Ashtanga Hridayam Shareerasthanam Chapter 4:  Marmavibhagam Shareeram Adhyaya (Classification of the vital spots of the body)

The 4th chapter of Shareeram sthanam of Ashtanga Hridayam is named as Marma Vibhaga Shareera Adhyaya. This chapter deals with the explanation of the classification of vital spots of the body.

The topics covered in this chapter include –

–        Number of Marmas and their distribution in the body
–        Sakha Marma – vital spots of the extremities
–        Madhayamanga marma – vital sports of the trunk
–        Prishtagata marma – vital sports of the back
–        Jatrurdhva marma – vital spots in the head and neck
–        Vishalyaghna marma – vital spots which cause death after removal of foreign body
–        Sadyo pranahara marma – vital spots which cause immediate death
–        Definition of marma
–        Marma Sankhya – number of vital spots
–        Marma viddha laksana – signs of Injury to vital spots
–        Names of vital spots which cause instant death
–        Names of vital spots which cause death after some time
–        Names of vital spots which cause death after removal of the foreign body
–        Names of vital spots which cause distortion or disability
–        Names of vital spots which cause pain
–        Marma pramana – size of the vital spots
–        Marmbhighata phala – effect of injury to vital spots
–        Importance of checking the bleeding in the injured vital spot
–        Reasons for avoidance of administration of alkalis, poisonous medicines etc on the vital spots
–        Importance of Marmas

Pledge by the author(s)

अथातो मर्मविभागं शारीरं व्याख्यास्यामः।

इति ह स्माहुरात्रेयादयो महर्षयः।गद्यसूत्रे॥२॥

After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the classification of the vital spots of the body. Thus say (pledge) Atreya and other sages.

Number of Marmas and their distribution in the body

सप्तोत्तरं मर्मशतं तेषामेकादशादिशेत् ।

पृथक्सक्थ्नोस्तथा बाह्वोस्त्रीणि कोष्ठे नवोरसि ॥ १ ॥

पृष्ठे चतुर्दशोर्ध्वं तु जत्रोस्त्रिंशच्च सप्त च ।

Marmas (vital sports, vulnerable places) are one hundred and seven; of them, eleven are present in the thighs and arms separately in each (thus forty-four in the four extremities); three in the abdomen, nine in the chest, fourteen in the back (thus twenty six in the trunk); and thirty seven in parts above the shoulders (neck and head)

