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

PriShtha Marmas :— Now we shall discourse on the Marmas in the back (of a man). An injury to any of the Katika-tarunas* (sacro-iliac articulation), situated in the region of the S'roni Csacrum) on both sides of the spinal column, gives rise to an excessive haemorrhage and consequent pallor and ends in death. A hurt to any of the Kukundara Marmas | (lit : — a hollow — the great sacro-sciatic notch), situated on both sides of the spinal column and in the region slightly below the waist (in the loins), results in complete anaesthesia and inoperativeness of the lower extremi- ties. A hurt to the Nitamva-Marmas,| attached to the side above the Sroni (pelvis) and attached inside to the muscles of the waists, gives rise to Sosha (atrophia) in the lower extremities, weakness and ultimately brings on death. An injury to the PairsVa-Sandhi-Marmas § (caelic axes) which are situated just at the middle below the extremities of the sides (P^rsva) and which lies attached at the middle between the loins at their lower regions, feels the Koshtha (abdomen) with the blood and results into death A hurt to the Vrihati-Marmas 1]

* It is an Aslhi-Marma, half a finger in length and of the Kalantara- maraka class.

t They ate Joint-matmas (Sandhi), half a finger in length and of the Vaikalyakara group.

J It is a bone Marma, half a finger in length, and of the Kalantara clas§,

§ It is a S'ira-Marma to the length of half a finger and belongs to the Kalantara class.

li They are S'ira-Marmas (arterial anestomsis) to the lengt of half a finger and belong to the KaUntara class.

Chap. VI.J SARIRA STHANAM. iS$

which commencing from the roots of the breast
course round both the sides of the spinal column
(Pristha-vams'a), cause excessive bleeding, and the patient
dies, as supervening symptoms arise from an excessive
loss of blood. An injury to any of the two Amsa-phalaka»
Marmas* situated on either side of the vertebral column
and connected with the scapula brings on anesthesia
or atrophy (Sopha) of the arms. There are two Marmas
known as Amsa-Marmasf which are situated on either
side midway between the neck and the head of the arms
and connect the Amsa-Pitha (glenoid cavity) and the
Skandha (shoulder). An injury to any of these Marmas
is attended with an incapacity of moving the hands.
Thus the fourteen Marmas in the back have been
described. 57-65.

The Jatrugata- Marmas :-Now we shall

describe the Marmas which are situated in the regions above the clavicles (Urddhva-Jatru). There are four Dhamani (arteries) about the two sides of the Kantha- Nadi (wind-pipe). Two of them are known as Nilai, and the other two as Manyai. One Nild and one Manyd are situated on either side of the larynx, (i.e , anterior and posterior side of the larynxl An injury to any of them produces dumbness, and change of voice (hoarseness), and also the loss of the faculty of taste. | An injury to any of the eight Siras (arteries), four being on each side of the neck (Griva), and known as Sirak-Ma^trika- Marmas § ) ends fatally within the day. 65-69.

* It is an Asthi-Marma, half a finger in length and is Vaikalyakara.

t They are Snayu Marmas, half a finger in length and of the Vaikalyakara class.

t They are S'ira-Marmas, to the lengrh of four fingers and of the Vaikalyakara class.

§ They are S'ira-Marmas, four fingers in length and of the Sadyo- Matan class,

1 86 THE SUSHRUTA SAMHttA. [Chap. Vl.

An injury to any of the two Marmas lying at the junction of the head and neck (Griva) and known as Krikaitikat* (transverse process of the arch of the atlas) results in a free movement of the head. A hurt to any of the Marmas attached to the lower end of an ear (posterior extrensic ligament) and known as the Vidhurat Marma results in the loss of hearing. An injury to the Phana-Marmast attached to the interior channels of both the nostrils, results in the loss of the faculty of smell. An injury to the Apaknga-Marmas § (Anastomosis of the infra-orbital artery) situated below the tips of the eye-brows and about the external corners of the eyes, brings on blindness or defective vision. An injury to the Avarta-Marmas 11 situated above and below the eye-brows, brings on blindness and impaired vision. An injury to the Sankha-MarmasIT (meeting or suture of the temporal, frontal and sphenoid bones — Pterion)^ situated over the tips of the eye-brows and between the ears and the forehead, results in death within the day. The Marmas situated over the two temples (Sankha) and at the border of the hair (sculp) are called Utkshepa- Marma (meeting of the posterior and anterior temporal arteries)$. An extraction of a shaft (Salya) or of any

* They are Sandhi-Marmas, half a finger in length, and of the Vaikalyakara group.

t It is a S'nayu-Marma, and is of the Vaikalyakara class.

