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A Survey of Marmani Chikitsa By: Emily Laine Levoy

Introduction

   Ayurveda, the knowledge of life, is India’s most ancient system of healing.  Its fundamental aim is to bring each and every one of us into alignment with our true nature as Spirit, and thus allow us to be our best, healthiest, Selves.  Through the application of myriad therapies using herbs, colors, aromas, foods, breath, movement, meditation, oil, massage and more, Ayurveda prescribes a unique program to balance the unique constitution of each unique individual that exists in the world. 
 
   Ayurveda’s origins are in Samkhya philosophy, which teaches that in the beginning there existed only Purusha, the potential for pure consciousness, and Prakriti, the potential for pure matter.  Purusha desired to know itself and merged with Prakriti in the act that was the beginning of the world as we know it.  From this merging the cosmic vibration of Aum emerged, the qualities of Sattva (clarity or mind), Rajas (motion or life), and Tamas (inertia or matter) were produced, and the five basic elements of earth, water, fire, air, and ether were created.  The elements are the building blocks for all that exists, and their physical and subtle forms are the basis for Vata (physical air and ether), Pitta (physical fire and water), and Kapha (physical water and earth), and for Prana (subtle air and ether), Tejas (subtle fire and water), and Ojas (subtle water and earth).  It is with these six elemental combinations that Ayurveda diagnoses and treats it’s patients.   
 
   Under the umbrella of Ayurvedic treatments falls Marma Therapy, also called Marmani Chikitsa, which involves the stimulation of sensitive points to promote healing in the physical, mental, and energetic planes by affecting the flow of prana.  Marma points can be found all over the body from the hands and feet to the trunk and head, and when manipulated via massage, pranic healing, oil and herb application, heat, or pressure, can “alter both the organic functions and structural conditions of the body” (Muley).  Since all was created from Purusha and Prakriti, all matter is fundamentally the same.  While it may be difficult to perceive this oneness of all, marma points provide a super sensitive entry point into these more subtle realms of the physical-energetic connection that resides in all of us.  In the words of Dr. Vasant Lad, “Like quantum mechanics, Ayurveda holds that a human being is not a solid, stable material structure but an ever-changing, dynamic collection of energy and intelligence in the larger field of energy and intelligence that is the universe.” (Lad, 19)   Marma points are vortexes of prana, the life force that can be used as a gateway into this dynamic field.
 
   The purpose of this exposition is to provide a general overview of the origins and classical uses of marma, as well as a survey of the application of marma therapy in the modern age.  For in depth information on any specific marma point, therapy, or Ayurvedic concept please refer to the copious information available in the sources cited at the end of this paper.

History and Evolution:

   The aim of marma therapy in the modern day is to promote healing, however as vital points of life marma have also been used for harm.  In his course on marma therapy, Dr. Marc Halpern said, “any area of the body that can be harmed with a forceful blow can be healed with a therapeutic touch,” and it is this dichotomy that can be seen in the history and evolution of marma.  An important part of Ayurveda, Yoga, and the martial arts of Southern India, marma originated in the most ancient of Indian civilizations known as the Indus-Sarasvati culture (3500 - 1700 BCE) which was located in the north of India and evolved along with other Vedic disciplines from this time.2 Emphasized as a means to inflict injury on an opponent, as guidelines for healing wounds,4 and as a map for the use of body armor in combat, marma points were an integral part of South Indian martial arts and “the path of the warrior who learned to master his Prana for both defensive and offensive purposes”(Frawley, 8).  Wartime surgeons in classical times were versed in the energetics of marma points in order to provide the best possible care on the battlefield.8  References to marma points can be found in a wide variety of ancient texts including the Rig Veda, Mahabharata, Charaka Samhita, Sushruta Samhita, and classical yogic texts where marmas are incorporated with asana, pranayama, and the nadis.2
 
   A noted Ayurvedic surgeon, Sushruta is recognized as the leading contributor to the classical study of marma.  His text, the Sushruta Samhita, defines marma as fatal spots8 and contains details for manipulating marmas through surgical techniques and in the treatments of acute conditions.  In the section of his text on anatomy there exists documentation on the location and effects of each marma point (detailed below) and this knowledge has evolved with each generation of practitioner.4 
 