Sakha Marma – vital spots of the extremities

मध्ये पादतलस्याहुरभितो मध्यमाङ्गुलीम् ॥ २ ॥

तलहृन्नामरुजया तत्र विद्धस्य पञ्चता ।

अङ्गुष्ठाङ्गुलिमध्यस्थं क्षिप्रंआक्षेपमारणम् ॥ ३ ॥

तस्योर्ध्वं द्व्यङ्गुले कूर्चः पादभ्रमणकम्पकृत् ।

गुल्फसन्धेरधः कूर्चशिरःशोफरुजाकरम् ॥ ४ ॥

जङ्घाचरणयोः सन्धौ गुल्फो रुक्स्तम्भमान्द्यकृत् ।

जङ्घान्तरे त्विन्द्रवस्तिर्मारयत्यसृजः क्षयात् ॥ ५ ॥

जङ्घोर्वोः सङ्गमे जानु खञ्जता तत्र जीवतः ।

जानुनस्त्र्यङ्गुलादूर्ध्वमाण्यूरुस्तम्भशोफकृत् ॥ ६ ॥

उर्व्यूरुमध्ये तद्वेधात्सक्थिशोषोऽस्रसङ्क्षयात् ।

ऊरुमूले लोहिताक्षं हन्ति पक्षमसृक्क्षयात् ॥ ७ ॥

मुष्कवङ्क्षणयोर्मध्ये विटपं षण्ढताकरम् ।

इति सक्थ्नोस्तथा बाह्वोर्मणिबन्धोऽत्र गुल्फवत् ॥ ८ ॥

कूर्परं जानुवत्कौण्यं तयोर्विटपवत्पुनः ।

कक्षाक्षमध्ये कक्षाधृक् कुणित्वं तत्र जायते ॥ ९ ॥

In the centre of the sole, in the line of the middle toe is talahrdaya, injury to this will lead to death from (severe) pain in between the big toe and the first toe, is a vital spot known as ksipra, injury to this causes convulsions leading to death. Two angula (finger breadth) above this is located a vital spot named kurca, injury to this will produce twisting of the foot and tremors just below the ankle joint is kurcasira, its injury causes swelling and pain at the junction of the calves and foot is gulpha, its injury causes pain, stiffness (or loss of control) of the leg or loss of activities in the centre of the calf muscle is indrabasti, its injury leads to death by (severe) loss of blood at the junction of calves and thighs is the janu, its injury produces lameness if he is alive. Three angulas above on either side of the janu are the ani, its injury causes stiffness of the thighs and swelling of the leg (thigh) in the centre of the things is urvi, its injury causes emaciation of the thigh from loss of blood. Above the urvi, below the angle of the groin and at the root of the thigh is lohitaksa, its injury causes hemiplegia from loss of blood in between the scrotum and groin is vitapa, its injury causes impotence marmas of the arms similar to those of the thighs, in the arms, just like the gulpha it is manibandha (called manibandha or wrist marma instead of gulpha) kurpara (in upper limb / arm) is similar to janu (in the lower limb), injury to these causes distortion of the arm, just like in vitapa in between the axilla and collar bone is kaksadhra, just like vitapa, its injury also causes distortion of arm.

Madhayamanga marma – vital sports of the trunk

स्थूलान्त्रबद्धः सद्योघ्नो विड्वातवमनो गुदः ।

मूत्राशयो धनुर्वक्रो वस्तिरल्पास्रमांसगः ॥ १० ॥

एकाधोवदनो मध्ये कट्याः सद्यो निहन्त्यसून् ।

ऋतेऽश्मरीव्रणाद्विद्धस्तत्राप्युभयतश्च सः ॥ ११ ॥

मूत्रस्राव्येकतो भिन्ने व्रणो रोहेच्च यत्नतः ।

देहामपक्वस्थानानां मध्ये सर्वसिराश्रयः ॥ १२ ॥

नाभिः सोऽपि हि सद्योघ्नो द्वारमामाशयस्य च ।

सत्त्वादिधाम हृदयं स्तनोरःकोष्ठमध्यगम् ॥ १३ ॥

स्तनरोहितमूलाख्ये द्व्यङ्गुले स्तनयोर्वदेत् ।

ऊर्ध्वाधोऽस्रकफापूर्णकोष्ठोनश्येत्तयोःक्रमात् ॥ १४ ॥

अपस्तम्भावुरपार्श्वे नाड्यावनिलवाहिनी ।

रक्तेन पूर्णकोष्ठोऽत्र श्वासात्कासाच्च नश्यति ॥ १५ ॥

पृष्ठवंशोरसोर्मध्ये तयोरेव च पार्श्वयोः ।

अधोऽंसकूटयोर्विद्यादपालापाख्यमर्मणी ॥ १६ ॥

तयोः कोष्ठेऽसृजा पूर्णे नश्येद्यातेन पूयताम् ।

Attached to the large intestine is guda marma, which expels the flatus and faces, its injury leads to quick death. Mutrashaya (urinary bladder) curved like a bow, made up of very little of muscle tissue and blood, located inside the pelvis, with one orifice pointed downwards, it is the basti (marma); injury to it causes death quickly, even without formation of ulcer caused by urinary stone (while removal of stone) even in this, if this ulcer (formed by urinary stone) is formed on both sides, it still causes quick death if it is injured on one side and ulcer develops through which urine flows out, it heals with difficulty after great effort (treatment) in the body, in between the stomach and large intestine is the nabhi, the seat of all the siras (veins) even its injury causes death quickly. In between the chest and abdomen, between the two breast and at the opening of the stomach is the hrdaya, which is the seat of satva (soul/life) etc (injury to it also causes quick death) stanarohita and stanamula are situated two angula above and below the breast respectively; injury to these leads to death from accumulation of blood and kapha in the kostha (chest) respectively on either side of the tube of the chest (trachea) are the two tubes which carry air, known as apastambha, injury to these causes death from accumulation of blood inside the chest, cough and dyspnoea in the space between spine and chest, on both sides of the same (space between spine and chest), below the shoulder joints, are the two vital spots known as apalapa, their injury causes accumulation of blood in the chest cavity which (blood) later gets converted into pus leading to death

