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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 14-18

Exploring the Scientific Potential of Marma Therapy as a Nonpharmacological Intervention in Pain Management


Department of Rachna Sharir, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, India

Date of Submission11-Jan-2022
Date of Decision13-Apr-2022
Date of Acceptance13-Apr-2022
Date of Web Publication15-Sep-2022

Correspondence Address:
Jagjeet Singh
Room No. 316, Department of Rachna Sharir, Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_7_22

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  Abstract 


Pain is the most common problem in today's busy and exhausting life, and it is one of the grievous problems present throughout the globe because of its high prevalence and fifth vital sign. Fast-acting and quick relief is the preferred way in today's hectic schedule, even though these relief agents such as analgesics and anti-inflammatory drugs have adverse effects on the human body. Ayurveda pain management comprises pharmacological and nonpharmacological approaches such as Marma Chikitsa, Yoga, and meditation which help in releasing the pain effects without any adverse effects on the body. Marma is combined with an ability to perceive and direct the flow of Prana; Marma Chikitsa becomes a powerful tool in influencing the healing of almost every known ill condition like pain. In this review, the scientific potential of Marma therapy as a nonpharmacological intervention in pain management will be analyzed.

Keywords: Ayurveda, Marma Chikitsa, nonsteroidal anti-inflammatory drugs, pain management


How to cite this article:
Singh J, Sabharwal P. Exploring the Scientific Potential of Marma Therapy as a Nonpharmacological Intervention in Pain Management. AYUHOM 2022;9:14-8

How to cite this URL:
Singh J, Sabharwal P. Exploring the Scientific Potential of Marma Therapy as a Nonpharmacological Intervention in Pain Management. AYUHOM [serial online] 2022 [cited 2022 Oct 7];9:14-8. Available from: http://www.ayuhom.com/text.asp?2022/9/1/14/356172




  Introduction Top


Ayurveda is the science of life dealing with treating the mind, body, and soul to ensure an overall state of health, the topic of Marma consists of ancient and scientific knowledge, and health can also be maintained by the knowledge of Marma. According to Charak, the human body consists of Panchbhautik Dravya (Akash. Jal, Agni, Vayu, and Prithvi), and the soul is known as Sada DhatuPhurusa or Chikitsiya Phurusa. The human body comprises of Sapta Dhatu, i.e., Rasa, Rakta, Mamsa, Meda, Asthi, Majja, and Shukra. The human body consists of three Doshas, i.e., Vata, Pitta, and Kapha. These three Doshas are the main constituents in the human body which is when in equilibrium can provide good health to the human body but if there is a slight disturbance in the equilibrium of Dosha can cause diseases.[1] The ultimate aim of the science of Ayurveda is the prevention and cure of the disease (Swasthya Swasth Raksana).[2] In the ongoing times, various health ailments are the causes of concern. The main cause of these sufferings is stress which is induced by competitiveness, changing lifestyles, and behavior which results in physical and mental illness. As a result, human being suffers from physical and mental illnesses. In Ayurveda, Adhyatmic (mental), Adhibahuatik, (physical), and Adhidaivik (spiritual) are three types of suffering; these sufferings can be treated with Mantras, Marma therapy, and yoga, and Ayurveda collectively.[3] Marma Vigyanam is the oldest treasure of Ayurveda which is not until now fully explored. The details of Marma are not only present in ayurvedic scriptures but also in Vedas, Upanishad, Itihaasa, and Purana too.[4] Marma has been defined as the meeting place of Mamsa, Sira, Sanayu, Asthi, and Sandhi where Prana or life resides.[5] One of the most serious sufferings in the human body is pain, so understandings the importance of Marma can help in nonpharmacological intervention in the prevention and promotion of public health.


  Methods Top


This research is a conceptual one. As source materials, the classical Ayurveda texts along with the commentaries available in the library of Ch. Brahm Prakash Ayurved Charak Sansthan, Delhi, is referred. Other than this, various related research article published has also been studied. All the relevant matter is further compiled and analyzed for the discussion and attempts to conclude the scientific potential of Marma therapy as a nonpharmacological intervention for the prevention and promotion of public health.


