A CRITICAL REVIEW of SHANKHA MARMA with SPECIAL REFERENCE to SIGNIFICANCE of SADYO- PRANAHAR MARMA Neeraj Kumar Pali1, Chhaya V

Review Article International Ayurvedic Medical Journal ISSN:2320 5091

A CRITICAL REVIEW OF SHANKHA MARMA WITH SPECIAL REFERENCE TO SIGNIFICANCE OF SADYO- PRANAHAR MARMA Neeraj Kumar Pali1, Chhaya V. Patil2, Sayali Uday Barve3 1PG Scholar, Department of Sharir Rachana, 2H.O.D., Department of Sharir Rachana 3PG Scholar, Department of Sharir Rachana Y.A.C. P.G.T. & R.C., Kodoli, Dist. Kolhapur, Maharashtra, India

ABSTRACT Ayurveda is a profound system of mind-body medicine and natural living. Marma (vital points) is a unique and important concept discussed in Ayurveda. The Marma Shareera has been well explained in detail by Acharya Sushruta and Acharya Vagbhata in their respective Samhitas. Acharya Charaka has given emphasis on Trimarma. The Marmas are said to be “Jeevasthanas” (Site of life) and they are 107 in number. Trauma to these vital points leads to instant death, rigorous pain or enduring disability. One among them is Shankha Marma, present in between the tragus of the ear and the Lateral Canthus of the eye, on each side. It is present at the Temporal bone. After collecting information from various ancient texts and detailed dissection on cadaver, the structures present at the site of Shankha Marma can be understood as temporal bone along with temporalis muscle, temporal and internal Carotid artery, temporal vein, facial and corda tympani nerve. As per the ancient texts, it is a Sadyo-pranahara Marma, resulting in Sudden death due to excess haemorrhage and shock. But, if the injury is not very severe or distal part of Marma, it can act as Kalantara pranahara Marma (death within 15 days). Key Words: Ayurveda, Marma, Shankha Marma, Sadyo-pranahara Marma, Dissection

