Clinical understanding of Marma in Manasaroga

Introduction

Marma literally means tender, secret or vital things. There is a likelihood of death after infliction to these places and hence called as marma. Marma serves as seat of Pranavata in the body¹ .

There are totally 107 marmas in the body under four categories. Marma is the meeting point of Mamsa, Asthi, Sira, Snayu, Dhamani and Sandhi and where the Prana is concentrated² . They may also described as the junction where vata,pitta and kapha meet where satva,rajas and tamas meet or where eternity and relativity meet. Deeper examination of the mind reveals its presence at the marma sites. Each energy point is related to Manas, the sensory mind, and directly communicates Perception, Thought and Emotion. Every Marma is also related to Budhi, via cognition, retention and Memory, because Marma are doorways to the Nervous System and related Mental faculties. The subconscious memories are stored in the deep connective tissue of Majjadhatu. These memories can be directly accessed by stimulating the Marma, as they are a part of Majjadhatu. Marma are intrinsically connected to the mind via the media of majjadhatu and manovahasrotas. Ayurveda system of medicine says that in the body-mind apparatus, mind controls the body thus proving importance of the mind towards the body. The mind is responsible for many of funtions like perception,taking the right decisions,thinking and understanding.

Injuries to these vital points called marmabhighata, Acharyasusruta explained marmabhighatalakshanas like bhrama (vertigo), pralapa (delirium), patina (inability to balance the body), pramoha (hallucinations or delusions), vicheshtanam (abnormal movements), samlaayanam (functional aspect of mind) srasthangata (dislodging or dislocation), moorcha (fainting or loss of consciousness), urdhvavata (dysponea), teevraruja (severe pain), mamsaodakabhasraava(exudations from body parts), sarvendriyathauparama(impairment in the perception)³ .

Acharyas has described the various locations (sthana) of mind. acharyacharaka explained the sthana of mind in hridaya while describing apasmara, sarvashareera (all over the body) while explaining srothas and even mentioned shira. AcharyaBhela explained the location in between shira and thalu. Haritha explained manas resides in bhrumadhya at the upper part of Nasa.

Marmani serve as points of access to the body’s innate intelligence, opening the doorway to health and well-being. They are vehicles to reach the ultimate goal of Ayurveda⁴.

Marma and mahabhoota

107 marma and are categorized like

Sadyopranaharamarma (19in number),

(agnimahabhoota predominant)

All 5 eliments like mamsa,sira,snayu,asthi and sandhi

Kalantharapranaharamarma (33in number)

(agni+jalamahabhoota predominant)

4 eliments like sira, snayu, asthi and sandhi

Vaikalyakaramarma (44 in number)

(jalamahabhootapredominant )

2 eliments like mamsa and sira

Rujakaramarma (8 in number).

(agni+vayumahabhoota predominant )

5 Eliments like mamsa, sira, snayu, asthi and sandhi

Vishalyaghnamarma (3 in number)

(vayumahabhoota predominant )

3 elimentssira, snayu and asthi

Marmaabhighatalakshanas:-

Acharyasusruta explained marmabhighatala kshanas like bhrama(vertigo), pralapa (delirium), patina (inability to balane the body), pramoha (hallucinations or delusions), vicheshtanam (abnormal movements ), samlaayanam (functional. srasthangata(dislodging or dislocation), moorcha (fainting or loss of consciousness), urdhvavata(dysponea), teevraruja(sever pain), mamsaodakabhasraava (exudations from body parts), sarvendriyathauparama (impairment in the perception )

We will get a direct reference of manoroga caused by marmabhighata In Trimarmeeyasidhiadhyaya, acharyacharaka explained the abhighatalakshana of hridayamarma like unmada, apasmara, pralapa and chittanasha etc. and in shiraabhighatamoha, cheshtanasha and in ojakshaylakshanaacharya explained the manorogalakshanas and even in the chapter madatyaya as there is more consumption of madya leads to ojakshaya. acahryavaghbhata explained in the abhighata of seemanthamarmalakshana like unmada and apasmara

Sadhyopranaharamarmalakshanas includes loss of consciousness, hampering of sensory functios (indriyartheshuasamprapthi), impaired thought content-disorientation (manoviparyaya), impaired intellect-confusion (bhudhiviparyaya)

Vishalyaghnamarmaabhighatalakshana similar like sadhyopranaharamarma but in milder degree .

