Sushruta Samhita Sharirasthana Chapter 6 Pratyeka Marma Nirdeśa Shariram (Description of Fatal Spots)

The 6th chapter of Sharirasthana of Sushruta Samhita is named as Pratyeka Marma Nirdeśa Shariram Adhyaya. This chapter deals with Description of fatal spots.

अथातःप्रत्येकमर्मनिर्देशंशारीरंव्याख्याख्यामः॥१॥
यथोवाचभगवान्धन्वन्तरिः॥२॥

We will now expound the chapter by name Pratyeka Marma Nirdeśa Sārīra — description of each fatal spot separately as revealed by the venerable Dhañvañtari.

Marma sañkhyā and bheda – number and kinds of fatal spots 

सप्तोत्तरंमर्मशतम्।तानिमर्माणिपञ्चात्मकानिभवन्तितद्यथा – मांसमर्माणि,स्नायुमर्माणि, अस्थिमर्माणिसन्धिमर्माणिचेति। नखलुमांससिरास्नाय्वस्थिसन्धिव्यतिरेकेणान्यानिमर्माणिभवन्ति, यस्मानोपलभ्यन्ते॥३॥ 

Marmas are the vital or fatal spots / areas in the body. They are one hundred and seven in number. These are classified into five categories. They are –

Apart from the mentioned types of marmas i.e. vital spots composed of muscles, veins, ligaments, bones and joints mentioned above, there are no other kinds of marmas, since no other different type of fatal spots other than these are found.

Classification of Marma based on content (make up) of marma

तत्रैकादशमांसमर्माणि, एकचत्वारिंशत्‌सिरामर्माणि,सप्तविंशतिः स्नायुमर्माणी,  अष्टावस्थिमर्माणि, विंशतिःसन्धिमर्माणिचेतितदेतत्‌सप्तोत्तरंमर्मशतम् ॥४॥

Thus, there are all together, one hundred and seven Marmas.

Marma Vyahana – distribution of fatal spots in the body

तेषामेकादशैकस्मिन्‌सक्थ्निभवन्ति, एतेनेतरसक्थिबाहूचव्याख्यातौ, उदरोरसोर्द्वादश, चतुर्दशपृष्ठे, ग्रीवांप्रत्यूर्ध्वंसप्तत्रिंशत् ॥५॥

Below mentioned is the distribution of these 107 Marmas in different parts of the body –

Marma Nama – names of fatal spots: –

तत्रसक्थिमर्माणि क्षिप्रतलहृदयकुर्चकूर्चशिरोगुल्फेन्द्रबस्तिजान्वाण्युर्विलोहिताक्षाणि विटपंचेति,एतेनेतरत्सक्थिव्याख्यातम् ।उदरोरसोस्तुगुदबस्तिनाभिहृदयस्तनमूलस्तनरोहितापलापान्यापस्तम्भौचेति। पृष्ठमर्माणितु कटीकतरुणकुकुन्दरनितम्बपार्श्वसन्धिबृहत्यंसफलकान्यंसौ चेति। बाहुमर्माणितु क्षिप्रतलहृदयकूर्चकूर्चशिरोमणिबन्धेन्द्रबस्तिकूर्पराण्युर्वीलोहिताक्षाणि कक्षधरंचेति; एतेनेतरोबाहुर्व्याख्यातः। जत्रुण‌ऊर्ध्वं चतस्त्रोधमन्योऽष्टौ मातृका द्वे कृकाटिके द्वे फणे द्वावपाङ्गौ द्वावुत्क्षेपौ  द्वौ शङ्खावेकास्थपनीपञ्चसीमन्ताश्चत्वारिशूङ्गाटकान्येकोऽधिपतिरिति ॥६॥

Sakti marma-Below mentioned are the names of the Marmas of Sakthi i.e. one leg / lower limb –

–       Kshipra

–       Talahrdaya

–       Kurca

–       Kurcasira

–       Gulpha

–       Indrabasti

–       Janu

–       Ani

–       Urvi

–       Lohitaksha and

–       Vitapa

The same are the names of Marmas of the other lower limb also. The number of Marmas are also the same – 11 in number.