  Results Top


Concept of pain and pain management (nonpharmacological) in Ayurveda

Ayurveda is India's oldest traditional healing system and its intense system of mind-body medicine, natural living, and yogic health.[6] Marma Science is the most important and hidden topic of Ayurveda. Marma science has been mentioned in ancient texts such as Vedas, Brahmanas, Upanishads, Puranas, and Samhita's (laghutaryee and briuhatyree) of Ayurveda. Detailed knowledge of Marma can be found in Sharir-Sthana of Susrutha Samhita. Marma is not just a superficial edifice or mark on the body surface, but these are deep-seated crucial physio-anatomical sutures. Acharya Sushruta has defined, Marma is known as the junction of Mamsa, Sira, Sanayu, Asthi, sandhi and where Dwadesha Parana is embedded and Marma is also known as Jeevasthana/Pranayatana and is a source of energy.[5] Agni, Soma, Vayu, Satwa, Rajah, Tama, Bhuthatma, and Panchendriyas are called Dwadesha Pranas.[7] It includes all basic factors that sustain life. Acharya Charka has mentioned only Trimarma (three Marma - Hridaya, Basti, and Nabhi) and it is the site of Chetana, and hence, a sense of pain will be more in this region as compared to all other body parts.[8] Acharya Vagbhata in Ashtanga Hridaya has mentioned Marma as the site where Mamsa, Sira, Sanayu, Santhi, Asthi, and Dhamni meets.[9] According to Maharishi Susrutha, Marma is classified into five types based on Rachna - Sadya Pranahara, Kalantra Pranahara, Vishalyaghana, Vaikalyalkara, Rujakara Marma and made up of PanchMahabhutaDravya, i.e., Sadya Pranahara Marma is made of AgniMahabhuta, Kalantra is made up of Soma and AgniMahabhuta, Vishalyaghana is made up of Vayu Mahabhuta, Vaikalyalkara is made up of Soma Mahabhuta, Rujakara Marma is made up Agni and Vayu.[10] Hence, these Marma is made up of Panchmahabuta Darvayas. Acharya Susrutha has mentioned a total no Marma is 107 which includes 22 on lower extremities (11 on each), 22 on upper extremities (11 on each), 12 on the thoracic region, 14 on back, 37 on head and neck.[11] Marma points can be used to balance the Tridosha and Triguna, and these Marma points are specific areas on the body which have relation to various internal organs, Dosha and Srotas.[12]

In modern days' busy and tiring schedules, one of the many problems occurring is pain. Pain is the most commonly occurring and one of the vital problems in human beings. Pain can be explained in terms of disease (Roga), prodromal symptoms (Poorva Ropa), of a disease, or a complication of diseases (Updaravas) and caused by physical injury (Abhighata).[13] Pain is regarded as the fifth vital sign which should be considered in the vital parameters.[14] Pain is a protective mechanism of the body in response to a harmful stimulus.[15]