Kalantharapranaharamaramaabhighatalakshna includes sudden loss of vital substances (dhatus ) from the body .

Krikatikamarmaabhighata leads to epilepsy, persistant mental strain like anxiety.

In majority of psychosomatic illness the involvement of different Marma in the zone. Ayurvedic classics state that mind prevails throughout the body and its seat is hridaya (marma). The channels of mind in the body are ubiquitous &cannot be specified as in case of tridosha too. Prana has intricate relation with mind and vata is the sole cause for motivating and controlling the mind. The three qualities of mind sattva,rajas and tamas are also found in the marma which are three contents of mind itself. This makes an easy explanation that why the status of mind and its disturbances are reflected upon marma. more the mind is susceptible and sensitive, so is the state of marma.while considering the tridosha concept the vata is located below the nabhi and in between hridaya and nabhi pitta is located and above uraskapha is located.

Treatment for marmabhighata

“To defy from dangers to marma, to follow the hygienic measures every day and to treat the affliction, are the means to care marma”.

Living in constant stress, worry, grief, fear, etc.are known to have direct impact on hridayamarma. Living in noice pollution and excessive use of sensory apparatus such as eyes etc. causes the provocation of vata in head (shiras). The person desirous of positive health must withheld physical impulse (manovegas) viz.passion, anger ,greediness etc. and should not restrain from natural physical impulses. Voluntarily inhibiting the vegas not only increases vata but have tendency to inflict certain marma following the dinacharyas and moodhnitailas are used to maintain the healthy life as weelasprotecting the marmas .

Can administer the panchakarma therapies like basti karma, nasya karma, snehapaana, mruduvirechana, Murdhinitailaetc are important. All these therapies have direct impact on Brain as these medicines crosses blood brain axis, HPA axis and Gut brain axis.

Using of herbs like guduchi, bala, rasna, amalaki, ashwagandha, taila, milk, gheeetc are important. And some formulations like ajasthibhasma, perandabhasma, kapardhikabhasma, suvarnabhasma, rajatabhasma, marmagulika etc. are important. And marma also treated at its site.

Discussion

According to different acharyas we can consider the sthana of manasevery where in the body and any injury to any part of the body or the cell may affect the mind and in any discomfort to the mind shows some physical symptoms. [ Picture 2 ]

also mind and body is having an inseparable relationship. Any injury or imbalance caused in the body directly affect the mind. In any marmaabhighata or injury to the body causes imbalances in the mind and its functions.

Post-traumatic stress disorder⁶-Post-traumatic stress disorder symptoms may start after a traumatic event. These cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.

Symptoms of intrusive memories:

• Recurrent, unwanted distressing memories of the traumatic event

• Reliving the traumatic event as if it were happening again (flashbacks)

• Upsetting dreams or nightmares about the traumatic event

• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Symptoms of avoidance :

• Trying to avoid thinking or talking about the traumatic event

• Avoiding places, activities or people that remind you of the traumatic event

Symptoms of negative changes in thinking and mood :

• Negative thoughts about yourself, other people or the world

• Hopelessness about the future

• Memory problems, including not remembering important aspects of the traumatic event

• Difficulty maintaining close relationships

• Feeling detached from family and friends

• Lack of interest in activities you once enjoyed

• Difficulty experiencing positive emotions

• Feeling emotionally numb

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) :

• Being easily startled or frightened

• Always being on guard for danger

• Self-destructive behaviour, such as drinking too much or driving too fast

• Trouble sleeping

• Trouble concentrating

• Irritability, angry outbursts or aggressive behaviour

• Overwhelming guilt or shame

For children 6 years old and younger:

• Re-enacting the traumatic event or aspects of the traumatic event through play

• Frightening dreams that may or may not include aspects of the traumatic event

post partum psychosis⁷ - Many women will experience mild mood changes after having a baby, known as the "baby blues". This is normal and usually only lasts for a few days.But postpartum psychosis is a serious mental illness and should be treated as a medical emergency.It's sometimes called puerperal psychosis or postnatal psychosis. Symptoms usually start suddenly within the first two weeks after giving birth.

