Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
Nitamba is an important Marma – vital or delicate point in the body. It is located above the pelvic region, one on each side of the spine. It is predominantly made up of Asthi – bones.
श्रोणित काण्डकोः उपरि आशयात् छादनौ पार्श्व अन्तर प्रतिबद्धौ नितम्बौ, तत्र अधः काय शोषो दौर्बल्यात् च मरणम्।(सु.शा.६)
Nitamba Marmas are located one on either side of the lower part of the Prushta Vamsha (Spine, Backbone) exactly above the Shroni Kaandas (pelvic bones), covering the aashayas (mutrashaya i.e. kidneys / urinary bladder and also the part of abdominal cavity consisting of aashayas or visceral organs). They are interposed between the two paarshwas (abdominal sides or flanks). Nitamba Marmas are located in the proximity of the lower ribs.
Categories in which the Nitamba Marma is included
Nitamba Marma is classified into various categories. They are as below mentioned –
i) Prushta Gata Marma (Prushta = Back)
ii) Asthi Marma – Nitamba marma is predominantly made up of Asthi i.e. Bone, which form the structural component of this Marma. Therefore it is classified under Asthi Marma. The other elements namely Snayu (ligaments), Siraa (blood vessels, veins), Sandhi (joints) and Mamsa (muscles) are also present but in a lesser proportion.
iii) Kaalantara Praanahara Marma – (Kaalantara – Gradual, Pranahara – life taking) Nitamba Marma is said to produce death over a period of time, gradually.
Pramana (measurement of Nitamba Marma) –
Nitamba Marma occupies a space of ½ angula dimension (approximately equal to the horizontal dimension or breadth of middle segment of one’s own middle finger)
Effect of Injury
तत्र अधः काय शोषो दौर्बल्यात् च मरणम्।(सु.शा.६
Injury of Nitamba Marma causes gradual death.
Injury of Nitamba Marma leads to Adhah Kaaya Shosha i.e. emaciation of the lower parts of the body, including the pelvic region, butts and lower limbs which leads to dourbalya (extreme weakness) eventually resulting in gradual death. Here gradual death or kaalantara pranahara term can be limitedly used for the death (rendered functionless of lifeless) of the local parts i.e. lower limbs instead of understanding it as death in general terms.
Modern Perspective (Practical anatomy) of Nitamba Marma
Structures falling in the area of Nitamba Marma –
- Lower ribs, floating ribs
- Abdominal viscera below the floating ribs
- Lumbar plexus of nerves and surrounding structures
Though all the elements which comprise a marma i.e. snayu (ligaments), mamsa (muscles), siraa (veins) and sandhi (joints) are all present in the site of this Marma, it is predominant in the Asthi or bones making up the Nitamba Marma, therefore it is a Asthi Marma.
When Nitamba marma gets damaged, the effect of injury will chiefly involve the bones, mainly the pelvic bones which make up the Nitamba Marma in comparison to the extent of damage caused to other tissues.
Just Before Finishing
Nitamba Marmas which are located above the pelvic region corresponding to the lower ribs is a delicate area. Injury to this region may damage the structures in the abdomen guarded by the floating ribs. At the same time, the injury involving these marmas can damage the nerves passing towards pelvis and lower limbs. When the nerves are damaged, the neuro-muscular conductivity to the lower parts of the body including the pelvic floor muscles, butt and lower limb muscles may be hampered. As a result of such damage emaciation of lower parts of the body can lead to extreme weakness putting a brake to all the life activities related to locomotion
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