% They are S'ira-Marmas to the length of half a finger and of the Vaikalyakara class,

§ They are S'ira Marmas to the length of half a finger and of the Vaikalyakara class.

II They are Sandhi-Marmas, to the length of half a finger and of the Vaikalyakara class.

^ They are Asthi-Marmas to the length of half a finger.

$ They are S'ndyu-Marmas, half a finger in length and of the Vis'alyaghna class.

Chap. V/. J SARIRA STHANAM. liy

extraneous pointed thing lodged into these Marmas, results in the death of the patient, who, on the contrary, lives as long as the shaft is allowed to remain inside or if the shaft comes out itself (after putrefaction). 70-75. An injury to the Sthapani-Marma* (nasal arch of the frontal veins), situated in the middle of the eye- browSj ends in the manner of the preceding one. An injury Co any of the five joints of the head which are known as the Simanta-Marmast, results in fear, insensi- bility and madness of the patient and terminates in death. An injury to any of the four Sringaktaka- Marmas]: which forms the junction of the four Siras (nerves), (branches of the facial artery) and soothes the nose, the eyes, the ears and the tongue, proves fatal within the day. An injury to the A dhipati- Marmas § (the vertical groove on the frontal bone) which is marked in the inner side of the roof of the cranium by the Sifd- Sannipdta (superior longitudinal sinus), and on the exterior side by the ringlet of the hair (Romavarta) proves fatal within the day. Thus we have described the thirty-seven Marmas, situated in the region aboVe the clavicles (Urddhva-Jatru). 76-80.

IVIeinorable Verses :— An incision should

be made at the spot a fingers width remote from the
Urvi, Kurchcha-Sir^, Vitapa, Kaksha and a Pdrsva-
Marma ; whereas, a clear space of two fingers should

* They are S'ira-Marmas to the length of half a finger and of the Visalyaghna class.

t They are Sandhi-Marmas to the length of four fingers and of the Kalantara-Pranahara class.

t They are S'ira-Marmas to the length of four fingers and of the Sadyah-Pranahara class.

§ It is a Sandhi-Marma, half a finger in length and of the Sadyah- Pranahara class.

1 88 THE SUSHRUTA SAMHITA . [Chap. VI.

be avoided from its situation in making any incision
about the Stanamula, Manivandha or Gulpha-Marma.
Similarly a space of three fingers should be avoided
from the Hridaya, Vasti, Kurchcha, Guda or Nabhi
Marma ; and a space of four fingers should be avoided
in respect of the four Sringatakas, five Simantas and
ten Marmas in the neck (Nila etc.) ; a space of half
a finger being the rule in respect of the remaining (fifty-
six).* Men, versed in the science of surgery, have laid
down the rule that, in a case of surgical operation, the
situation and dimension of each local Marma should
be first taken into account and the incision should be
made in a way so as not to affect that particular Marma,
inasmuch as an incision, even extending or affecting,
in the least, the edge or the side of the Marma, may
prove fatal. Hence all the Marma-Sthanas should be
carefully avoided in a surgical operation. 8i.

The amputation of a hand or a leg may not prove fatal whereas a wound in any of the Marmas situated therein is sure to bring on death. The vessels become contracted in the case of a cut in the leg or in the hand of a man, and hence the incidental bleeding is compara- tively scantier. Therefore it is that a cut in any of these parts of the body, however painful, does not necessarily prove fatal, like the lopping off of the branches of a tree. On the contrary, a man pierced into in any such Marmas, as the Kshipra or the Tala, suffers from excessive

* Some are of opinion that a surgical operation (in the case of the remaining fifty-six) should be made, leaving a space equal in measurement to the dimensions of a palm (from the affected part). Gayadasa, having learnt from Bhoja, explains that a space of two fingers should be left (from the affected part) in making surgical operations of the ten marmas, namely, the two Gulphas, the roots of the two breasts, the four Indravastis, and the two Manivandhas.

