An English Translation of the Sushruta Samhita (Bhishagratna ed.)

Different Opinions on the IVIarmas : —

Some assert that Marmas, which are the firm union of the five bodily factors (of veins, ligaments, muscles, bones and joints), belong to the first group (Sadya-Prana- hara) ; that those, which form the junction of four such, or in which there is one in smaller quantity, will prove fatal in the long run, in the event of their being hurt or injured (Kdldntara-Pranahara).* Those, which are the junction of three such factors, belong to the Vis'alya-Prcinahara-f* group ; those of the two belong to the Vaikalyakara X

* The Marmas, such as Stana-mula, Apalapa, Apastambha, Simanta, Katika-Taruna, Parsva-Sandhi, Vrihati, and Nitamva be- longing to the Kalantara-maraka group, are devoid of Mansa (muscles) ; and the 'Marmas' known as Stanarohita, Talahridaya, Kshipra, and Indravasti, belonging to the same class, are devoid of Asthi (honest

t The Ulkshepa marma, belonging to the Vis'alya.pr^nahara group, is devoid of Mansa (muscles) and Sandhi (joint).

X The Sthapani- Marma, belonging to the Vaikalyakara class, is devoid of Mansa (muscle), S'ira and Snayu ; (he Lohitaksha-marma (of the same group) is devoid of Snayu, Sandhi and Asthi (bones) ; the Janu-marma (of the same group) is devoid of Mansa, S'ira and Snayu: the Urvi-marma (of the said group) is devoid of Asthi, Mansa and Snayu ; the Vitapa-marma (of the same class) is devoid of Mansa, Sira and Asthi ; the Kurpara-marma (of the same class) is devoid of Mansa, S'ira, and Snayu ; the Kukundara-marma (of the same class) is devoid of Mansa, S'ira and Sandhi ; the Kakshadhara-marma (of the same class) is devoid of S'ira, Asthi, and Sandhi ; the Vidhura-marma (of the said group) is devoid of Mansa, Sira and Sandhi ; the Krikatika-marma is devoid of Mansa, S'ira, and Sandhi; the Ansa-marma (of the same group) is devoid of Mansa, Snayu and Sandhi ; the Ansa-phalaka-marma

178 THE SUSHRUTA SAMHITA . [Chap. VI.

group ; and those in which only one of them exists belongs to the last or pain-generating type (Rujdkara)*.

But the fore going theory is not a sound one, inas-
much as blood is found to exude from an injured joint
which would be an impossibility in the absence of any
vein, ligament (Snayu) and muscle being intimately
connected with it. Hence every Marma should be
understood as a junction or meeting place of the five
organic principles of ligaments, veins, muscles, bones
and joints. 24-25.

IVletrical text:— This is further corroborated
by the fact that the four classes of Sira or vessels (which
respectively carry the Vdyu, Pitta, Kapha and the blood)
are found to enter into the Marmas for the purpose
of keeping or maintaining the moisture of the local
ligaments (Snayu), bones, muscles and joints and thus
sustain the organism.f The Vayu, aggravated by an
injury to a Marma, blocks up (those four classes of
vessels) in their entire course throughout the organism
and gives rise to great pain which extends all over the
body. All the internal mechanism of a man (of which a
Marma has been pierced into with a shaft or with any
other piercing matter) becomes extremely painful, and
seems as if it were being constantly shaken or jerked,
and symptoms of syncope are found to set in. Hence a
careful examination of the affected Marma should

(of the said group) is devoid of Mansa, Snayu and Sandhi ; the Nila, Manya and Phana Marmas (of the same group) are devoid of Mansa, Sandhi and Asthi ; the Avarta-marma is devoid of S'irsL, Sniyu and Mansa ; the Apdnga. marma (of the said class) is devoid of Mansa, Sniyu and Sandhi.

* The Gulpha, Manibandha, and Kurchcha-s'ira Marmas, belonging to the Rujakara group, are devoid of Mansa, S'ir^, Sniyu and Asthi, i.e. Sandhi alone is present in these.

t Hence the piercing of a bone is attended with bleeding.

Chap. VI.] SARIRA STHANAM, 179

precede all the foregoing acts of extricating a Salya from
its inside. From that similar aggravated conditions and
actions of the Pitta and the Kapha should be presumed
in the event of a Marma being any v^ay injured or
pierced into. 26—29.