   Interestingly, in his commentary of the Sushruta Samhita, Prof K.R. Krikantha Murthy specifically comments on the use of marma for therapeutic effect as is common in modern day.  “
  • A recent trend among some Ayurveda scholars is an attempt to equate and correlate knowledge of Marma with the ancient Chinese method of treatment known as Acupuncture.  Though recognition of special spots on the body is common to both, the aim of approach of each one is thoroughly opposite of the other.  While Ayurveda describes the ‘Marma’ as seats of prana… the descriptions are mainly intended to warn the surgeon not to cause injury [where as] Acupuncture… spots are considered centers of ‘vital energy’ that when stimulated by sharp needles… brings about cure of many diseases.  Nowhere in Ayurvedic texts is there any suggestion of meddling with the Marma for either relief of pain or for cure of diseases” (Murthy, 115). 
   Dr. Frank Ros, however, states that errors were made in earlier translations of the Sushruta Samhita, and upon further review, “evidence was found showing that the marmas correspond precisely with traditional acupuncture points used to treat the vital organs in the flow of qi” (Frawley, 215).  The terms dhamanis and siras were previously misinterpreted to mean arteries and veins, when actually they correspond to the channels, which control the flow of prana (or qi).  Many prominent Ayurvedic scholars agree with Dr. Ros’s statement, including Dr. Vasant Lad whose entire book, Marma Points of Ayurveda, is a comparison of Marma and Acupuncture 
Whether marma were classically used for healing or not, it is nonetheless now commonly used as such in Ayurvedic clinics and schools around the world.

Locations, and Categorizations:

   According to Sushruta and Dr. David Frawley there are 107 marma, though others including Vagbhata and Dr. Vasant Lad indicate there to be 116 or 117.  Vagbhata says that “structures which show irregular pulsation and where the pain on pressure persists can be labeled as Marmasthana” (Muley).  Sushruta categorizes marma according to the following tissue types: Mamsa (Muscular) Marma, Sira (Venous) Marma, Snayu (Ligament) Marma, Asthi (Bony) Marma, and Sandhi (Joint) Marma.8   Some say marma may contain all five tissue types, and some may contain only two.  Marma can be measured by the unit angula, which are defined as “the width of the patient’s middle finger measured across the proximal interphalangeal joint” (Lad, 316).  
   
   The following table and diagram of marma points with their location and size is composed of the 107 marma according to Sushruta.  While there are descriptions available as to the locations of marma points on the physical body, every body is different, thus is may take a trained marma therapist to locate the specific points.
 
Marma Location Size Number of Points
Adhipati Crown Chakra ½ angula 1
Amsa Shoulder ½ angula 2
Amsaphalaka Shoulder blade ½ angula 2
Ani Lower region of upper arm and upper leg ½ angula 4
Apalapa Armpits ½ angula 2
Apanga Outer corner of each eye ½ angula 2
Apastamba Medial and inferior to nipples on abdomen ½ angula 2
Avarta Midpoint above each eyebrow ½ angula 2
Bhavi Inside of upper arm 1 angula 2
Basti Lower abdomen/ bladder 4 angula 1
Brihati Broad region of upper back ½ angula 2
Guda Rectum 4 angula 1
Gulpha Ankle 2 angula 2
Hrdaya Heart 4 angula 1
Indrabasti Center of forearm and lower leg ½ angula 4
Janu Knee 3 angula 2
Kakshadhara Coracoid Process 1 angula 2
Katika Taruna Hip joint ½ angula 2
Krikatika Neck joint ½ angula 2
Kshipra Between thumb and index finger and between big toe and second toe ½ angula 4
Kukundara Sides of the lower iliac spine ½ angula 2
Kupara Elbow joint 3 angula 2
Kurcha Bottom of thumb and big toe 4 angula 4
Kurchashira Base of thumb joint and base of big toe joint 1 angula 4
Lohitaksha Lower frontal end of shoulder and hip joint ½ angula 4
Manibandha Wrist 2 angula 2
Manya Side of the neck 4 angula 2
Nabhi Naval 4 angula 1
Nila Base of the throat 4 angula 2
Nitamba Upper buttock ½ angula 2
Parshva Sandhi Upper hip ½ angula 2
Phana Side of each nostril ½ angula 2
Shankha Temple ½ angula 2
Shringataka Just below each cheek bone 4 angula 4
Simanta Sagittal Suture of skull 4 angula 5
Sira Matrika Base of the neck 4 angula 8
Stanamula Nipples 2 angula 2
Stanarohita Superior and medial to nipples ½ angula 2
Sthapani Third eye center ½ angula 1
Talahrdaya Center of palm of hand and sole of foot ½ angula 4
Utkshepa Above ears ½ angula 2
Urvi Mid-region of upper thigh 1 angula 2
Vidhura Behind and below ears ½ angula 2
Vitapa Perineum 1 angula 2
 