Udara-uras Marma–Below mentioned are the names of the Marmas present in the abdomen and chest –

–       Guda

–       Basti

–       Nabhi

–       Hrdaya

–       Stanamula

–       Stanarohita

–       Apalapa and

–       Apastambha

Prstha marma – Below mentioned are the names of the Marmas present in the back – each 2 in number –

–       Katikataruna

–       Kukundara

–       Nitamba

–       Parsvasandhi

–       Brhati

–       Amsaphalaka

–       Amsa

Bahu marma :- Below mentioned are the names of the Marmas present in the arm –

–       Kshipra

–       Talahrdaya

–       Kurcha

–       Kurchasira

–       Manibandha

–       Indrabasti

–       Kurpara

–       Ani

–       Urvi

–       Lohitaksha

–       Kaksadhara

The same are the names of Marmas of the other upper limb also. The number of Marmas are also the same – 11 in number.

Jatrūrdhva Marma— Below mentioned are the names of the Marmas present above the level of shoulders i.e. in the head and neck –

–       Dhamanis – 4

–       Matrka – 8

–       Krkatika – 2

–       Vidhura – 2

–       Phana – 2

–       Apanga – 2

–       Avarta – 2

–       Utkshepa – 2

–       Shanka – 2

–       Sthapani – 1

–       Simanta – 5

–       Srngataka – 4

–       Adhipati – 1

Names of Mamsa etc Marmas

तलहृदयेन्द्रबस्तिगुदस्तनरोहितानिमांसमर्माणि,नीलधमनीमातृकाशृङ्गाटकापाङ्गस्थपनीफणस्तनमूलापलापापस्तम्भहृदयनाभिपार्श्वसन्धिबृहतीलोहिताक्षोर्व्यःमर्माणि,आणीविटपकक्षधरकूर्चकूर्चशिरोबस्तिक्षिप्रांसविधुरोत्क्षेपा :स्नायुमर्माणि,कटीकतरुण सिरानितम्बांसफलकशङ्खास्त्वस्थिमर्माणि,जानुकूर्परसीमन्ताधिपतिगुल्फमणिबन्धकुकुन्दरावर्तकृकाटिकाश्चेतिसन्धिमर्माणि॥७॥ 

Mamsa Marma – Below mentioned are the Mamsa Marmas –

–       Talahrdaya,

–       Indrabasti,

–       Guda,

–       Stanarohita

Sira Marma – Below mentioned are the Sira Marmas –

–       Nīladhamanī,

–       Mātrka,

–       Srñgāțaka,

–       Apāñga,

–       Sthapanī,

–       Phaņā,

–       Stanamūla,

–       Apasthambha,

–       Hrdaya,

–       Nabhi,

–       Parsvasandhi,

–       Brhati,

–       Lohitaksa and

–       Urvi 

Snayu Marma – Below mentioned are the Snayu Marmas –

–       Ani,

–       Vitapa,

–       Kaksadhara,

–       Kurca,

–       Kurcasira,

–       Basti,

–       Ksipra,

–       Amsa,

–       Vidhura and

–       Utksepa

Asthi Marma – Below mentioned are the Asthi Marmas –

–       Katīkataruna,

–       Nitamba,

–       Amsaphalaka and

–       Sankhā

Sandhi Marma – Below mentioned are the Sandhi Marmas –

–       Janu,

–       Kurpara,

–       Simanta,

–       Adhipati,

–       Gulpha,

–       Manibandha,

–       Kukundara,

–       Avarta and

–       Krkatika

Classification of Marmas, effect-wise

तान्येतानिपञ्चविकल्पानिभवन्तितद्यथा – सद्यःप्राणहराणि,कालान्तरप्राण हराणि,विशल्यघ्नानि,वैकल्यकराणि,रुजाकराणिचेति।तत्रसद्य :प्राणहराण्येकोनविंशतिः,कालान्तरप्राणहराणित्रयस्त्रिंशत्,त्रीणिविशल्यनानि,चतुश्चत्वारिंशद्वैकल्यकराणि,अष्टौ रुजाकराणीति॥८॥ 

Based on the effect they cause when they get injured, Marmas are again of five kinds. They are –

