Marma and its Management

Marma Vigyan is one of the specialities of Ayurveda. The development of standards of treatment for the acutely injured has been closely related to several significant medical discoveries, organised care of the acutely injured, though comparatively recent innovations. In history of trauma in the world is traced, from period of sushrat in India when Crimean war 1854 casualties broke out the care of military and civilian causalities was a random hap-hazard process since being civil control over trauma epidemics.

Due to foreign rule in India for plenty of time, the medical science of the level could not progress therefore development of Marma Vigyan also suffered. There was discriminative treatment to Indian medical science so far as the development is concerned. However it can be pleaded that Marma Vigyan is collection of fundamental of knowledge of Marma. Newer techniques of investigation and management have changed the scenario of acutely injured patients but the anatomical importance of the structure and tissues still holds the importance. Marma of Sushruta and even before that period is in very precise form. Many scholars have on it to explain and interrupt the couplets but in author’s opinion unless and until the material provided in classics is not supported by documentation the relevancy of the product is at stake. The authors have made a little effort through his book to support the observation laid in classics regarding Marma Vigyan to enhance its importance and application in today’s life. The subject has been tried to update with the help of illustrative diagrams and experience of surgeons and scientists on military and civil wounds published in medical journals.

The author of the book was born in a city of western U.P. i.e. Farrukhabad on 28th Oct. 1944. His school going activities were performed in Lucknow, Varanasi and Gonda. He completed his college education from G.N.L.D. Rastogi College Lucknow and did his High school from U.P. board Allahabad in 1960. He passed intermediate in 1962 from Kanya Kubja Inter College, Lucknow and completed University level education from K.K.C. in 1964.

Prof. Mishra entered professional education in State Ayurvedic College Lucknow, a faculty of Lucknow University in 1964 and passed in 1969 with professional Training. He started his private practice from a sub-urban area of Lucknow in Bakshi-ka-Talab.

He had been always interested in teaching profession. Therefore, he did not join as medical officer two times. But in 1974 he was selected for teaching in State Ayurvedic College as demonstrator in Anatomy since then he continued their till his retirement on 31st Oct. 2004 working on different posts such as: Lecturer, Reader and Professor.

His teaching and research skill can be judged by his long 31yrs experience of post graduated teachings and research. Many research papers published in national and international journals. He has been awarded Ph.D. in the subject in 1984.

His subject of interest of teaching was Marma Vigyan and he had been teaching Marma. He has undertaken research projects on Marma also and certain paper published on the subject in reputed journals. He has tried to present his experiences in the form of a book on Marma Vigyan.

Surgery is not the ideal management but is an interim relief for it relives but does not cure. The knowledge of anatomy and physiology are very essential subjects to become good surgeon or physician. Likewise the Marma Vigyan and Srotas Vigyan are contemporary to surgeons and physician. Being a teacher of anatomy Marma Vigyan has been fascinating me since long the quivering thought of writing something on this subject became stronger when I did my Ph.D. in 1983. However, I was not satisfied by my experience on relevant commentary, research work in the department and conferences and seminars. I was still finding difficult to answer, many queries; I preferred to explore more literature such as generals and books regarding military and civil wounds. I traced many gems during my teaching program through different questions raised by my students. I was in a search of a good student who could have the dictation and transform it into printing material. I am really thankful from the core of my heart to Dr. Pradeep Kumar Chouhan who rose to the level of “Co-author” of the book who impressed me through his sincere and hard work with devotion during his study periods as M.D. student under me.

The Ayurvedic literature particularly Marma Vigyan is very precise and incomplete. The commentators have resolved the mystery with possible zeal and knowledge. Still many things were unanswered but the interest showed by many authors in this subject could bring this book into the present form. The importance of this subject may be evaluated from the necessity of the trauma centres being felt all over the world and India has taken lead in the subcontinent. The present first edition might have left some blanks, which are still required to be filled-up. Many mistakes may be felt which need correction; I promise to improve in next edition. The intention of writing this book is to make it a reference book on Marma Vigyan and it has been designed in such a manner that the trauma surgeons may also be benefited. I am thankful to my parents and Goddess “Saraswati” who excelled out through my mind which translated the whole material through my tongue and pen of my pupil. This edition includes following features: 1. Full description of Marmas according to classical versions along with commentaries. 2. The logical interpretations supported by textual anatomy and surgery. 3. The help from journals and books on War wounds and civil wounds has been taken to explain the classical view. 4. The fundamentals of management have also been included to have addition and clear vision of Marmas.

