation – Traumatic ⃞ / Fatigue ⃞ / Pathological ⃞

Specification :__________

 

Page 196: Prustamarma, sr

                                                                                                    ANNEXURE  

“A study on Prushtha marma W.S.R. to stabdhabahuta in Amsa marmabhighata”  Page 5 

b. No. of fragments ________ : Displaced ⃞ / Undisplaced ⃞

c. Direction of displacement _____________

d. Alignment – _______________

e. Evidence of union – _______________

f. Evidence of adjacent joint injury –_______________

g. Joint condition –_______________

h. Condition of the articulating surface –_______________

i. Joint space –________________

j. Others –________________

9. Pathological investigation :

a. Blood – DC TLC Hb% ESR Fbs

b. Urine – Routine Microscopic

Signature of the Guide –

Signature of the Co-guide – Signature of the Scholar –

 

Page 197: Prustamarma, sr

Sr No

OPD/IPD No. of

Patient Age Sex Occupation Diet

Habit

Chief complaints

Shoulder pain (Amsa ruja)

Restricted movements

(cheshtopaghata)

Tenderness (sparshaasahatva)

Motor weakness

(Kriyahaani) 1 29545 62 M farmer mixed 3 3 1 32 30476 46 M farmer veg 2 2 0 33 29497 28 F housewife veg 1 3 0 44 31573 95 M other veg 0 4 0 35 31774 59 M farmer veg 3 2 1 46 31735 44 M driver mixed 4 3 2 37 32009 32 F sports mixed 2 3 0 38 32557 32 F other mixed 3 2 1 39 36339 35 M teacher veg 0 3 0 4

10 37204 59 M other mixed 3 3 1 311 82 F housewife veg 0 4 0 012 76 M other veg 3 2 1 213 65 M farmer veg 2 3 0 314 34 M sports mixed 4 3 1 315 56 F housewife mixed 0 4 0 116 67 M farmer veg 3 3 0 317 33 M sports mixed 3 3 0 318 43 F housewife mixed 2 3 0 419 56 M farmer mixed 1 3 0 420 34 F sports mixed 3 4 1 221 42 M driver mixed 4 3 0 322 55 M driver veg 3 2 0 323 32 F teacher veg 2 3 0 424 28 F sports mixed 4 4 1 225 61 M farmer mixed 0 4 0 026 27 M sports mixed 4 3 1 227 23 M sports veg 3 3 0 4

Page 198: Prustamarma, sr

28 45 M driver mixed 3 4 2 229 49 F housewife mixed 2 3 0 430 55 M farmer veg 0 4 0 0

Page 199: Prustamarma, sr

history of present illness clinical examination

Modern diagnosis Ayurvedic diagnosisVisible

Deformity numbness

(Stabdhata) trauma pathology arm drop sign

absent negative yes no positve Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no positve Frozen Shoulder Stabdhabahuta

palpable positve yes no positve Erb's Paralysis Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no positve Rotator cuff injury Stabdhabahutaabsent negative yes no positve Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahuta

palpable positve yes no positve Klumpke's Paralysis Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no positve Rotator cuff injury Stabdhabahuta

palpable positve yes no positve Klumpke's Paralysis Stabdhabahutaabsent negative yes no positve Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no positve Frozen Shoulder Stabdhabahutaabsent negative yes no positve Frozen Shoulder Stabdhabahutaabsent negative yes no positve Rotator cuff injury Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahutaabsent negative yes no positve Rotator cuff injury Stabdhabahuta

palpable positve yes no positve Klumpke's Paralysis Stabdhabahutaabsent negative yes no positve Rotator cuff injury Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahuta

Page 200: Prustamarma, sr

absent negative yes no positve Rotator cuff injury Stabdhabahutaabsent negative yes no negative Frozen Shoulder Stabdhabahuta

palpable positve yes no positve Erb's Paralysis Stabdhabahuta