Names of Sadhyo pranahara etc Marmas

भवन्तिचात्र
शृङ्गाटकान्यधिपतिःशङ्खौकण्ठसिरागुदम्॥
हृदयंबस्तिनाभ्यौचघ्नन्तिसद्योहतानितु॥९॥
वक्षोमर्माणिसीमन्ततलक्षिप्रेन्द्रबस्तयः॥
कटीकतरुणेसन्धीपार्श्वजौबृहतीचया॥१०॥
नितम्बावितिचैतानिकालान्तरहराणितु॥
उत्क्षेपौस्थपनीचैवविशल्यघ्नानिनिर्दिशेत्॥११॥
लोहिताक्षाणिजानूर्वीकूर्चविटपकूर्पराः॥
कुकुन्दरेकक्षधरेविधुरेसकृकाटिके॥१२॥
अंसांसफलकापाङ्गानीलेमन्येफणौतथा॥
वैकल्यकरणान्याहुरावर्तीद्वौतथैवच॥१३॥
गुल्फोद्वौमणिबन्धौद्वौद्वेद्वेकूर्चशिरांसिच।
रुजाकराणिजानीयादष्टावेतानिबुद्धिमान्॥
क्षिप्राणिविद्धमात्राणिघ्नन्तिकालान्तरेणच॥ ॥१४॥

Some verses here 

Sadhya Pranahara Marmas –

Number – 19

Effect of injury – they kill the person quickly when they get injured.

Kalantara Pranahara Marmas –

Number – 33

Effect of injury – they kill the person gradually, after some time, when they get injured.

Vishalyaghna Marmas –

Number – 03

Effect of injury – they kill the person when the salya – foreign body embedded in them is removed.

Vaikalyakara Marmas –

Number – 44

Effect of injury – they will cause deformity when they get injured.

Rujakara Marmas –

Number – 308

Effect of injury – these marmas would produce severe pain when they get injured.

Kșipra marma causes death either quickly or after some time, when injured / punctured.

Marma – Prāņa sthāna – seats of life 

मर्माणिमांससिरास्नाय्वस्थिसन्धिसन्निपाताःतेषुस्वभावत‌एवविशेषेणप्राणास्तिष्ठन्तितस्मान्मर्मस्वभिहतास्तांस्तान्भावानापद्यन्ते॥१५॥ 

Marmas are confluence of the below mentioned structures (which also make up the marmas) –

–       Mamsa – muscles

–       Sira – veins

–       Snayu – ligaments

–       Asthi – bones and

–       Sandhi – joints

Prana – the life entity or life energy is said to reside in such confluence of these structures by nature. Therefore, when these marmas are injured, they produce their respective effects (enumerated above).

Marma svabhāva – nature of fatal spots 

तत्रसद्य : प्राणहराण्याग्नेयानि, अग्निगुणेष्वाशुक्षीणेषुक्षपयन्तिकालान्तरप्राणहराणिसौम्याग्नेयानि, अग्निगुणेष्वाशुक्षीणेषुक्रमेणचसोमगुणेषुकालान्तरेणक्षपयन्तिविशल्यप्राणहराणिवायव्यानि, शल्यमुखावरुद्धोयावदन्तर्वायुस्तिष्ठतितावज्जीवति, उद्धृतमात्रेतुशल्येमर्मस्थानाश्रितोवायुर्निष्क्रामति, तस्मात्सशल्योजीवत्युद्धतशल्योम्रियते (पाका.त्पतितशल्योवाजीवति) वैकल्यकराणिसौम्यानि,सोमोहिस्थिरत्वाच्छैत्याच्चप्राणावलम्बनं करोतिरुजाकराण्यग्निवायुगुणभूयिष्ठानि, विशेषतश्चतौरुजाकरौपाञ्चभौतिकीचरुजामाहुरेके॥१६॥ 

Sadyah prāṇahara marma– These marmas are agneya in nature i.e. they are predominant in fiery qualities. Due to this fiery nature only, these marmas kill the debilitated persons quickly.

Kālāñtara prāņahara marma – These marmas are Saumya-agneya in nature. They are predominant with qualities of both water and fire. Due to the agneya or fiery nature – hot quality, these marmas kill the debilitated persons in quick time. Also, due to their watery nature – cold qualities, they kill other persons gradually, after some time.