Prishtagata marma – vital sports of the back

पार्श्वयोः पृष्ठवंशस्य श्रोणिकर्णौ प्रति स्थिते ॥ १७ ॥

वंशाश्रिते स्फिजोरूर्ध्वं कटीकतरुणे स्मृते ।

तत्र रक्तक्षयात्पाण्डुर्हीनरूपो विनश्यति ॥ १८ ॥

पृष्ठवंशं ह्युभयतो यौ सन्धी कटिपार्श्वयोः ।

जघनस्य बहिर्भागे मर्मणी तौ कुकुन्दरौ ॥ १९ ॥

चेष्टाहानिरधःकाये स्पर्शाज्ञानं च तद्व्यधात् ।

पार्श्वान्तरनिबद्धौ यावुपरि श्रोणिकर्णयोः ॥ २० ॥

आशयच्चादनौ तौ तु नितम्बौ तरुणास्थिगौ ।

अधःशरीरे शोफोऽत्र दौर्बल्यं मरणं ततः ॥ २१ ॥

पार्श्वान्तरनिबद्धौ च मध्ये जघनपार्श्वयोः ।

तिर्यगूर्ध्वं च निर्दिष्टौ पार्श्वसन्धी तयोर्व्यधात् ॥ २२ ॥

रक्तपूरितकोष्ठस्य शरीरान्तरसम्भवः ।

स्तनमूलार्जवे भागे पृष्ठवंशाश्रये सिरे ॥ २३ ॥

बृहत्यौ तत्र विद्धस्य मरणं रक्तसङ्क्षयात् ।

बाहुमूलाभिसम्बद्धे पृष्ठवंशस्य पार्श्वयोः ॥ २४ ॥

अंसयोः फलके बाहुस्वापशोषौ तयोर्व्यधात् ।

ग्रीवामुभयतः स्नाव्नी ग्रीवाबाहुशिरोऽन्तरे ॥ २५ ॥

स्कन्धांसपीठसम्बन्धावंसौ बाहुक्रियाहरौ ।

On either side of the vertebral column, situated on (against) the earlike bones of the pelvis, attached (embedded in) to the spine, above the buttocks, are the two katikataruna, injury to these causes pallor due to less of blood, emaciation and death on either side of the spinal column, at the junction of the pelvis and flanks on both sides, on the outer portion of hip / butt, are two kukundara marmas, injury to these causes loss of functions (movements) and loss of sensation in the lower portion of the body bound to the region in between the flanks and the spine (on either side of the vertical column), the two areas above the ear like projections of the pelvis (outside the buttocks), concealing the visceral organs and composed of delicate cartilages are two nitamba (marmas), injury to these leads to swelling and debility in the lower portion of the body and death. At the lower end of the flanks and attached at the centre of the sides of the front part of the pelvis, located side wards and upwards are the parsvasandhi, injury to these leads to death from accumulation of blood in the abdomen in straight line with the stanamula, on either side of the vertebral column are the two brhati sira, injury to them leads to death by complications arising from severe loss of blood at the root of the arms, on either side of the vertebral column are embedded / bound two amsaphalaka, injury to these causes loss of tactic sensation and emaciation on either side of the neck, the sinews (tendons) located between the neck and head / root of the shoulder joint, binding the root of the shoulder with the nape of the neck, are two amsa, injury to these causes loss of function of the arms.