• hallucinations

• delusions – thoughts or beliefs that are unlikely to be true

• a manic mood – talking and thinking too much or too quickly, feeling "high" or "on top of the world"

• a low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping

• loss of inhibitions

• feeling suspicious or fearful

• restlessness

• feeling very confused

• behaving in a way that's out of character

Post partum depression⁸ - Postpartum depression may be mistaken for baby blues at first and its eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier during pregnancy or later up to a year after birth.

• Mood swings

• Anxiety

• Sadness

• Irritability

• Feeling overwhelmed

• Crying

• Reduced concentration

• Appetite problems

• Trouble sleeping

• Depressed mood or severe mood swings

• Excessive crying

• Difficulty bonding with your baby

• Withdrawing from family and friends

• Loss of appetite or eating much more than usual

• Inability to sleep (insomnia) or sleeping too much

• Overwhelming fatigue or loss of energy

• Reduced interest and pleasure in activities you used to enjoy

• Intense irritability and anger

• Fear that you're not a good mother

• Hopelessness

• Feelings of worthlessness, shame, guilt or inadequacy

• Diminished ability to think clearly, concentrate or make decisions

• Restlessness

• Severe anxiety and panic attacks

• Thoughts of harming yourself or your baby

• Recurrent thoughts of death or suicide Untreated, postpartum depression may last for many months or longer.

Pakshaghata / hemiplegia⁹ - Paralysis of the muscles of one side of the body. The most common cause of hemiplegia is damages of the corticospinal tracts in one hemisphere of the brain. Damage to the right cerebral hemisphere results in paralysis of the left side of the body. Damage to the left hemisphere of a right-handed person may also result in aphasia. Other causes of hemiplegia include trauma, such as spinal cord injury; brain tumours; and brain infections.

• Loss of Motor Functions: Loss of motor skills lead to difficulty in movements and difficulty in performing everyday tasks.

• Loss of Sensation: Sensation can be lost on one side of the body, which may be total, partial loss of sensationor tingling on the affected side.

• Mental Aberrations: These can be characterized by changes in cognition, mood, and perception.

• Seizures & Muscle Spasm: Seizures and spastic attacks can severely debilitate thepatient.

• Pusher Syndrome: This syndrome arises from traumatic brain injuries and causes a person to shift their weight to the affected side. This greatly hinders motor skills, making it painful and difficult for the patient to walk.

• Speech and Associated Problems: Face difficulty in speaking, slurred speech, difficulty in swallowing and breathing.

Organic mental disease- Organic mental disorders are disturbances that may be caused by injury or disease affecting brain tissues as well as by chemical or hormonal abnormalities. These person may have difficulty concentration and confusion. Managing relationships and collaborating and communication also be difficult. The severity of the symptoms and the type of symptoms a person may varies with respect to the cause.

• Confusion

• Agitation

• Irritability

• Change in behavioural ,impaired brain function, cognitive ability

Apasmara / epilepsy¹⁰- Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behaviour, sensations, and sometimes loss of awareness.

• Temporary confusion

• A staring spell

• Uncontrollable jerking movements of the arms and legs

• Loss of consciousness or awareness

• Psychic symptoms such as fear, anxiety or déjà vu

In above mentioned diseases there will be involvement of the one or the other marma and its injury, and it will be affecting the mind and its functioning, any injury to the body or abhighata to the marma there will direct effect to the mind and can cause abnormality to the mind.

Conclusion

Marma is the vital points of the body, likely hood of death after infliction to these places. Mindis said to be present all over the body and can cause certain disturbances in the functioning of mind. And there is a relation between mind and body as mind and body are in inseparable relation. Any injury to the body or these points will get affect to the mind leading to various psychiatric disorderswhich might be mild to moderate based on dosha, kala and bala of the patient. All these are Krichrasadyavyadhi (Difficult to manage). Hence understanding the sthana of manas and marma plays a very important role in the management.