Višalya prāņahara marma – These marmas are Vayavya in nature i.e. they are predominant with qualities of air. When the salya – foreign body like arrow enters the body of the person at these marmas, they block the air inside these areas and prevent it from escaping out. The person survives as long as the air remains inside, obstructed from coming out by the foreign body. But as soon as the foreign body is removed by pulling it out, the air which had been blocked by it in the vital spot gets released and comes out and this is when the person dies. So, the person survives when the foreign body is present inside and dies when it is pulled out. (the person survives if the salya comes out as a result of suppuration at that marma).

Vaikalyakara marma – These marmas are Saumya in nature i.e. they are predominant in qualities of water or moon. These marmas will cause deformities when injured but due to their stability and cold nature, the moon / water would help in sustenance of life.

Rujākara marma – These marmas are agneya and vayavya in nature i.e. they have predominance of both fire and air elements. Both these have capacity of producing pain and hence when injured, these marmas cause severe pain. According to some authorities, pain is Panchabhautika i.e. caused by all the five bhutas – elements together.

Anya mata – different opinion 

केचिदाहुर्मासादीनांपञ्चानामपिसमस्तानांविवृद्धानांसमवायात्सद्य :प्राणहराणि,एकहीनानामल्यानांवाकालान्तरप्राणहराणि,द्विहीनानांविशल्यप्राणहराणि,त्रिहीनानां वैकल्यकराणि,एकस्मिन्नेवरुजाकराणीति।नैवं,यतोऽस्थिमर्मस्वप्यभिहतेषुशोणितागमनं भवति॥१७॥ 

Below mentioned are the opinions of some scholars / experts

–       Sadyah Pranahara Marmas – In these marmas, there is presence of all the five components i.e. mamsa, sira, snayu, asthi and sandhi in great proportions and they are intimately mixed together.

–       Kalantara Pranahara Marmas – In these marmas, only four of the five components will be present with deficit of any one of them or they will be present in less quantity.

–       Visalyaghna Marmas – In these marmas any two components will not be present and they will be made up of only three components.

–       Vaikalyakara Marmas – In these marmas, only two components out of five will be present, with the absence of three components.

–       Rujakara Marmas – These marmas are made up of any one among the five components and the other four components will be absent.

This view is not correct since we see that there is bleeding even when the asthi marma is injured.

Marma mahatva – importance of fatal spots 

चतुर्विधायास्तुसिराःशरीरे
प्रायेणतामर्मसुसन्निविष्टाः॥
स्नाय्वस्थिमांसानितथैवसन्धीन्
सन्तर्प्यदेहंप्रतियापयन्ति॥१८॥
ततःक्षतेमर्मणिताःप्रवृद्धः
समन्ततोवायुरभिस्तृणोति॥
विवर्धमानस्तुसमातरिश्वा
रुजःसुतीब्राःप्रतनोतिकाये॥१९॥
रुजाभिभूतंतुततःशरीरं
प्रलीयतेनश्यतिचास्यसंज्ञा॥
अतोहिशल्यंविनिहर्तुमिच्छ
न्मर्माणियत्नेनपरीक्ष्यकषेत्॥२०॥

All the four kinds of siras present in our body are generally found to be situated in the marmas. These siras sustain and maintain the body by nourishing the other four components i.e. snayu, asthi, mamsa and sandhi.

This is the reason the vata which gets aggravated when these marmas are injured would invade and cause abnormalities in the siras and thus produce severe pain in the body.

The person thus affected by severe pain caused by vata would greatly suffer and will also lose his consciousness.

Therefore, a physician / surgeon who is planning to pull out the foreign body from their point of impact in the body should carefully examine the marmas present in its vicinity. He should first understand its nature and only after that he should pull out the salya – foreign body.

एतेनशेषंव्याख्यातम्।।२१।।

By describing the activities of vata above, the author has also explained the activities of the remaining doshas also.