Jatrurdhva marma – vital spots in the head and neck

कण्ठनाडीमुभयतः सिरा हनुसमाश्रिताः ॥ २६ ॥

चतस्रस्तासु नीले द्वे मन्ये द्वे मर्मणी स्मृते ।

स्वरप्रणाशवैकृत्यं रसाज्ञानं च तद्व्यधे ॥ २७ ॥

कण्ठनाडीमुभयतो जिह्वानासागताः सिराः ।

पृथक् चतस्रस्ताः सद्यो घ्नन्त्यसून्मातृकाह्वयाः ॥ २८ ॥

कृकाटिके शिरोग्रीवासन्धौ तत्र चलं शिरः ।

अधस्तात्कर्णयोर्निम्ने विधुरे श्रुतिहारिणी ॥ २९ ॥

फणावुभयतो घ्राणमार्गं श्रोत्रपथानुगौ ।

अन्तर्गलस्थितौ वेधाद्गन्धविज्ञानहारिणौ ॥ ३० ॥

नेत्रयोर्बाह्यतोऽपाङ्गौ भ्रुवोः पुच्चान्तयोरधः ।

तथोपरि भ्रुवोर्निम्नावावर्तावान्ध्यमेषु तु ॥ ३१ ॥

अनुकर्णं ललाटान्ते शङ्खौ सद्योविनाशनौ ।

On the two sides of the trachea, there are four siras (veins) which are embedded in the jaws, of them two marmas are called nila and two (others) are called manya, injury to them produces loss or disorder of speech and loss of taste perception on either side of the throat are four siras (veins), located in the tongue and nose separately, known as matrka, their injury leads to quick death, at the junction of the throat and the head are the two krkatika, injury to these causes, tremors (shaking) of the head below the back of the ears are two vidhura, injury to these causes deafness on either side of the nostrils, adjoining the opening of the ears, located inside the throat, are the two phana, injury to these cause loss of perception of smell at the outer angle of the eye, at the tail end of eye-brows and below are the two apanga, in the depression above the eyebrow, (on the forehead) are the avarta, injury to these (apanga and avarta marmas) causes either blindness or disorders of vision at the end of the forehead (above the tail end of brows) adjoining the ears, on the forehead are the two Sankha, injury to these causes quick death.

Vishalyaghna marma – vital spots which cause death after removal of foreign body

केशान्ते शङ्खयोरूर्ध्वमुत्क्षेपौ स्थपनी पुनः ॥ ३२ ॥

भ्रुवोर्मध्ये त्रयेऽप्यत्र शल्ये जीवेदनुद्धृते ।

स्वयं वा पतितेपाकात्सद्यो नश्यति तूद्धृते ॥ ३३ ॥

Above the sankha, at the lower border of the hairs, are the two utksepa (marma); between the two eyebrows is the sthapani; in these three (when injured) the person can live with the foreign body still intact, or when it falls off by itself or after putrefaction; while its removal causes sudden death.

Sadyo pranahara marma – vital spots which cause immediate death

जिह्वाक्षिनासिकाश्रोत्रखचतुष्टयसङ्गमे ।

तालून्यास्यानि चत्वारि स्रोतसां तेषु मर्मसु ॥ ३४ ॥

विद्धः शृङ्गाटकाख्येषु सद्यस्त्यजति जीवितम् ।

कपाले सन्धयः पञ्च सीमन्तास्तिर्यगूर्ध्वगाः ॥ ३५ ॥

भ्रमोन्मादमनोनाशैस्तेषु विद्धेषु नश्यति ।

आन्तरो मस्तकस्योर्ध्वं सिरासन्धिसमागमः ॥ ३६ ॥

रोमावर्तोऽधिपो नाम मर्म सद्यो हरत्यसून् ।

At the meeting place of four orifices of the tongue, eyes, nose and ears and in the palate and oral cavity where the four channels related to tongue etc meet, in them is the vital spot, by name srngataka, four in number, Injury to these causes quick death. The five joints in the head (skull) spread side wards and upwards is known as simanta marma, injury to these leads to death from insanity, giddiness and loss of intellect inside the head, at the meeting place of the joints of veins, on the top and at the spiral of hairs is located the marma named adhipati, injury to this causes quick death

Definition of marma

विषमं स्पन्दनं यत्र पीडिते रुक्च मर्म तत् ॥ ३७ ॥

मांसास्थिस्नायुधमनीसिरासन्धिसमागमः ।

स्यान्मर्मेति च तेनात्र सुतरां जीवितं स्थितम् ॥ ३८ ॥

बाहुल्येन तु निर्देशः षोढैवं मर्मकल्पना ।

प्राणायतनसामान्यादैक्यं वा मर्मणां मतम् ॥ ३९ ॥

         Marma is that place which has unusual throbbing and pain on touch the meeting place of muscle, bones, tendons, arteries, veins and joints, is called marma life entirely resides in them (any injury or assault to these causes danger to life) they are indicated by the predominant structure found in them, on this basis the marmas (vital sports) are of six kinds; they are one kind only on the common factor “as seats of life”