INTRODUCTION Ayurveda is a profound system of The Marmas are said to be ‘Jeevasthanas’ mind-body medicine and natural living. It is and are 107 in number3. They are distributed the God gifted very ancient and the first throughout the human body. The Marma medical science which was memorized and Shareera has been explained by Acharya composed by the originator Brahma1 Sushruta in “Pratyeka Marma Nirdesha (Swayambhoo) and considered it as the Shareera”4. In Marma, there is aggregation branch of Atharva-veda. Ayurveda means of Mamsa (muscles), Sira (veins), Snayu "the science of life". Life is the combination (ligaments and supporting structures), Asthi of four factors (Sharir, Indriya, Satwa and (bones), Sandhi (joints) and particularly Atma)2. Detail scientific study of the subject Prana5,6 (Agni, Soma, Vayu, Satva, Raja, Sharir Rachana is well organized by Tama, Panchendriya, and Bhutatma). Ayurveda. Marma point is defined as The Marma Shareera is a unique anatomical site where Mamsa, Sira, Snayu, concept and interesting topic of Ayurveda. Asthi and Sandhi meet together. This does Neeraj Kumar Pali et al :A Critical Review Of Shankha Marma with Special Reference To Significance Of Sadyo- Pranahar Marma not mean that all the structures must be Sadyo-pranahara (sudden death)14, 15 which present collectively at the site of the Marma. is the common condition seen today The concept of Marma is grossly correlated specially in accidents. An effort is taken to with traumatology. If there is some injury to elaborate it with the help of available any Marma, that either can result into death literature and cadaveric dissection to or can cause various diseases or deformities understand the anatomical structure present which are difficult to cure7. Acharya at its site. Sushruta and Acharya Vagbhata have MATERIALS AND METHODOLOGY mentioned various types of Marmas materials according their position, constitution, 1. Literature of Ayurvedic and Modern number, dimensions and prognosis of injury Science available from Vedic era to to it. There are five types as Sadyo- Present era. pranahara, Kalantara pranahara, 2. Two cadavers- one male, one female. Vishalyaghna, Vaikalyakara and Rujakara 3. Dissection kit. according after-effect of injury to marmas8. methodology Out of them, Sadyo-pranahara Marmas are Study type: Observational study the points where injury causes sudden death9 1. Literature study: Collection of (when injury at the Madhya viddha/central information regarding Shankha Marma region) and if there is injury at the Anta from ancient texts like Sushruta viddha (peripheral region) of those Marma, Samhita, Ashtang Hridayam is done in they will act like Kalantara Pranahara10 detail. (death within 15-30 days). Sadyo-pranahara 2. Cadaveric study: Dissection of two Marmas are total 19 in number. Shankha cadavers (one male, one female) was Marma is explained as Asthi marma11, 12 done in dissection hall of department of (based on constitution), total 2 in number- 1 anatomy- Y.A.C. P.G.T. & R.C., Kodoli, each on temporal bone. The word Shankha Kolhapur. At first markings were done means ‘Conch’ the temple. It controls sense on cadaver regarding the position of organ of touch and Vata13. Shankha Marma in Shirapradesha Clinicians of old times have explained in Ayurvedic texts. Temporal collected detailed information regarding region (in Shira pradesha) was dissected injuries and their prognosis on every vital as per the guidelines given in part of body and have presented that theory Cunningham’s manual of practical in a very concise form known as Marma- anatomy16and Human anatomy by B. D. Shareera. There is need to understand this Chaurasia17. Superficial and deep ancient science in modern ways as in today’s dissection was done carefully to study world, incidences of traumas in the form of the structures present at the marked site. accidents, natural calamities, wars etc. have 3. The information collected from literature increased. The science of Marma is very was co-related to the findings from vast. Out of all the vital points explained, a dissection and conclusion was drawn. point in head- Shankha Marma is selected. OBSERVATIONS Its prognosis after injury is given in books as 870 www.iamj.in IAMJ: Volume 3; Issue 3; March- 2015 Neeraj Kumar Pali et al :A Critical Review Of Shankha Marma with Special Reference To Significance Of Sadyo- Pranahar Marma The site of Shankha Marma is given in The structural study of Shankha Marma with Sushruta Samhita as- It is situated at the the help of cadaveric dissection showed that lateral end of Bhru (Eye-brows), in between there is aggregation of Temporal bone, the Karna (Ear) and Lalaata (forehead) Temporalis muscle, Temporal and internal By considering all these points, a region was carotid artery, temporal vein, Facial and marked on cadaver in the temporal region. corda tympani nerve. Depending upon the On the detailed dissection of the marked dominance of anatomical structure present in region following structures were seen- that site, it termed as Asthi Marma. So, 1. Temporal is muscle, temporal fascia and injury to this region can result into damage a thin extension and a thin epicranial of any of these structures, specially blood aponeurosis from which the extrinsic vessels or nerves. auricular muscle arises. The study reveals that the anterior and 2. Superficial temporal artery, middle posterior branches of middle meningeal meningeal artery, temporal vein. artery are covered by temporal bone, due to 3. Facial nerve and corda tympani nerve. irregular ‘H’ shaped suture at the point of 4. Temporal bone. Pterion, and the thinness of the bone convert this region into a weak area, therefore a DISCUSSION comparatively trauma of less intensity The study was carried out in two parts- causes fracture of bone which is main cause literature study and cadaveric study. of the laceration of the artery. Shankha Marma is present on lateral aspect of skull bones and it is completely formed CONCLUSION by temporal bone. The Shankha Marma is completely formed The points to be understood regarding by temporal bone. The structures those are Shankha Marma from literature study were- present in the region of Shankha Marma are- 1. They are total 2 in number- 1 in each 1. Temporalis muscle. side 2. Three arteries-Temporal and internal 2. Based on predominance of anatomical carotid artery, middle meningeal artery, structure, it is Asthi Marma Temporal vein with tributaries 3. Based on prognosis of injury to it, it is 3. Two nerve- Facial and corda tympani Sadyo-pranahara Marma (Agni nerve Mahabhuta dominant) 4. Temporal bone. 4. It is on lateral border of Lalaata Shankha Marma can be termed as Sadyo- (forehead) near to the Karna (Ear) pranahara Marma as injury to its Madhya upwards to the eye brow. The word viddha (central region) causes sudden death Shankha means ‘Conch’ the temple, due to haemorrhage and shock because of temporal bone. It is a bony structure. rupture of middle meningeal and temporal 5. Shankha Marma measures ½ Anguli artery. When injury occurs at the Anta (finger breadth) in dimensions. viddha (peripheral region) of this Marma, it (1 Anguli is approximately 2cm, so ½ will get converted into Kalantara means 1 cm in diameter.) Pranahara (death within 15-30 days). This