Viddha sthāna phala – late effect of injury 

तत्रसद्यःप्राणहरमन्तेविद्धंकालान्तरेणमारयति,कालान्तरप्राणहरमन्तेविद्धंवैकल्यमापादयति,विशल्यघ्नंवैकल्यकरंचभवति,वैकल्यकरंकालान्तरेणक्लेशयतिरुजांचकरोति,रुजाकरमतीव्रवेदनंभवति॥२२॥ 

Pariņāma kāla – time of effects 

तत्रसद्य : प्राणहराणिसप्तरात्राभ्यन्तरान्मारयन्ति,कालान्तरप्राणहराणिपक्षान्मासाद्व, तेष्वपितुक्षिप्राणिकदाचिदाशुमारयन्ति,विशल्यप्राणहराणिवैकल्यकराणिचकदाचिदत्यभिहतानिमारयन्ति।।२३।। 

Site and names of fatal spots 

1. Sakthi marma – fatal spots of the leg 

अत‌ऊर्ध्वंसक्थिमर्माणिव्याख्यास्यम : -तत्रपादस्याङ्गुष्ठाङ्गुल्योर्मध्येक्षिप्रंनाममर्म,तत्रविद्धस्याक्षेपकेणमरणंमध्यमाङ्गुलीमनुपूर्वेणमध्येपादतलस्यतलहृदयंनाम,तत्ररुजाभिर्मरणंक्षिप्रस्योपरिष्टादुभयतःकूर्चीनाम,तत्रपादस्यभ्रमणवेपनेभवतःगुल्फसन्धेरध‌उभयत : कूर्चशिरः,तत्ररुजाशोफौपादजङ्घयोःसन्धानेगुल्फः,तत्ररुजःस्तब्धपादताखञ्जतावापाणिप्रतिजङ्घामध्ये‌इन्द्रबस्तिः,तत्रशोणितक्षयेणमरणंजबोर्वोःसन्धानेजानु,तत्र खञ्जताजानुन‌ऊर्ध्वमुभयतस्त्र्यङ्गुलमाणी,तत्रशोफाभिवृद्धिःस्तब्धसक्थिताच‌ऊरुमध्ये‌उर्वी,तत्रशोणितक्षयात्सक्थिशोष : उर्व्या‌ऊर्ध्वमधोवसणसंधेरूरुमूलेलोहिताक्षं,तत्रलोहितक्षयेणमरणंपक्षाघातोवावंक्षणवृषणयोरन्तरेविटपं,तत्रषाण्ढ्यमल्पशुक्रतावाभवति‌एवमेतान्येकादशसक्थिमर्माणिव्याख्यातानि।एतेनेतरसक्थिबाहूचव्याख्यातौ।विशेषतस्तुयानिसक्थ्निगुल्फजानुविटपानि,तानिबाहौमणिबन्धकूर्परकक्षधराणियथावङ्क्षणवृषणयोरन्तरेविटपमेवंवक्षःकक्षयोर्मध्येकक्षधरं,तस्मिन्विद्धेत‌एवोपद्रवाःविशेषतस्तुमणिबन्धेकुण्ठता,कूर्पराख्येकुणिः,कक्षधरेपक्षाघातः।एवमेतानिचतुश्चत्वारिंशच्छाखासुमर्माणिव्याख्यातानि॥२४॥ 

Further, we will describe the fatal spots in the leg as follows 

Thus, the eleven marmas of one sakti – leg / lower limb have been enumerated. With this, the marmas present in the other leg and two bahu – arms / upper limbs too have been described (they carry the same names). Gulpha Marma, Janu Marma and Vitapa Marma are special to the lower limbs.

The names change in the upper limb. The counter parts in the upper limb are –

–       Manibandha Marma – wrist marma – in place of Gulpha Marma

–       Kurpara Marma – elbow marma – in place of Janu Marma

–       Kaksadhara Marma – in place of Vitapa Marma

Kaksadhara Marma is located in between chest and axilla, just like the Vitapa Marma in the upper limb is located between the scrotum and groin. When injured, this marma will also give rise to same kind of troubles.

When Manibandha Marma is injured especially, it causes loss of functions of the hand. Likewise, when Kaksadhara Marma is injured, it causes paralysis of half portion of the body – arms especially.

In this way, the forty-four marmas present in the extremities – upper and lower limbs together, have been described.