Marma Sankhya – number of vital spots

मांसजानि दशेन्द्राख्यतलहृत्स्तनरोहिताः ।

शङ्खौ कटीकतरुणे नितम्बावंसयोः फले ॥ ४० ॥

अस्थ्न्यष्टौ स्नावमर्माणि त्रयोविंशतिराणयः ।

कूर्चकूर्चशिरोऽपाङ्गक्षिप्रोत्क्षेपांसवस्तयः ॥ ४१ ॥

गुदापस्तम्भविधुरशृङ्गाटानि नवादिशेत् ।

मर्माणि धमनीस्थानि सप्तत्रिंशत्सिराश्रयाः ॥ ४२ ॥

बृहत्यौ मातृका नीले मन्ये कक्षाधरौ फणौ ।

विटपे हृदयं नाभिः पार्श्वसन्धी स्तनाधरे ॥ ४३ ॥

अपालापौ स्थपन्युर्व्यश्चतस्रो लोहितानि च ।

सन्धौ विंशतिरावर्तौ मणिबन्धौ कुकुन्दरौ ॥ ४४ ॥

सीमन्ताः कूर्परौ गुल्फौ कृकाट्यौ जानुनी पतिः ।

मांसमर्म गुदोऽन्येषां स्नाव्नि कक्षाधरौ तथा ॥ ४५ ॥

विटपौ विधुराख्ये च शृङ्गाटानि सिरासु तु ।

अपस्तम्भावपाङ्गौ च धमनीस्थं न तैः स्मृतम् ॥ ४६ ॥

Mamsa Marma are ten viz, indrabasti (4), Talahrdaya (4) and Stanarohita (2), asthi marma are eight; Sankha (2), Katikatakaruna (2), Nitamba(2), and Amsaphalaka (2), snayu marmas are 23 in number, ani (4), kurcha (4), kurchashira (4) apanga(2), ksipra(4), Utkespa(2), Amsa(2), and Basti(1), dhamani marma are nine in number, Guda(1), Apasthambha(2), Vidhura(2), and Srngataka(4), sira marmas are thirty seven; Brhati (2), Matrka (8), Nila (2), Manya (2), Kasadhara (2), Phana (2), Vitapa (2), Hrdaya (1), Nabhi (1), Parsvasandhi (2), Stanadhara (2), Apalapa(2), Sthapani(1), Urvi(4), and Lohitaksa(4), sandhi marma are twenty; Avartha (2), manibhandha (2), Kukundrara (2), Simanta (5), Kurpara (2), Gulpha (2), Krkatika (2), Janu (2) and Adhipati (1. In the opinion of some, Guda is Mamsa Marma; Kaksadhara are Snayu marma along with Vitapa and Vidhura, Shringataka is Sira marma, together with Apastambha and Apalapa and not Dhamani Marma

Marma viddha laksana – signs of Injury to vital spots

विद्धेऽजस्रमसृक्स्रावो मांसधावनवत्तनुः ।

पाण्डुत्वमिन्द्रियाज्ञानं मरणं चाशु मांसजे ॥ ४७ ॥

मज्जान्वितोऽच्चो विच्चिन्नः स्रावो रुक् चास्थिमर्मणि ।

आयामाक्षेपकस्तम्भाः स्नावजेऽभ्यधिकं रुजा ॥ ४८ ॥

यानस्थानासनाशक्तिर्वैकल्यमथवान्तकः ।

रक्तं सशब्दफेनोष्णं धमनीस्थे विचेतसः ॥ ४९ ॥

सिरामर्मव्यधे सान्द्रमजस्रं बह्वसृक्स्रवेत् ।

तत्क्षयात्तृड्भ्रमश्वासमोहहिध्माभिरन्तकः ॥ ५० ॥

वस्तु शूकैरिवाकीर्णं रूढे च कुणिखञ्जता ।

बलचेष्टाक्षयः शोषः पर्वशोफश्च सन्धिजे ॥ ५१ ॥

When mamsa marma (i.e. vital spot predominant in muscle tissue) are injured, three will be continuous bleeding, blood being thin, resembling water in which meat is washed; pallor(of the skin), loss of function of the sense organs and quick death when asthi marma (i.e. vital spot rich in bone tissue) are injured there is discharge of thin fluid mixed with bone marrow, not as continuously (as in injury of mamsa marma) and intermittent pain. When snayu marma are injured three will be bending (contractions) of the body, convulsions, stiffness / rigidity, very severe pain, inability for riding, sitting etc, distortions or even death when dhamani marma (the vital spots which are predominantly made up of arteries) are injured the blood which is frothy and warm flows out with a sound, and the person becomes unconscious in case of injury to sira marma (vital spots which are predominantly made up of veins), blood which is thick flows out continuously and in large quantity; from its loss, thirst, giddiness, dyspnoea, delusion (unconsciousness), and hiccup manifest leading to death in case of injury to sandhi marma (vital spots wherein there is predominance of joints), the site (of injury) feels as though full of thorns (spicule / spike), even after healing (of the wound) there is shortening of the arm, lameness, decrease of strength and movement, and emaciation(of the body) and swelling of the (small joints of the hands, inter-phalangeal joints) joints