   As their origins lie in combat, five types according to the result of injury additionally categorize marma points.  The following information comes from Prof K.R. Krikantha Murthy’s translation of the Sushruta Samhita:
  • Sadya Pranahara:  Immediately causing death
  • The marma of this type are Shringataka (four points), Adhipati (one point), Shankha (two points), Kanthasira/ matrika (eight points), Guda (one point), Hrdaya (one point), Basti (one point), Kshipra (four points), and Nabhi (one point).  According to Sushruta, Sadya Pranahara points have the qualities of fire, and this is why they quickly cause death.  Some classical physicians said that Sadya Pranahara points are those containing all five tissue types (Mamsa, Sira, Snayu, Asthi, and Sandhi).  Sushruta disagrees and says that all five tissue types are present in the below four types of marma.
  • Kalantara Pranahara: Causing death after some time
  • Kalantara Pranahara have the qualities of water and fire, thus with their hot/fiery qualities kill debilitated people quickly, and with their cold/watery qualities kill others after some time.  Sushruta designates the following marma as Kalantara Pranahara:  Stanamula (two points), Stanarohita (two points), Apalapa (two points), Apastamba (two points), Simanta (five points), Tala (four points), Indrabasti (four points), Katika Taruna (two points), Brihati (two points), and Nitamba (two points).  
  • Visalya Pranahara:  Fatal if pierced
  • Visalya Pranahara points have the quality of air, thus are fatal if the air residing in the marma is disturbed.  If pierced, the air will remain undisturbed if the foreign object is not removed, but upon removal of the foreign object air will be allowed to escape from the marma and thus cause death.  Marma of this type are Utkshepa (two points) and Sthapani (one point).
  • Vaikalyakara:  Disability causing
  • Sushruta describes Vaikalyakara marma as “possessing qualities of the moon/water” and explains that the corresponding stable and cold qualities help with the sustenance of life when these points are injured.  Thus, only disability is caused.  Points of Vaikalyakara nature are Lohitaksha (four points), Ani (four points), Janu (two points), Urvi (four points), Kurcha (four points), Vitapa (two points), Kupara (two points), Kukundara (two points), Kakshadhara (two points), Vidhura (two points), Krikatika (two points), Amsa (two points), Amsaphalaka (two points), Apanga (two points), Nila (two points), Manya (two points), Phana (two points), and Avarta (two points).
  • Rujakara:  Pain causing
  • o The final categorization of marma point is Rujakara, which designates points composed of the qualities of fire and air, which produce pain.  These marma are Gulpha (two points), Manibandha (two points), and Kurcha Sira (four points).  
 

Relations to Ayurveda & Diagnosis

   Ayurveda bases its diagnoses on the fundamentals of the three doshas:  Vata, Pitta, and Kapha.  As already explained, each dosha is a combination of two elements, and it is the qualities of these elemental combinations that provide clues as to the nature of a given imbalance.  Treatment is then accomplished using the opposite qualities to those of the condition .  Conditions of Vata nature will present with qualities such as cold or dry, and they may have decreased tissues, energy, pain, or insomnia.  Sensitivity upon light pressure of a marma would be indicative of Vata.  Pitta conditions will display warm or hot qualities such as fever, anger, or bleeding, and would be indicated by sensitivity to moderate pressure on a marma.  Kapha conditions will be those of heaviness such as water retention, excess weight, tissue, mucus or swelling.  Heavy pressure causing sensitivity would indicate a Kapha imbalance at the site of a marma.  Any of the qualities of a specific dosha can be observed at the site of a marma to provide clues to determine the best course of treatment.  
   
   Different marma points also relate specifically to different doshas and body systems, and can be used both to indicate an imbalance, and in the treatment.  These relationships are detailed in the tables below:
 
Relationship of Doshas, Subdoshas, and Marma Points
Vata
                                      Pitta                                   Kapha
Prana Vayu Adhipati Sadhaka Pitta Adhipati Tarpaka Kapha Adhipati
  Sthapani   Simanta   Simanta
  Phana   Hrdaya   Hrdaya
  Vidhura Alochaka Pitta Kurcha   Shringataka
  Kshipra   Kurchashira   Krikatika
  Talahrdaya   Sthapani Bodhaka Kapha Shringataka
Udana Vayu Nila   Apanga   Manya
  Manya Bhrajaka Pitta Nila   Phana
  Krikatika   Manya Avalambaka Kapha Hrdaya
  Amsa   Talahrdaya   Stanamula
Vyana Vayu Hrdaya   Amsa   Talahrdaya
  Brihati   Katika Taruna Kledaka Kapha Nabhi
  Amsaphalaka Pachaka Pitta Nabhi   Apastamba
  Talahrdaya   Apastamba   Kurchashira
  Kshipra   Kurchashira Sleshaka Kapha Janu
Samana Vayu Nabhi   Indrabasti   Kupara
  Apastamba Ranjaka Pitta Nabhi   Manibandha
  Kurchashira   Kupara   Gulpha
Apana     Basti   Janu   Katika Taruna
  Guda   Kukundara    
  Vitapa        
  Talahrdaya (feet)        
  Lohitaksha (Legs)        
  Utkshepa        
 