2. Madhyamāñga marma – fatal spots in the trunk 

अत‌ऊर्ध्वमुदरोरसोर्मर्माण्यनुव्याख्यास्यामः- तत्रवातवर्षोनिरसनस्थूलान्त्रप्रतिबद्धंगुदंनाममर्म,तत्रसद्योमरणंअल्पमांसशोणितोऽभ्यन्तरतःकट्यांमूत्राशयोबस्तिः,तत्रापिसद्योमरणमश्मरीव्रणादृते,तत्राप्युभयतोभिन्नेनजीवित,एकतोभिन्नेमूत्रस्रावीव्रणोभवति,सतुयत्नेनोपक्रान्तोरोहतिपक्वामाशययोर्मध्येसिराप्रभवानाभिः,तत्रापिसद्योमरणंस्तनयोमध्यमधिष्ठायोरस्यामाशयद्वारंसत्त्वरजस्तमसामधिष्ठानंहृदयं,तत्रापिसद्य‌एवमरणंस्तनयोरधस्ताद्व्यङ्गुलमुभयतःस्तनमूले,तत्रकफपूर्णकोष्ठतया(कासश्वसाभ्यां)म्रियतेस्तनचूचुकयोरूर्ध्वंव्यङ्गुलमुभयतःस्तनरोहितौ,तत्रलोहितपूर्णकोष्ठतयाकासश्वासाभ्यांचम्रियते‌अंसकूटयोरधस्तात्पार्वोपरिभागयोरपलापौनाम,तत्ररक्तेनपूयभावंगतेनमरणंउभयत्रोरसोनाड्यौवातवहे‌अपस्तम्भौनाम,तत्रवातपूर्णकोष्ठतयाकासश्वासाभ्यांचमरणम्‌एवमेतान्युदरोरसोर्टादशमर्माणिव्याख्यातानि॥२५॥ 

After this, the marmas of the abdomen and chest shall be described.

 Thus, the twelve marmas present in the abdomen and chest have been described.

III. Prsthamarma – fatal spots in the back 

अत‌ऊर्ध्वंपृष्ठमर्माणिव्यख्यास्यामः – तत्रपृष्ठवंशमुभयतःप्रतिश्रोणिकाण्डमस्थिनीकटीकतरुणे,तत्रशोणितक्षयात्पाण्डुर्विवर्णोहीनरूपश्चम्रियतेपार्श्वयोर्जघनबहिर्भागेपृष्ठवंशमुभयतोकुकुन्दरे,तत्रस्पर्शाज्ञानमध : कायेचेष्टोपघातश्चश्रोणीकाण्डयोरुपर्याशयाच्छादनौपाश्र्वान्तरप्रतिबद्धौनितम्बौ,तत्राध : कायशोषोदौर्बल्याच्चमरणं,अधपान्तरप्रतिबद्धौजघनपार्श्वमध्ययोस्तिर्यगूर्ध्वंचजघनात्पार्श्वसन्धी,लोहितपूर्णकोष्ठतयाम्रियतेस्तनमूलाजूभयतःपृष्ठवंशस्यबृहती,तत्रशोणितातिप्रवृत्तिनिमित्तैरुपद्रवैम्रियतेपृष्ठोपरिपृष्ठवंशमुभयतस्त्रिकसंबद्धे‌अंसफलके,तत्रबाह्वोःस्वापशोषौबाहुमूर्धग्रीवामध्ये‌अंऽसपीठस्कन्धबन्धनावंसौ,तत्रस्तब्धबाहुता‌एवमेतानिचतुर्देशपृष्ठमर्माणिव्याख्यातानि॥२६॥ 

After this, the marmas of the back shall be described.

Thus, the twelve marmas present in the back have been described.

4. Ürdhvāñga marma – fatal spots of head and neck 

अत‌ऊर्ध्वमूर्ध्वजत्रुगतानिव्याख्यास्यामः – तत्रकण्ठनाडीमुभयतश्चस्रोधमन्योद्वेनीलेद्वेचमन्येव्यत्यासेन,तत्रमूकतास्वरवैकृतमरसग्राहिताचग्रीवायामुभयतश्चतस्रःसिरामातृकाः,तत्रसद्योमरणंशिरोग्रीवयोःसन्धानेकृकाटिके,तत्रचलमूर्धताकर्णपृष्ठतोऽध : संश्रितेविधुरे,तत्रबाधिर्यंघ्राणमार्गमुभयतःस्रोतोमार्गप्रतिबद्धे‌अभ्यन्तरतःफणे,तत्रगन्धाज्ञानंभूपुच्छान्तयोरधोऽक्ष्णोर्बाह्यतोऽपाङ्गौ,तत्रान्ध्यंदृष्टयुपघातोवाभ्रुवोरुपरिनिम्नयोरावर्तीनाम, 