In Ayurveda term for pain is Sula, Vedana, Dukkha, Pida, Sula, Ruk, Ruja, Beda, Sadana, Avasada.[13] In the perspective view of Ayurveda, there is a brief and important detailed description of Sula (pain), types of pain, and its treatment (interventional and noninterventional).[16] Sula is a cardinal symptom of Vata Dosha. This Vata Dosha disorder arises due to occlusion of Vata (Avarana) or due to depletion of Dhatu (body tissue). In Ayurveda, several types of pain (Sula) that are described in the context of vitiated Vata (one of the three basic elements of the body), pricking pain (Toda), splitting pain (Bheda), piercing pain (Vyadha), binding type pain (Veshtana), pain during joint movements (Parsaran-KunjanVedana), severe pain (Maharuja), etc., are present in various terminologies in the literature.[13] In Ayurveda, assessment criteria of pain are present which can be applied without any radiography. Trividhapareeksha consists of three aspects of patient's examination that are (Darshan), palpation (Sparshan), and interrogation (Parshana),[16] these are very crucial to understand the etiopathogenesis of a disease. The main principle of treatment of pain in Ayurveda depends on understanding the causative factors (Hetu), analyzing the etiopathogenesis (Samprapti), and selecting the treatment. Ayurveda treatment can be briefly divided into two groups, i.e., pharmacological and nonpharmacological methods.[16] Ayurveda has a great and vast area of the pharmacopeia of herbal and mineral ingredients that can be utilized in treating pain and inflammation.[16] Pharmacological treatment comprises two therapies, i.e., internal and external therapy. Internal therapy consists of various drugs and formulations. External therapies consist of oil massage (Abhyanga), hot fermentation (Swedana), application of the paste of drug on the affected area (lepa), thermal cauterization (Agnikarma), and bloodletting (Raktamoksha). Nonpharmacological treatment approach using various yoga postures, lifestyle modifications, trigger point pressure massage (Marma therapy), and dietary modifications.[16] Acharya Susrutha has mentioned that “Hastamevam Pradhanatamam yantram[17] (the human hand is the most powerful and important instrument). For Marma therapy mainly fingertips, knuckles, thumbs, the elbow is used, which provide an extremely light stimulation to the Marma points on the body, and this helps to get rid of the obstructions from the vital point and provides physical-psychological recreation and potency.[18] When pressure is applied gently on Marma points present on the skin, this leads to the stimulation of a chain of events [Flow chart 1].



Concept of pain and pain management in bio-medicine

Pain common nomenclature is sharp, crushing, burning, cramping, gassy, throbbing, cutting, aching, slashing, pinpoint, continuous spasm, tearing, lancing, knifing, etc.[19]

According to the duration of symptoms medicine, pain can be classified into:[19]

  • Acute pain (duration <3 months) - Severe but usually manageable such as surgical pain and pain from injuries
  • Transitional pain (duration between 3 and 6 months) - Not easily diagnosed, needs aggressive treatment to prevent transition to chronic
  • Chronic pain (duration >3–6 months) - Difficult to treat, personality changes, drug-seeking.


Patient's pain can be explained by some special features (according to the International Association of the Study of Pain):[19]

  1. Region of the body involved (e.g., abdomen and lower limbs)
  2. The system of which any dysfunction may be the cause of the pain (e.g., nervous and gastrointestinal)
  3. Duration and manner of occurrence
  4. Intensity and time since onset-about intensity, it is common to ask the patient to grade his/her current pain with a scale from 0 to 10 (0 means no pain and 10 means the worst pain)
  5. Cause.


Pathogenesis of pain

Pain is a physical response of an immediate protective reflex. Pain is caused by excessive stimuli of the intensity threshold for sensory nerve endings. The nervous impulses are produced by the stimulation of peripheral receptors (Nociceptor), which is inferred as pain within the higher cerebral centers. Such types of nervous activity may be produced by several physical phenomena, i.e., pressure, squeezing, tension, tearing, punching, and by change of temperature or chemical effects such as the change of pH, i.e., the concentration of histamine--like substances, bradykinin, serotonin, and another polypeptide compound [Flow chart 2].[16]



Pain pathways[16]

The sensation of pain in the human body is perceived by four physiological processes:

  1. Transduction: The stimulus is converted into the electrical activity at the nerve ending
  2. Transmission: It is the means of conduction of electrical activity
  3. Modulation – Changes in nociceptive transmission
  4. Perception.