The story of evolution of medicine is a long story stretching from prehistoric to modern times. Hennery Siegerist the medical historian has stated that every culture had developed a system of medicine and medical history but, one aspect of the history of the culture. Ancient medicine is the mother of sciences and played a large role in the integration of early culture. The art of healing began thousands of years ago with the innovation of the primitive man trying to provide relief to those of his kindred in sickness and suffering motivated by feeling of sympathy of kindness. In the absence of an obvious explanation disease and other calamities were attributed to the wrath of God, the evasion of the body by evil spirit is the influence of stars and plants. There is also evidence that prehistoric man developed stones and flint instruments to perform circumcisions, amputations and trepanation of skull. The medicine in prehistoric era (5000 BC) was mixture of superstition, religion, magic and witchcraft. India a place of Aryan is first, probably, on the earth to develop the system of science. Ayurveda which is known to be one of Vedas is practiced throughout India where as Siddha System of medicine is prevalent throughout in Tamil speaking area of South India. It defers very little from Ayurveda in theory and practice. Ayurveda the science of life is traced back to Vedic time about 5000 BC. Charak the most popular name of the Ayurvedic medicine was a court physician to the Buddhist king Kanishka who added to original Agnivesha Samhita, similarly, Sushrut of Varanasi compiled the surgical knowledge of his time (1000 BC). It is the main source of knowledge about surgery in ancient India. The early Indians set fracture, performed amputations, excised tumours, repaired herneas and did couching for cataract. Chinese medicine claims to be the first organised body of medical knowledge dating back to 2700 BC. The Chinese system of “bare foot doctors” and acupuncture anaesthesia has attracted worldwide attention in recent years.

Egyptian medicine (2000 BC) believes that disease was due to putrefaction of blood and formation of pus. The ancient world considered the Egyptians to be the best of all. The Greek theory of humors, blood, phlegm, yellow bile and black bite is similar to Tridosha theory of Ayurveda.

Instruction in battle field to protect Marma Asthals and techniques of attacking Marma places to inactive the opponent are available in Vedas. Military wounds have provided one of the major incentives to the development of vascular surgery. The disease and trauma have been the part of life and the measures adapted to treat them developed with the development of knowledge and civilization.

Vedic Samhitas, Brahmans and Upanishads reflect light on the concept of origin of life, birth, death and disease. The knowledge of Ayurveda inspired from Veda such as Rig-Veda. Atharvaveda and Upanishads. Vedas are to be derived from divine agencies, which have been held to the expression of total knowledge of natural laws governing the universe and its creature human being is said to be the greatest creation of the universe, which is virtually an epitome of this universe. The great thinkers devoted their time for the maintenance of health, longevity of life and freedom from disease.

Marma is one of the important subjects of Ayurveda. Different school of thoughts analyzed this subject from different angles and developed their own thought. For instance Acharya Charak has stressed upon Trimarma in Trimarmiya Siddhi Addhayaya which appears to be relevant with reference to assessment of clinical health even today we do not have more to go beyond this. Marma Vigyan may be taken as synonym of Traumatology. Performance of surgery is a skill which requires perfect knowledge of preoperative, operative, and postoperative measures. The history of trauma can be anticipated from the date-survival is the fittest-exists. In India the trauma and its management is reported from the Vedic period where in ancient wars, surgeons had, frequently, to attend the Aryans chief and soldiers. In Rigveda the reference of amputated legs and its rehabilitation by substitutes may be traced. Injured eyes were enucleated and arrow shaped objects were extracted from the limbs of the Aryan Soldiers. The surgical experience of the ancient age has been compiled systematically in Sushrut Samhita, which is the first documentation of its kind. The wounds in ancient time were commonly caused by stabs with sword, arrow, spear etc. These are low velocity missile and pathways are guided by the tail attached to it. The wars in epics of Ramayana and Mahabharata are the illustrations.