तत्राप्यान्ध्यंदृष्ट्युपघातोवाभ्रुवोरन्तयोरुपरिकर्णललाटयोर्मध्येशङ्खौ,तत्रसद्योमरणंशङ्खयोरुपरिकेशान्त‌उत्क्षेपौ,तत्रसशल्योजीवेत्पाकात्पतितशल्योवानोद्धतशल्यःभ्रुवोर्मध्येस्थपनी,तत्रोत्क्षेपवत्पञ्चसन्धयःशिरसिविभक्ताःसीमन्तानाम,तत्रोन्मादभयचित्तंनाशैर्मरणंघ्राणश्रोत्राक्षिजिह्वासंतर्पणीनां -सिराणांमध्येसिरासन्निपातःशृङ्गाटकानितानिचत्वारिमर्माणि,तत्रापिसद्योमरणंमस्तकाभ्यन्तरोपरिष्ठात्सिरासन्धिसन्निपातोरोमावर्तोऽधिपतिः,तत्रापिसद्य‌एव।एवमेतानिसप्तत्रिंशदूर्ध्वजत्रुगतानिमर्माणिव्याख्यातानि॥२७॥ 

After this, the marmas of the head and neck shall be described.

Thus, the thirty-seven marmas present in the jatrurdhwa desha i.e. in the parts of the body above the level of collar bone / clavicle i.e. head and neck have been described.

Marma Pramāņa – Dimension of the fatal spots

भवन्तिचात्रश्लोका :
उर्व्यःशिरांसिविटपेचसकक्षपार्थे
एकैकमङ्गुलमितंस्तनपूर्वमूलम्॥
विद्धङ्गुलद्वयमितंमणिबन्धगुल्फं
त्रीण्येवजानुसपरंसहकूर्पराभ्याम्॥२८॥
हृदस्तिकूर्चगुदनाभिवदन्तिमूर्ध्नि
चत्वारिपञ्चचगलेदशयानिचद्वे॥
तानिस्वपाणितलकुञ्चितसंमितानि
शेषाण्यवेहिपरिविस्तरतोऽङ्गुलार्धम्॥२९॥

Some verses here 

एतत्प्रमाणमभिवीक्ष्यवदन्तितज्ज्ञाः
शस्त्रेणकर्मकरणंपरिहृत्यकार्यम्॥
पार्वाभिघातितमपीहनिहन्तिमर्म
तस्माद्धिमर्मसदनंपरिवर्जनीयम्॥३०॥

According to the opinion of wise persons, surgical procedures including use of sharp instruments should be done after knowing the width of marmas, avoiding injury to the marmas.

Injury done even to the sides of the marmas will also kill the person. Therefore, the marmas should be carefully avoided.

Apāya – hazards from injury 

छिन्नेषुपाणिचरणेषुसिरानराणां
सङ्कोचमीयुरसृगल्पमतोनिरेति॥
प्राप्यामितव्यसनमुग्रमतोमनुष्या :
संच्छिन्नशाखतरुवन्निधनंनयान्ति॥३१॥
क्षिप्रेषुतत्रसतलेषुहतेषुरक्तं
गच्छत्यतीवपवनश्चरुजंकरोति॥
एवंविनाशमुपयान्तिहितत्रविद्धा
वृक्षा‌इवायुधनिपातनिकृत्तमूला : ॥३२॥
तस्मात्तयोरभिहतस्यतुपाणिपादं
छेत्तव्यमाशुमणिबन्धनगुल्फदेशे॥ 

The veins in the hands and feet get constricted when the hands and feet are cut off. As a result, little bleeding occurs. The person does not die in spite of experiencing great suffering, just like a tree which does not die when its branches are cut off. 

Injury to Ksipra and Talahrdaya Marmas leads to bleeding in large quantity and aggravation of vata, which produces pain. As a result, the person dies when these marmas are injured, just like the tree dies out when its roots are cut off by the instruments. Hence, the hands and feet of the persons whose Ksipra and Talahrdaya marmas are injured should be amputated (cut off) quickly at the wrist joint and ankle joint respectively.

