Vital points (marma)

A footnote defines marma as a particular place where an injury usually causes death, citing the derivation 'that which kills is marma'.

Each leg is said to have eleven marmas: kshipra, talahridaya, kurcha, kurchashira, gulpha, indravasti, janu, ani, urvi, rohitaksha and vitapa; the other leg and each arm have eleven likewise.

In the arms the wrist (manibandha), elbow (kurpara) and kakshadhara stand in place of the ankle, knee and vitapa and give the same signs when injured, so forty-four fixed marmas are described in the four limbs.

Twelve marmas are described in the abdomen and chest: guda, basti and nabhi in the abdomen, and hridaya, the stanamula pair, the stanarohita pair, the kapala pair and the apastambha pair in the chest.

Fourteen marmas are described in the back, as pairs: katikataruna, kukundara, nitamba, parshvasandhi, brihati, amsaphalaka and the pair between neck and shoulder (amsa).

Thirty-seven marmas are described from the throat up to the head.

By structure the marmas are of five kinds: bone (asthi), ligament (snayu), joint (sandhi), vessel (sira) and flesh (mamsa) marmas.

Bone marmas are katikataruna, amsaphalaka, shankha and nitamba; ligament marmas are kakshadhara, kurcha, kurchashira, krakanyamsaka (amsa), basti, vidhura, vitapa, utkshepaka, kshipra and ani; joint marmas are janu, kurpara, gulpha, simanta, avarta, adhipati, krikatika, manibandha and kukundara.

Vessel marmas are apalapa (kapala), sthapani, phana, stanamula, nila, manya, shringataka, apanga, matrika, urvi, brihati, parshvasandhi, hridaya, nabhi, apastambha and lohitaksha, as the omniscient one taught; flesh marmas are talahridaya, indravasti, guda and stanarohita.

By outcome the marmas are again of five kinds: immediately fatal (sadyah pranahara), fatal after an interval (kalantara pranahara), fatal when the dart is removed (vishalyaghna), disabling (vaikalyakara) and pain-causing (rujakara); a physician who knows them should determine the disease from contrary and non-contrary signs and treat accordingly.

Nineteen marmas are immediately fatal: the eight neck vessels (matrika), guda, hridaya, basti, nabhi, adhipati, the two shankha and the four shringataka. Twenty-nine are fatal after an interval: the eight chest marmas, four talahridaya, four indravasti, four kshipra, five simanta, two parshvasandhi and two brihati.

Utkshepaka and sthapani kill when the lodged dart is drawn out (vishalyaghna); forty-eight marmas are disabling: janu, urvi, vitapa, kakshadhara, kurcha, apanga, nila, amsa, avarta, kukundara, amsaphalaka, lohitaksha, ani, manya, phana, nitamba, vidhura, kurpara, krikatika and katikataruna; eight are pain-causing: the four kurchashira of hands and feet, two manibandha and two gulpha.

In all 107 marmas are counted: 19 immediately fatal, 29 fatal after an interval, 3 fatal when the dart is removed, 48 disabling and 8 pain-causing.

When the end, middle or side region of a marma is harmed by disease or injury, the result follows that region: if the end of an immediately fatal marma is pierced it kills after an interval, and if the end of one fatal after an interval is pierced it becomes disabling; the good physician should state the outcome after dispelling doubt through the scriptures taught by the Apta.

Intense pain even in the vital points (marma), with needle-like pain in the body from aggravated vata and distress like that of one stung by a fierce scorpion, is listed among the signs of a person who lives only three days.

The body is said to have 107 vital points (marma).

A footnote gives the sizes: urvi, kurchashira, vitapa and kakshadhara one finger-breadth each; stanamula, manibandha and gulpha two; janu and kurpara three each; hridaya, basti, kurcha, guda, nabhi, the four of the head (shringataka), the five of the skull and the ten of the throat (matrika, two nila, two manya) four each; all the rest half a finger-breadth.