Sadyo pranahara marma – vital spots which cause instant death

नाभिशङ्खाधिपापानहृच्चृङ्गाटकवस्तयः ।

अष्टौ च मातृकाः सद्यो निघ्नन्त्येकान्नविंशतिः ॥ ५२ ॥

सप्ताहः परमः तेषां कालः कालस्य कर्षणे ।

Nabhi (1), Sankha (2), Adhipati (1), Apana (Guda) (1), hrdaya (1), Srgataka (4), basti (1) and the eight Matrka (8); these nineteen , take away life immediately (hence these are known as sadyahpranahara) seven days is maximum time for these marmas to attract death (death of manifest)

Kalantara pranahara marma – vital spots which cause death after some time

त्रयस्त्रिंशदपस्तम्भ तलहृत्पार्श्वसन्धयः॥५३॥

कटीतरुण सीमन्तस्तनमूलेन्द्रवस्तयः।

क्षिप्रापालापबृहती नितम्बस्तनरोहिताः॥५४॥

कालान्तर प्राणहरा मासमासार्धजीविताः।

Apastambha (2), talahrdaya (4), Parsvasandhi (2), Katitaruna (2), simanta (5), Stanamula (2), indrabasti (4), Kshipra (4), Apalapa (2), brhati (2), Nitamba (2) and stanarohita (2); these thirty three are Kalantara Pranahara (take away the life after some time); one or one and half months is the period of life (when these are injured)

Vishalyaghna marma – vital spots which cause death after removal of the foreign body

उत्क्षेपौ स्थपनी त्रीणि विशल्यघ्नानि तत्र हि ॥ ५५ ॥

वायुर्मांसवसामज्जमस्तुलुङ्गानि शोषयेन् ।

शल्यापाये विनिर्गच्चन् श्वासात्कासाच्च हन्त्यसून् ॥ ५६ ॥

The two utksepa (2) and sthapani (1) these three are Visalyaghna  marmas. Injury to them will cause death when the arrow (foreign body) is removed, by the exit of vayu; or when Mamsa, Vasa, majja and mastulunga get dried up, leading to development of dyspnoea and cough and destroys the life (of the person)

Vaikalyakara marma – vital spots which cause distortion or disability

फणावपाङ्गौ विधुरे नीले मन्ये कृकाटिके ।

अंसांसफलकावर्तविटपोर्वीकुकुन्दराः ॥ ५७ ॥

सजानुलोहिताक्षाणिकक्षाधृक्कूर्चकूर्पराः ।

वैकल्यमिति चत्वारि चत्वारिंशच्च कुर्वते ॥ ५८ ॥

हरन्ति तान्यपि प्राणान् कदाचिदभिघाततः ।

Phana (2), Apanga (2), Vidhura (2), Nila (2), Manya (2), Krkatika (2), Amsa (2), Amsaphalaka (2), Avarta (2), Vitapa (2), urvi (4), Kukundara (2), Janu (2), lohitaksa (4), Ani (4), kaksadara (2), Kurca (4), and Kurpara (2), these forty-four are Vaikalyakara (causing distortion, irregularity etc); they might also take away (destroy) the life sometimes when injured

Rujakara marma – vital spots which cause pain

अष्टौ कूर्चशिरोगुल्फमणिबन्धा रुजाकराः॥५९॥

Kurcasira (4), Gulpha (2), manibandha (2) – these eight are Rujakara (causing pain)