Importance of having the knowledge of marmas

मर्माणिशल्यविषयार्थमुदाहरन्ति
यस्माच्चमर्मसुहतानभवन्तिसद्यः।
जीवन्तितत्रयदिवैद्यगुणेनकेचित्ते
प्राप्नुवन्तिविकलत्वमसंशयंहि॥३३॥
संभिन्नजर्जरितकोष्ठशिर : कपाला
जीवन्तिशस्त्रनिहतैश्चशरीरदेशः।
छिन्नैश्चसक्थिभुजपादकरैरशेषैर्येषां
नमर्मसुकृताविविधाःप्रहाराः॥३४॥

Since persons die quickly when their marmas are injured, the knowledge of marmas is described as half of the knowledge of Salya Tantra – surgical science. Even if any person whose marma has been injured happen to survive due to the skill and efficiency of the physician / surgeon, he will surely end up suffering from deformities.

If the marmas are not injured by different kinds of assault and are preserved, the person would not die in spite of his internal organs being punctured, skull bones broken to pieces, other parts of the body having been cut by sharp weapons and even when his legs, shoulders, feet and hands are completely cut off.

Components of vital / fatal spots

सोममारुततेजांसिरजःसत्त्वतमांसिच॥
मर्मसुप्रायशःपुंसांभूतात्माचावतिष्ठते॥३५॥
मर्मस्वभिहतास्तस्मान्नजीवन्तिशरीरिणः॥

The below mentioned reside in the marmas especially –

–       Soma – moon, kapha

–       Maruta – vata

–       Tejas – pitta, heat

–       Rajas

–       Sattva

–       Tamas and

–       Bhutatma – soul

Hence living beings whose marmas are injured will not survive.

Marmahatalaksana- effects of injury 

इन्द्रियार्थेष्वसंप्राप्तिर्मनोबुद्धिविपर्ययः॥३६॥
रुजश्चविविधास्तीव्राभवन्त्याशुहरेहते॥
हतेकालान्तरघ्नेतुध्रुवंधातुक्षयोनृणाम्॥३७॥
ततोधातुक्षयाज्जन्तुर्वेदनाभिश्चनश्यति॥
हतेवैकल्यजननेकेवलंवैद्यनैपुणात्॥३८॥
शरीरंक्रिययायुक्तंविकलत्वमवाप्नुयात्॥
विशल्यनेतुविज्ञेयंपूर्वोक्तंयच्चकारणम्॥३९॥
रुजाकराणिमर्माणिक्षतानिविविधारुजः॥
कुर्वन्त्यन्तेचवैकल्यंकुवैद्यवशगोयदि॥४०॥

Effects of injury to the marmas

छेदभेदाभिघातेभ्योदहनाद्दारणादपि॥
उपघातंविजानीयान्मर्मणांतुल्यलक्षणम्॥४१॥

When any upaghata i.e. minor injury of the below mentioned kinds occur in the close vicinity of marmas, similar symptoms are produced –

–       Cutting

–       Breaking

–       Hitting

–       Burning by fire

–       Bursting / dividing etc.

मर्माभिघातस्तुनकश्चिदस्ति
योऽल्पात्ययोवाऽपिनिरत्ययोवा॥
प्रायेणमर्मस्वभिताडितास्तु
वैकल्यमृच्छन्त्यथवाम्रियन्ते॥४२॥

Usually, all kinds of injuries occurring to the marmas either produce deformity or death. Therefore, no injury to the marmas should be considered as mildly dangerous or not-dangerous.

मर्माण्यधिष्ठायहियेविकारा
मूर्च्छन्तिकायेविविधानराणाम्॥
प्रायेणतेकृच्छ्तमाभवन्ति
नरस्ययत्नैरपिसाध्यमानाः॥४३॥ 

In spite of treating them with all efforts, many kinds of diseases in spite of being curable generally become very difficult to cure, when they develop in / on the region of marmas.

इतिश्रीसुश्रुतसंहितायांशारीरस्थानेप्रत्येकमर्मनिर्देशशारीरंनामषष्ठोऽध्यायः॥६॥

Thus ends the Sixth chapter by name Pratyeka Marma Nirdeśa in Sarira Sthāna of Suśruta Samhita.