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JOURNAL PRESENTATION

PRESENTATION BY Dr. S. KAMALAKAR 1ST YEAR PG

DEPARTMENT OF SAMHITA SIDDANTA

International Ayurvedic Medical Journal 2014, 5(2), 160-163 A CONCEPTUAL REVIEW OF

VISHALYAGHNA MARMA Bhosgikar Anup

Lecturer, Department of Rachana Shareera, N.K.Jabshetty Ayurvedic Medical College & P.G Center Bidar, Karnataka.

AUTHOR LANGUAGE STYLE AND EXPRESSION

Very simple,

Easily understandable language

Gramatically correct,straight to point

Has systematically arranged the information under proper headings

CONTENT

S1.INTRODUCTION2.DESCRIPTION OF VISHALYAGNA MARMA3.DISCUSSION4.AUTHOR’S CONCLUSION5.FURTHER UNDERSTANDING6.MY CONCLUSION

Marmas is that vital organs / vital parts of the body where trauma / injury may be cause sudden death and may be deformity in the body.

These are 107 in number and classified under various categories, Vishalyghna is one among them.

injury to these causes death but it is after removal of shalya from injured part

INTRODUCTION

What is criteria behind to name marma as vishalyaghna

The term vishalya coined as, it is not a fatal one up to removal of the shalya (foreign body) i.e. the person will live till the removal of foreign body.

In this context, Acharya Sushruta tries to emphasize on the concept that without removing the foreign body the person can survive, if it stays and drops itself after paka (suppuration).(type of parinama)

The Vishalyaghna Marmas are Vayu Mahabhuta predominant, totally three Vishalyaghna are present in the body. There are

2 Utkshepa marma and 1 Sthapani marma

CLASSIFICATION

It is located above the Shankha (temporal region) Marma as literally reviewed regarding Utkshepa marma it is located near the hair margin and it is half angula pramana (half finger unit).

Structures come under this superficial and deep fascia of temporal region i.e. up to the meninges.

Penetrating wounds if effects the meninges there may be the chances of intra cranial negative pressure rises, hemorrhage etc.

UTKSHEPA MARMA

UTKSHEPASANKHA

The direct impact to temporal or occipital can produce basilar skull fractures.

Possibility it can lead to tear of dural vessels and injury to brain or pial vessels with or without fractures resulting in epidural hematoma

So if after injury of dural vessels and pial vessels hemorrhage can lead to high negative pressure rise in the brain and the person will die and, so the shalya will not be removed from the site.

STHAPANI MARMA It is located in between two eye brows , so anatomically it is also half

anguli in pramana.

Structures come under this superficial and deep fascia, occipito-frontalis muscle, frontal bone, and glabella and can also be considered up to saggital sinus.

Injury to one-third of saggital sinus can be treated by packing or by legating the anterior one-third of superior saggital sinus.

Injury to this may require micro-surgical repair which can be extremely difficult in given situation, hence any depressed bony fragments, and foreign body involving dural sinuses also should not be removed

DISCUSSION

• When any foreign body is impacted in the skin or any part of body, it tears the vessels or enters into them.

• Such foreign bodies as long as present there will be no bleeding but if extracted forcibly, vessels are going to open and start to bleed.

• So if foreign bodies are allowed to remain there only the tissue granulation chances will be there.

• This closes the mouth of vessels. Consequently there are less chances of bleeding that may save the life of the individual.

CONCLUSION

• After reviewing all the facts reviewing of Vishalyghna marmas.these become fatal only after removal of shalya from the injured site.

• Utkshepa can be taken as temporal region up to meninges and Sthpani is taken as region of Glabella.

• Totally the conclusion what sushruta opines regarding not to remove the shalya from the site it is scientific.

FURTHER UNDERSTANDING

marma Any part of the body where the uneven pulsations are felt and

pressure over that part causes Pain, it is called as Marma.

Areas where mamsa, sira, snayus, asthi, and sandhi all are present sannipat(confluence) are called marmas(vulnerable areas)

Dalhana has used the word sannipata,to denotes the close relationship of all the aforesaid body structures like mamsa, sira, snayu

Which are specially and by virtue of their nature are the seats of prana(life)

Therefore any trauma on any of these marmas invariably causes death

presence of dosha and guna in marma

• Soma, vayu, tejas, sattwa,tamas,and jivatma all the factors are present in marma.