Relationship of Body Systems and Marma Points
Circulatory System Hrdaya, Nabhi, Kupara, Brihati, Janu, Lohitaksha, Sira Matrika
Digestive System Nabhi, Indrabasti, Kurchashira, Parshvasandhi, Shankha
Female Reproductive Guda, Vitapa, Gulpha, Basti
Lymphatic System Hrdaya, Kshipra, Stanamula, Lohitaksha, Amsaphalaka, Nila
Muscular System Kurchashira, Kakshadhara, Stanamula, Stanarohita, Guda
Nervous System Adhipati, Simanta, Sthapani, Apalapa, Apastambha, Shringataka
Respiratory System Talahridaya, Kshipra, Hridaya, Phana, Sthapani
Skeletal System Kukundara, Katikataruna, Janu, Manibandha, Simanta
Urinary System Basti, Guda, Kukundara
 

Methods of healing through Marma

There are many methods through which healing such as massage, oils, heat, herbs, and pranic healing which a trained therapist whilst interacting with marma points may employ.  There are other therapies such as yoga postures and meditation, which a person can use to independently affect their marma points and with the right knowledge affect the flow of their own prana.  Below some of these techniques are described. 
 
Massage/ Therapeutic Touch
   One of the most basic treatments in Ayurvedic Medicine is Abhyanga, the Ayurvedic Oil Massage.  A rejuvenating therapy with strokes coordinated with the five Vayus, or directions of Vata dosha, Abhyanga affects marma points through therapeutic touch, and through the healing qualities of the oils and any herbs or aromas that are used.  Specific attention to marma points may be included in the massage, but marma points are affected simply through the flow of Abhyanga strokes without specific concentration,
   
   Acupressure (also called Mardana by Dr. Frawley) is another form of therapeutic touch where firm pressure is held on a specific marma or collection of marmas until associated tension or pain is reduced or released.  The pressure used should be quite firm for Kapha conditions, moderate for conditions of Pitta, and light for those of Vata nature.

Herbs

   Ayurveda uses a vast breadth of herbs and formulations for internal and external healing.  The topical application of herbal medicated oils, pastes, and powders may be used to elicit a desired effect from a specific marma.  Dr. Frawley recommends Guggul as the most well rounded herb for marma therapy, citing it’s clearing properties and it’s affinity for reducing pain and promoting the flow of energy.  For healing of a specific condition an herbal formula with properties specifically targeted toward the desired result should be used. 

Oleation
   Most commonly used as part of the Abhyanga massage, the application of oils is deeply therapeutic most especially for conditions of Vata nature but can be therapeutic for imbalances of all doshas.  Warm sesame oil is best for the treatment of Vata, and the essential oil of sandalwood, calamus, or cinnamon can be added.  For pitta coconut or sunflower oils are best, potentially mixed with the essential oils of sandalwood or rose.  For Kapha, oil is generally contraindicated however sesame and mustard oil mixed together with the essential oils of camphor, menthol, or wintergreen would be balancing.2

 
   Another technique would be applying oil locally to the specific marma points that are being used for healing, rather than applying oil to the whole body as in Abhyanga,
 
Pranic Healing
   Pranic Healing involves transmitting energy from the healer to the client and can be accomplished by placing one’s hands above the specific area of the body (or in this case the marma point) that is the target of the healing.  In Ayurvedic terms marma points are part of the Majja dhatu, or nervous system, which is governed by prana.  Pranic healing can assist in the harmonious interaction of prana vayu (the flow of cellular intelligence), sadhaka pitta (present especially in the gray matter of the brain) and tarpaka kapha (the white matter covering the brain), to promote greater healing in the physical, mental, and emotional bodies. 
When contemplating the manipulation of the emotions, energetic body, or physical points remote to a specific marma it is interesting to note the correlation with modern superstring theory which considers all particles to be made of “infinitesimally small vibrating strings”5 which are the foundation of all energy. 
  • The oneness of mindbody and how it may be bundled as vibrating energy that is interconnected to everything else in the universe, is the basis of what may be called the "Cosmic Connection". Furthermore, vibrating bundles of energy (i.e., vibrating strings of mutual harmonic resonance that have coalesced to form an electromagnetic field operating at a given frequency -- not unlike a frequency for a radio station, for instance) create fields of influence around their physical selves.  A physical manifestation of the energy of thoughts is the instincts and/or emotions as they elicit as a response to a specific stimulus.7
   Since all matter, all emotions, and all thoughts are considered to be energy, and since all energy is thought to be made up of the same fundamental component, it becomes clear how the manipulation of certain points on the body could promote healing elsewhere.  According to Dr. Deepak Chopra, “Once you strip off its physical mask, a cell is really a junction point between matter and consciousness, a station where the quantum mechanical body and the outside world intersect.” (Chopra, 178) 