Chap. VI.] SARIRA STHANAM. 1 89

hemorrhage (from the affected part) and attended with
an excruciating pain, owing to the derangement of the
Vdyu, and meets his doom like a tree whose roots
have been severed. Hence, in a case of piercing or
of injury to any of these Marmas, the hand or the leg
should be immediately amputated at the wrist or at
the ankle (respectively). 82.

The medical authorities have described the Marmas
to have covered half in the scope of Salya Tantra
(Surgery), inasmuch as a person hurt in any of the
Marmas dies presently (i. e., within seven days of the
hurt). A deformity of the organ is sure to result from
an injury to one of these Marmas, even if death be
averted by a course of judicious and skillful medical
treatment. 83.

The life of the patient is not to be despaired of even
in the case of fracture or crushing of a bone of the
Koshtha, Sirah and Kapdla or perforation of the intestines
etc , if the local Marmas are found not to be in any way
hurt or affected. Recovery is common in cases of
cuts (pierce) in the Sakthi, Bhuja, Pdda and Kara
or in any other part of the body and even where a
whole leg or hand is found to be severed and carried
away if the Marmas are not in any way hurt or
affected. 84.

These Marmas form the primary seats of the Vayu,
the Soma (lunar) and Tejas (fiery principles of the
organism), as well as of the three fundamental qualities
of Satva, Rajas and Tamas, and that is the reason why
a man, hurt in any of the Marmas, does not live. 85.

An injury to a Marmaof the Sadyah-Prdnahara class
(in which death occurs within a day) is attended with
the imperfection of the sense organs, loss of conscious-
ness, bewilderment of Manah (mind) and Buddhi

IQO THE SUSHRUTA SAMHITA. [Chap VI.

(intellect) and .various kinds of pain. An injury to a
Marma of the KAlantara group (of a person) is sure to
be attended with the loss of Dbatus (blood etc.) and
various kinds of supervening symptoms (Upadrava) which
end in death. The body of a person, hurt in any of
the Vaikalyakara Marmas, may remain operative only
under a skillful medical treatment ; but a deformity
of the affected organ is inevitable. An injury to any
of the Vis'alyaghna Marmas ends in death for the
reasons mentioned above. An injury to any of the
Rujdkara Marmas gives rise to various kinds of pain
in the affected organ, which may ultimately bring about
a deformity of the same, if placed under the treatment
of an ignorant and unskillful Vaidya (Surgeon). S6.

An injury to the adjacent part of a Marma, whether
incidental to a cut, incision, blow (Abhighdta), burn,
puncture, or to any other cause exhibits the same
series of symptoms as an actually affected one. An
injury to a Marma, whether it be severe or slight, is
sure to bring deformity or death.* Sy.

The diseases which are seated in the Marmas, are
generally serious, but they may be made to prove
amenable with the greatest care and difficulty. 88-89.

* Gayadasa does not read this verse.

Thus ends the sixth Chapter of the S'arira Sthanam in the Sus'ruta Samhita, which treats of Marmas.

Now we shall discourse on the Siriram which treats of the description and classification of Sira or vascular

system * ( ^irsL-Varnana-Vibhaktinama ^ariram).

There are seven hundred Sirds (vessels) in the
human organism (except those which cannot be counted
for their extremely attenuated size). The vessels
(Siras) by their contractibility and expansibility &c ,
sustain and nourish the organism in the same manner
as streamlets and canals serve to keep a field or a
garden moist and fruitful. From the principal or cen-
tral trunk hundreds of small and minute vessels branch
off and spread all over the body, just as small or minute
fibres are found to emanate from the large central vein
of the leaf of a plant. They originate from the umbili-
cal region and thence they spread all over the body up-
wards and downwards and obliquely. 2.