• Therefore the living being cannot survive after an injury to marmas

• The body get consiousness due to its satwa, rajas and tamas properties

• The satwa, rajas and tamas are also named as prana of the body.prana lies in marma

• Hence when marmas are injured, prana escapes out of marmas and the man die

prana

Factors comprising pranaAgni ,soma, vayu, satwa, rajas, tamas, panchendriya, bhutatma all are representative of prana (su.sh.4/3)

sites of prana

According to charaka the ten pranayatanas are Shiras, kanta, hridayam, nabhi, gudam, basti, oja, sukra, sonitham, mamsa (cha.sh.7/9)

classification marma

MARMAS ARE 107 IN NUMBER THEY ARE OF 5 TYPES1. Mamsa(11)2. Sira(41)3. Snayu(27)4. Asthi(8)5. Sandhi(20) su.sh.6/3

PROGNOSTIC CLASSIFICATION OF MARMA6. Sadhyo pranhara(19)-causing instant death7. Kalantar(33)-causing death after some time8. Vishalyaghna(3)-death comes after removing shalya9. Vaiklyakara(44)-causing deformity10. Rujkara(8)-causing severe pain (su.sh.6/14)

VISHALYGHNA MARMA

Vishalyghna Marma is Vayupradhana.

Hence, after the trauma the shalya which is impacted in the vital parts gives protection to Prana until the wound heals normally on its own and the shalya is drained out with pus

But if the shalya is pulled intentionally before suppuration and auto-healing process, there will be sudden exit of Vayu and death is the only outcome.

So that is safe to keep the shalya in its place as it is.

UTHKSHEPA MARMA

Urdhwa jatrugata marma

• Vishalyagna marma

• Snayu marma

• Ardhangula pramana

• Vayu pradhaana marma

• 2 in number

•Temporalis muscle and fascia

Pterion• It is the area in the temporal fossa where four bones ( frontal,

parietal, temporal & sphenoind ) adjoin each other across an H- shaped suture.

• It is an important land mark because it overlise the anterior branches of the middle meningeal vessels

• A blow to the side of the head may fracture the thin bones forming the pterion, rupturing middle meningeal artery, resulting haematomas, excerts pressure on the cerebral cortex.

Utkshepa marma viddha

Shalyaapanayana

Vaayu vinirgathi

Mamsa,Rakta, Majja, Masthulunga shosha

Shwasa, Kaasa

Marana

Injury to pterion region

Removal of the object

Haemorrhage

Lack of blood supply to meninges & brain

Shock with metabolic acidosis ( Air hunger, Hyperventilation )

Death

STHAPANI MARMA

Urdhwa jatrugata marma

• Vishalyagna marma

• Sira marma

• Ardhangula pramana

• Vayu pradhaana marma

• 1 in number

•Nasal arch of frontal vein

1.Supra trochlear artery1.Supra orbital artery2.Supra trochlear nerve3.Frontal belly of occipito frontalis4.Fromtal bone4.Frontal nasal bone joint1

24 3

Why is the penetrated object not removed???

• Patients in whom the penetrating object is left in place have a significantly lower mortality than those in whom the objects are inserted and then removed.

• Retained fragments have not been associated strongly with infection, most authors have suggested they should be removed only if the fragments are accessible.

• In gun shot wounds, the bullet is not removed unless it is easily accessible because the risk of brain injury from the retrieval of the bullet exceeds the benefit of its removal.

• If the missile can be located readily it should be removed, but more damage may be done by searching through the brain for the metal than by leaving it in place.

•In case of stab wounds the knife or penetrating object should not be removed until the dura opened in the operating room and the procedure can be performed under direct vision.

CONCLUSION

Considering the above details one could safely make the following comparisons: The Utkshepa marma to Pterion region. As it is a snaayugata marma, can be compared to the

Meninges and Temporal fascia

Hence it is imperative to understand the regional anatomy and applied aspect of individual marmas, so as to manage and prevent complications pertaining to them more efficiently.

Extraction of Shalya from region of STHAPANI MARMA (A SIRA MARMA) will lead to Profuse bleeding of Blood leading to escape of Vayu in the form of Prana located in Rakta , Thus causing Dryness of Mamsa , Vasa , Majja , Mastulunga and finally Death.

If Depressed fractures (Shalya) of cranium are attempted to elevate there is a risk of severe hemorrhage from Sinuses leading to death .So these fractures are left alone and are not elevated .

Fracture of Anterior cranial fossa leads hemorrhage from the nose and escape of CSF (CSF rhinorrhoea) and even brain matter through the nose.

REFERENCES

SUSHRUTA SAMHITA SHARIRA 4, 6, 29 CHAPTERSCHARAKA SHARIRA 7 TH CHAPTERASTANGA HRIDAYA 3, 4 CHAPTERSSHARIR SUBHASHIT PROF D.G. THATTESHARIRA RACHANA-DR.RAMASUNDAR RAO