Management of pain

The main principle in the modern treatment of pain is nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesic, and surgery. NSAIDs and opioid analgesics have a high risk of adverse effects, mainly affecting gastrointestinal tract, renal system, and cardiovascular system.[20],[21]


  Discussion Top


Some researchers say that Marma points are the junction between physiology and consciousness.[22] Marma therapy, very mild stimulation of points on the body, is performed. It removes blockages in the Marma points providing physical and mental relaxation and the body's energy channels, known as Srotas. Marma points, when lightly pressed on the skin, may stimulate a chain of positive events.[23] Marma therapy is the energy recovery of Ayurveda; using 107 points or “doors” to the body and consciousness. Each stage allows for entry to the “chakras” - the vibrational energy centers along the spine from the “subtle” body, releasing blocked energy and stimulating pranic flow. Marma points, considered “doors” or “entry points” to our body's internal pathways, when lightly pressed on the skin may stimulate a chain of positive events.[23]

Marma therapy works with the subtle and dynamic inner transport system of the body-spirit organization in addition to the circulatory system to unlock the energy outlets in the body called Srotas.[15] This light stimulation also modulates the physiological response by releasing an increased amount of endorphin and serotonin transmittance to the brain and specific organs through nerves, Srotas (channels), and vital points.

Hence, this light stimulation on the Marma leads to a tingling sensation and causes the activation of the pathways having multifactorial effects like beneficial influences on the chemical environment of nearby Marma's, facilitation of tissue repair processes, decreasing the fatigues, and improving the microcirculation around the Marma.[18] Hence, Marma therapy can be understood as therapy resulting in multi-dimensional effects, i.e., physical, mental, social, and also spiritual.

Clinical studies conducted on Marma therapy

  1. A case study on cervical spondylitis: Local application (Abhyanga) of Mahanaryanam Tail and Ksheerbala Tail was done, after that Marma therapy was done which included the stimulation of Marma points of the upper limb and neck region involving kshipra, kurcha, kurchashira, Indrabasti, koorpara, Ani, Bahvi, lohitaksha, kakshadhara, krikatika, Asma, and Amsaphalaka. After that Patra Pinda Swedana was done. Complete resolution of scoliosis and pain was reported. The patient showed significant improvement after 3 months of follow-up[23]
  2. A study was done to evaluate the efficacy of Marma therapy with Janu Basti (with Ksheerbala Taila) in the management of Janu Sandhigata Vata (osteoarthritis of the knee). The therapeutic procedure involved administration of Marma therapy on four Marma points of the legs, i.e., Kshipra, Gulpha, Indravasti, and Janu, three times during the day, and Janu Basti with Ksheerbala Taila, followed by Nadi Sweda of Dashamoola Kwath. After 1 month of the treatment, the patient got complete relief from pain[24]
  3. A case report was done on the bood pressure normalizing effect of Talahridaya Marma therapy. In this case report, a young hypertensive male whose blood pressure significantly improved with Talahridaya Marma therapy. This patient was detected with raised blood pressure on repetitive examinations. The volunteer was subjected to Talahridaya Marma therapy where his classical Talahridaya Marma point on the left upper limb was physically stimulated in a controlled way for 10 days and the patient was also taught to perform the therapy on himself. The blood pressure was recorded, both before and after giving the therapy on each day. The volunteer showed a significant reduction in his blood pressure recordings.[25]


Benefits of Marma Chikitsa in day-to-day life[26]

  • Reduce the deep pain of nerves, muscles, ligaments, bones, and joints
  • Healthier skin
  • Reduces mental stress
  • Improved digestion and absorption
  • Increased immunity
  • Improves the function of the organs by homeostasis
  • Balances body temperature
  • Helps in balancing the “Doshas
  • By clearing of toxins on all levels
  • Secretes neurochemicals such as serotonin, melatonin for enhanced cognitive function and better sleep
  • Treats neuromuscular diseases and vata disorders.


Unique features and advantages of the Marma therapy[18]

  • Nonpharmacological treatment
  • Noninvasive treatment
  • Low-cost treatment
  • Less time consuming and no instruments used
  • This therapy can be used with other medical treatments like allopathy, Unani, Siddha, homeopathy, yoga, etc.



  Conclusion Top


In today's time, people are opting for mind-body and behavioral therapies for pain management to avoid the adverse effects of analgesics and anti-inflammatory drugs such as NSAIDs and opioids. Hence, there is a great opportunity for physicians to introduce various nonpharmacological measures such as Marma and Yoga for pain management. Marma Chikitsa has potential in the healing of pain and other suffering including hypertension.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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