A Marma of the Sadyah-Pr^nahara type being
perforated at its edge brings on death at a later time
(within seven days), whereas a deformity of the organ
follows from the piercing of a Kdlantara-Miraka*
Marma at the side (instead of in the centre). Similarly,
an excruciating pain and distressful after-effects mark a
similar perforation of a Marma of the Vis'alyaghnaf
group. And a Marma of the Rujdkara|: class pro-
duces an excruciating pain (instead of a sharp one) in
the event of its being pierced at the fringe. 30.

An injured Marma of the Sadyah-Pranahara type
terminates in death within seven days of the injury,
while one of the Kaldntara type, within a fortnight or a
month from the date of hurt (according to circumstances).
A case of injured Kshipra-Marma seldom proves fatal
before that time (seven days). An injured Marma of the
Vis'alyaghna or Vaikalyakara group may prove fatal
in the event of its being severely injured. 31.

Marmas of the Extremities :— Now we

shall describe the situation of every Marma. The

* If any of the Marmas of the Kalanlara-Pranahara group be deeply perforated, then this perforation is sure to bring on death within a day {i.e. it will act like a slightly injured Marma of the Sadyah- Pranahara group).

t Any M.-irma of the Vis'aiyaghna-group, being deeply perforated, brings on death within seven days (/. e. it will behave like a slightly injured Marma of the Kalantara-Prknahara class).

t Any Marma of the. Rujakara class, being deeply perforated (injured), is sure to bring excruciating pain etc, (i.e., it will act like a slightly injured Marma of the Vis'alyaghna group).

rSo THE SUSHRUTA SAMHITA. [Chap. VI.

Marma, known as the Kshipra*, is situated in the
region between the first and the second toes (Tarsal
articulation), which, being injured or pierced, brings
on death from convulsions. The Marma, known as the
Tala-Hridayat, is situated in the middle of the sole
of the foot in a straight line drawn from the root of
the middle toe. An injury to this Marma gives rise to
extreme pain which ends in death. The Marma, known
as the Kurchchat, is situated two fingers' width
above from the Kshipra one on each side of the
foot. An injury to this Marma results in shivering
and bending in of the foot. The Marma called
Kurchcha-Sirah § is situated under the ankle-joints,
one on each side of the foot (Gulpha-Sandhi) ; an
injury to it gives rise to pain and swelling of the
affected part. A perforation of the Gulpha-Marma !!,
which is situated at the junction of the foot and
the calf, results in pain, paralysis and maimedness
of the affected leg. 32-37-

An injury to the Marma which is. situated in the
middle muscle of the calf to the distance of between
twelve and thirteen fingers' width from the ankle, and
known as the Indravasti-Marma^lT results in excessive
haemorrhage which ends in death. 38.

* It is a Snayu-Marma (ligament) to the width of half a finger, and belongs to the Kalantara group.

t It is a Mansa-Marma to the width of half a finger and belongs to the Kalantara group.

:; It is a Snayu-Marma to the length of four fingers' width, and belongs to the Vaikalyakara group.

§ It is a Snayu-Marma, one finger in length and belongs to the Vaikalyakara group.

II It is a Sandhi-Marma, to the length of two fingers', and belongs to the Vaikalyakara group.

IF Indravasti measures two fingers in length according to Bhoja and

Chap. VI.] SARIRA ST HAN AM. iSl

An injury to or piercing of the Jatnu-Marma*
situated at the union of the thigh and the knee, results
in lameness of the patient. 39.

A piercing of the Aui-Marma,+ situated on both the
sides above three fingers' width from the Jdnu (knee joint),
brings on swelling and paralysis (numbness) of the
leg. 40.

A perforation of the Urvi-Marma,t situated in the
middle of the Uru (thigh), results in the atrophy
of the leg, owing to the incidental haemorrhage. An
injury to the Lohitaiksha-Marma,ll situated respectively
a little above and below the Urvi-Marma and the
Vankshana (groin-joint), and placed near the thigh, is
attended with excessive haemorrhage and causes para-
lysis (of the leg). 41-42.

An injury to the Vitapa-Marma,^ situated between
the Scrotum and the Vankshana (inguinal region), brings
on loss of manhood or scantiness of semen. Thus the
eleven Sakthi-Marmas of one leg have been described ;
those in the other being of an identical nature with the
preceding ones. The Marmas in the hands are almost
identical with those of the legs, with the exception that
Manivandha, Kurpara and Kakshadhara Marmas

Gayadasa, though half a finger in width according to others. It is a Mansa-Marma and belongs to the Kalantara group.