871 www.iamj.in IAMJ: Volume 3; Issue 3; March- 2015 Neeraj Kumar Pali et al :A Critical Review Of Shankha Marma with Special Reference To Significance Of Sadyo- Pranahar Marma vital point is very fragile due to bony 8. Dr.BhaskarGovindGhanekar, Sushrut condition and the vessels being placed in Samhita (Sharir sthana), Chapter 6, such a manner that the vulnerability is Citation no. 14, March 2006, enhanced. MeharchandLachhmandas Publications, Page no.185 REFERENCES 9. Dr.BhaskarGovindGhanekar, Sushrut 1. Dr.BramhanandTripathi,CharakSamhita- Samhita (Sharir sthana), Chapter 6, I,Sutrasthana chapter 1,Citation Citation no. 23, March 2006, no.04,Reprint 2004, MeharchandLachhmandas Publications, ChaukhambhaSurbharatiPrakashan Page no.186 Varanasi, Page no. 04. 10. Dr.BhaskarGovindGhanekar, Sushrut 2. Dr.BramhanandTripathi,CharakSamhita- Samhita (Sharir sthana), Chapter 6, I,Sutrasthana chapter 1,Citation Citation no. 29, March 2006, no.42,Reprint 2004, MeharchandLachhmandas Publications, ChaukhambhaSurbharatiPrakashan Page no.189 Varanasi, Page no. 13. 11. Dr.BhaskarGovindGhanekar, Sushrut 3. Dr.BhaskarGovindGhanekar, Sushrut Samhita (Sharir sthana), Chapter 6, Samhita (Sharir sthana), Chapter 6, Citation no. 12, March 2006, Citation no.02, Reprint, March 2006, MeharchandLachhmandas Publications, MeharchandLachhmandas Publications, Page no.185 Page no. 183. 12. Dr. BramhanandTripathi, 4. Dr.BhaskarGovindGhanekar, Sushrut AshtangHridayam, Sharirasthana Samhita (Sharir sthana), Chapter 6, chapter4, Citation no.40, Reprint Citation no.01, Reprint, March 2006, 2012,Chaukhambha Sanskrit Pratisthan, MeharchandLachhmandas Publications, New Delhi, Page no.395 Page no. 183 13. Dr.AvinashLele-Dr. SubhashRanade-Dr. 5. Dr.BhaskarGovindGhanekar, Sushrut David Frawley, Secrets of Marma, Samhita (Sharir sthana), Chapter 6, Chaukhamba Sanskrit Citation no. 22, March 2006, Pratishthan,Delhi,First Edition MeharchandLachhmandas Publications, 1999,Reprint 2011,Page no.83 Page no.186 14. Dr.BhaskarGovindGhanekar, Sushrut 6. Dr. BramhanandTripathi, Samhita (Sharir sthana), Chapter 6, AshtangHridayam, Sharirasthana Citation no. 15, March 2006, chapter4, Citation no.38, Reprint MeharchandLachhmandas Publications, 2012,Chaukhambha SanskritPratisthan, Page no.185 New Delhi, Page no.394 15. Dr. BramhanandTripathi, 7. Dr.BhaskarGovindGhanekar, Sushrut AshtangHridayam, Sharirasthana Samhita (Sharir sthana), Chapter 6, chapter4, Citation no.52, Reprint Citation no. 44, March 2006, 2012,Chaukhambha Sanskrit Pratisthan, MeharchandLachhmandas Publications, New Delhi, Page no.397 Page no.202 872 www.iamj.in IAMJ: Volume 3; Issue 3; March- 2015 Neeraj Kumar Pali et al :A Critical Review Of Shankha Marma with Special Reference To Significance Of Sadyo- Pranahar Marma 16. G. J. Romanes, Cunningham’s Manual of Practical Anatomy, Vol. 1, ELBS edition CORRESPONDING AUTHOR of 15th edition, Reprint, 1994, Oxford Dr. Neeraj Kumar Pali University press, Page no. 129-146. PG Scholar, Department of Sharir Rachana 17. B.D.Chaurasia, Human Anatomy, Vol. 2, Y.A.C. P.G.T. & R.C., Kodoli, Dist. Reprint, 2008, CBC Publication Delhi, Kolhapur, Maharashtra, India Page no.45-61 Email: [email protected]

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