Yoga Asana
   Yoga is known to increase general pranic levels  and also directly affects marma points through compression in certain poses.11  For example, Janu Sirsasana (seated forehead to knee pose) compresses Nabhi, Janu, and Sthapani marma as the third eye connects with the knee, and the abdomen is contracted.  Sirsasana (headstand) stimulates Adhipati through the connection of the crown chakra with the earth.  Halasana (shoulder stand) affects Hrdaya, Nila, and Nabhi as the frontal plane of the body is contracted and may also affect Brihati and Krikatika on the posterior plane.  With a thorough knowledge of marma points and yoga postures, a great variety of therapeutic applications may be derived. 

Meditation 
   Healing may be brought on by meditation upon a specific marma point, or set of points, to promote the free flow of prana independently of a therapist.  Simply concentrating one’s energy on the specific point(s), or by following the flow of energy within the body to or from a specific point, or by performing a complete rotation of consciousness around all the marma points of the body, awareness and healing may be achieved. 
   

Conclusion

The subject of Marma Therapy is vast and complex, with varying opinions from many prominent Ayurvedic physicians and scholars.  All seem to agree on at least one thing:  that marma points are regions on the body powerful enough that they can be used for harm or healing.  The experience of the author in the realm of using marma points for healing has been quite potent, through meditation, yoga postures, massage, and pranic healing techniques used on her self and in the use of therapeutic touch and pranic healing transmitted to others, and this experience was her motivation for embarking upon this research.
 

Bibliography:

1.    Bhishagratna, Kaviraj Kunja Lal.  An English Translation of the Sushruta Samhita.  Calcutta:  Published by Author, 1911
2.    Frawley, Dr. David.  Ayurveda and Marma Therapy.  Wisconsin: Lotus Press, 2003
3.    Halpern, Marc, The Importance of Marma Therapy in Ayurvedic Practice:  http://www.ayurvedacollege.com/importance-marma-therapy-ayurvedic-practice
4.    Lad, Vasant.  Marma Points of Ayurveda.  Albequerque: The Ayurvedic Press, 2008
5.    Smith, William L.  The Human Electromagnetic Energy Field:  It’s Relationship to Interpersonal Communication:  http://www.journaloftheoretics.com/articles/4-2/Smith.htm
6.    Swami Vivekananda Yoga Anusamdana Samsthana, Bangalore, India, Effects Of Yoga Practice on Acumeridian Energies: Variance Reduction Implies Benefits for Regulation: http://www.ncbi.nlm.nih.gov/pubmed/23439630
7.    Halpern, Marc. Ayurvedic Marma Therapy.  Course Supplement, 2004 - 2012.
8.    Murthy, Prof. K. R. Srikantha. Illustrated Sushruta Samhita, Vol 1,2,3.  Varanasi, Uttar Pradesh, India: Chaukhambha Orientalia, 2010.
9.    Chopra, Deepak. Perfect Health. New York: Three Rivers Press, 1991
10.    Muley, SK, Associate Professor and Head, Department of Sharira Rachana, Government Ayurved College, Nanded, Maharashtra, India, Study of Vaikalyakara Marma with special reference to Kurpara Marma: http://www.ncbi.nlm.nih.gov/pubmed/22661839
11.    Niharika Nagilla, Swami Vivekananda Yoga Anusamdana Samsthana (S-VYASA), Bangalore, India, Effects of yoga practice on acumeridian energies: Variance reduction implies benefits for regulation: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573545.
12.    Caraka.  Caraka Samhita.  R.K. Sharma and Bhagwan Dash translation.  Varanasi, India:  Chowkhamba Sanskrit Series Office, 1976.
 
 

About the Student Research Papers

The papers published on our website have been written by students of the California College of Ayurveda as a part of their required work toward graduation. After reviewing each paper, Dr. Halpern selects those papers that he feels are appropriate to publish. The information in each paper should not be construed as the final word on any subject nor should it be assumed that errors do not exist.