Marma pramana – size of the vital spots

तेषां विटपकक्षाधृगुर्व्यः कूर्चशिरांसि च ।

द्वादशाङ्गुलमानानि द्व्यङ्गुले मणिबन्धने ॥ ६० ॥

गुल्फौ च स्तनमूले च त्र्यङ्गुलं जानुकूर्परम् ।

अपानवस्तिहृन्नाभिनीलाः सीमन्तमातृकाः ॥ ६१ ॥

कूर्चशृङ्गाटमन्याःच त्रिंशत् एकेन वर्जिताः ।

आत्मपाणितल उन्मानाः शेषाणि अर्ध अङ्गुलं वदेत् ॥ ६२ ॥

पञ्चाशत्षट् च मर्माणि तिलव्रीहिसमान्यपि ।

Among them, Vitapa, Kaksadhara, Urvi, Kurcasira are twelve angula (finger breath) in size; Manibandha, Gulpha and Stanamula are two angula: janu, and Kurpura are three angula janu and kurpara are of three angulas Apana (Guda), Basti, hrdaya, Nabhi, Nila, Simanta, matrka, Kurca, srngataka, Manya – these twenty-nine are equal in size of one’s own palm; the remaining fifty-six are each half angula, in the opinion of some others, the size of the vital sports are equivalent to those of tila (sessamum seed) and vrhi (paddy grain).

Marmbhighata phala – effect of injury to vital spots

चतुर्धोक्ताः सिरास्तु याः ॥ ६३ ॥

तर्पयन्ति वपुः कृत्स्नं ता मर्माण्याश्रितास्ततः ।

तत्क्षतात्क्षतजात्यर्थप्रवृत्तेर्धातुसङ्क्षये ॥ ६४ ॥

वृद्धश्चलो रुजस्तीव्राः प्रतनोति समीरयन् ।

तेजस्तदुद्धृतं धत्ते तृष्णाशोषमदभ्रमान् ॥ ६५ ॥

स्विन्नस्रस्तश्लथतनुं हरत्येनं ततोऽन्तकः ।

The four types of siras mentioned previously (verses 19.37 of chapter 3) which nourish the entire body, are seated (located) in the marma (vital spots), so when the siras are injured, they too (vital spots) are injured, depletion / decrease of dhatus (tissues) takes place due to severe loss of blood; by that vayu (vata), getting increased produces severe pain, causes increase of pitta which in turn produces thirst, emaciation, intoxication (unconsciousness) and giddiness, perspiration, weakness and looseness of the body, gets carried away by death

Importance of checking the bleeding in the injured vital spot

वर्धयेत्सन्धितो गात्रं मर्मण्यभिहते द्रुतम् ॥ ६६ ॥

चेदनात्सन्धिदेशस्य सङ्कुचन्ति सिरा ह्यतः ।

जीवितं प्राणिनां तत्र रक्ते तिष्ठति तिष्ठति ॥ ६७ ॥

The injured part (the vital spot) should be cut (incised) immediately near its place of joining; by cutting the junctional area, sira (veins) get contracted and the bleeding stops, by stoppage of blood, the life of the people stays on

Reasons for avoidance of administration of alkalis, poisonous medicines etc on the vital spots

सुविक्षतोऽप्यतो जीवेदमर्मणि न मर्मणि ।

प्राणघातिनि जीवेत्तु कश्चिद्वैद्यगुणेन चेत् ॥ ६८ ॥

असमग्राभिघाताच्च सोऽपि वैकल्यमश्नुते ।

तस्मात् क्षारविषाग्न्यादीन् यत्नान्मर्मसु वर्जयेत् ॥ ६९ ॥

Though wounded greatly in places other than marmas (vital spots), the person survives but not so when injured on the vital spots; for, these are destroyers of life, some may survive by the expertise of the physician and partial injury to them, even then they cause distortions (irregularity) hence the use of ksara (application of caustic alkali) visa (poisonous drugs), agni (cautery by fire) etc. on the vital spots should avoided as far as possible (with all efforts).

Importance of Marmas

मर्माभिघातः स्वल्पोऽपि प्रायशो बाधतेतराम् ।

रोगा मर्माश्रयास्तद्वत्प्रक्रान्ता यत्नतोऽपि च ॥ ७० ॥

Injury to vital spots, though slight (mild) usually produces serve pain (trouble); so also the diseases which are localised in the vital spots (do not get cured) in spite of great effort in treating it.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमत् वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां द्वितीये शारीरस्थाने मर्मविभागो नाम चतुर्थोऽध्याय: । 

Thus ends the chapter called Marmavibhago sariram; the fourth in Sarira Sthana of Astangahrdayasamhita composed by SrimadVagbhata, son, of Sri Vaidyapati Simhagupta.