* It is a joint-Marma, three fingers in length and belongs to the Vaikalyakara group.

t It is a ligam';nt-Marma, half a finger in length, (three fingers according to Gayadasa) and is of the Vaikalyakara class.

X It is a S'ira-Marma, half a finger in length and of the Vaikalya- kara group,

II It is a S'ira-Marma, halfa finger in length and of the Vaikalya. kara group.

IT It is a Snayu-Marma to the length of one finger and of the Vaikalyakara group.

l82 THE SUSHRUTA SAMHITA. [Chap. VI.

occur in the place of the Gulpha, Jdnu and
Vitapa Marmas respectively. As the Vitapa-Marma
is situated between the scrotum and the Vankshana
(inguinal region), so the Kakshadhara-Marma is situated
between the Vaksha (chest) and the Kaksha (armpit).
An injury to these causes supervening symptoms.
An injury to the Manivandha-Marma (wrist-marma)
results specially in inoperativeness (Kuntha) of the
affected hand ; an injury to the Kurpara-Marma ends
in dangling (Kuni) of the hand ; and an injury to
the Kakshadhara results in hemiplegia. Thus the
forty-four Marmas of the upper and the lower extremi-
ties have been described. 43-46.

Marmas on the Thorax etc. :— Now we

shall describe the Marmas, situated in the region of
the thorax and the abdomen (trunk). A hurt to
the Guda-Marma*, which is attached to the large
intestine and serves as the passage of stool and flatus,
ends fatally (within twenty-four hours of the hurt).
An injury to the Vasti-Marma,t situated inside
the cavity of the pelvic region and the bladder and
composed of small muscles and blood (and which
serves as the receptacle of urine), proves fatal with-
in the day, except in the cases of extracting the
gravel, only when the injury to the organ is short
of complete perforation of both of its walls. The
urine oozes out through the aperture in the case
where only one of its walls has been perforated, and
which may be closed and healed up with proper
and judicious medical treatment. An injury to the

* It is a Mansa-Marma to the length of four fingers' width and be. long? to the Sadyo-maraka class.

+ It is a ligament combination (Snayumarma) to the length of four fingers, belonging to the Sadyah-Pranhara class.

Chap. VI.i SARIRA STHANAM. 183

Natbhi-Marma,* the root of all the Siras and situated
between the Amdsaya (stomach) and the Pakv^s'aya
(intestines) ends in death within the day. 47-50.

A hurt to the Hridaya-Marma,t which is situated
in the thorax between the two breasts and above the
pit of the Amasaya and forms the seat of the qualities
of Sattva, Rajas and Tamas, proves fatal within the
day. An injury to the Stana-mula-Marmas,]: situated
immediately below each of the breasts and about two
fingers in width fills the Koshtha (thorax) with deranged
Kapha, brings on cough, difficult breathing (asthma)
and proves fatal. An injury to any of the Stana-
Rohita-Marinas,§ situated above the nipples of
the breasts about two fingers in width, fills the cavity
of the Koshtha (thorax) with blood, producing symptoms
of cough and asthma, and ends fatally. An injury to
the Apalaipa-Marmas,!! situated below the Ansa-kuta
(balls of the shoulders) and above the sides (meeting
of the different branches of the sub-clavicle veins ue.
axilla', transforms the blood of the organism into pus
and proves fatal thereby. 51-54.

An injury to any of the Vayu-carrying vessels, known
as the Apastambha-Marmalf (meeting of the bifurcated
branches of the bronchi lying on both the sides

* It is a S'ira-Marma to the length of four fingers, belonging to the Sadyah-Pranahara class.

t It is a S'ira-Marma to the length of four fingers and of the Sadyah- Pranahara class.

+ It is a S'ira-Marma, two fingers in length and of the Kalantara class.

§ It is a Mansa-Marma about half a finger in length and of the Kalantara class, (according to Vgabhata, of the Sadyo-Maraka class).

II It is a S'ir^.Marma, half a finger in length, and of the Kalantara class.

H It is a S'ira-Marma, half a finger in length and belongs to the Kalantara class.

1 84 THE SUSHRUTA SAMHITA. [Chap. Vl.

of the breast), fills the Koshtha with the deranged
Vayu (tympanites) accomapanied by cough and dys-
pepsia, and terminates in death. Thus the twelve
Marmas situated in the thorax and abdomen are
described. 55-56.