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The Concept of Trimarmeeya [trimarmiya闭鈥擳丑别 Trimarma concept was put forwarded by Charaka. In his book he has dedicated two chapters to this namely Trimarmeeya Chikitsa and Trimarmeeya Sidhi. Among the one hundred and seven marmas in the body Charaka maintains that Hrdaya, Vasthi and Siras, as the most important. They are the main seats of prana, and hence when they are injured, it will affect the prana thereby vitiating the humours." Chakrapanidutta comments that injuries on these vital organs affects the prana as it is seated here. He compares this to the destruction of wall paint which occurs simultaneously when the wall is destroyed. Any destruction to any of these three vital organs will destroy the prana and also could turn fatal or cause ireppairable damage." 2 In Sidhisthana, Charaka emphasises the importance of these three marmas in relation to other marmas. He says that there are one hundred and seven marmas including the shakhas and the skandha. Here the term skandha represents antaradhy and the sira. He says that pain will be felt more in these parts when

injured than that of any other part of the body. This is 3 because the chetana is seated in this area. Here also Charaka describes siro marma as one. So among the 107 marmas this could be subdivide into skanda marma and shakha marma. The skanda marma represents the marmas of the koshtas, prishta, ura and jatruurdhwa. The sakha marma represents the marma points seen in bahu and sakthi. The skanda marma are more important than the sakha marma. Injury to the skanda affects the sakhas as they are attached to the skandha. Chakrapanidutta explains this as follows, compared to the shakha marmas, the skanda marma being the substratum of the former are of relatively greater importance. The trimarmas among them, by virtue of their important role in over all body mechanism are far more important. The sadya pranahara marma enumerated by Susruta and Vaghbata are skandhashraya and not shakhashraya. Hence care should be given more to skandasraya marma. The sadya pranahara marmas are Nabhi, Vasthi, Hrdaya, Sankha, Adhipa, Sringataka and Matruka. If this is further classified it is seen that these marmas are mostly siro marmas. Hrdaya is a uro marma. Nabhi and guda is a koshta marma. There is no 94

sakha marma seen which clearly states that these skandha marmas are more vital than the sakha marmas. Among the skandha marmas the three marmas namely the sira the hrdaya and the vasthi are the most important. This is because they are said to be the the moola of the body. 5 In Ashtanga Hrdaya, Vaghbata says that there are ten Jeevitha dhamas dhamas namely Sira, Rasanabandhanam (posterior part of the tongue) Khanda, Raktha, Hrdaya, Nabhi, Asthi, Sukra, Oja and Guda. 6 Here it should be noted that these are not marmas. However the Acharya in else where context consider these as playing a very prominent role in the maintanance of body. But one thing is sure that these function only when the hrdaya functions. Chakrapanidutta on Charaka Sidhi. Ch. 9 comments that even though the sankha do have very prominent role this could not be considered as the most important because they are not the ashraya of the body they are only pranayathana while hrdaya, are not only pranayathana but also asraya of the body." 7 95

1. Siras The siras, being the nerve centre governing all nervous activity of the body commands a position of paramount significance. It is intimately related to the sense of perception and is the centre of Prana as well. It is therefore justified being spoken as Uthamanga. It is the principal site for the formation of kapha. In fact the very term kapha is indicative of its origin in the siras. 9 The body is considered as a tree, upside down. Comparing the root as sira and appendages as branches throws light on the importance of siras. 10 Being the centre of the prana and the indryas, it is to the body what the sun is to the sky. 2. Hrdaya Apart from the seat of prana it serves the seat of Para-ojus. The apara ojus" which transverses all over the body is also centred in the 12 hrdaya. More over this is the root of pranavaha srothas in one hand and Rasavaha srothas on the other hand. 13,14 By virtue of its being the centre of various physiological activities in the body this marma holds unenviable significance among other marmas. 96

It is for this reason that Charaka compares the hrdaya to the axle of wheel on which different spokes are attached in such a way that the break down of the axle invariably means the collapse of the wheel or rather the cart itself. The spokes here is referred as dasa dhamani, prana, apana, manas, budhi, chethana, as well as mahabhuthas. 15 Herein Chakrapanidutta explains that prana and apana are nothing but inspiration and expiration. Here he says that mahabhutha referred here is sookshma bhutha related to Atma. 16 Realising the paramount significance of Hrdayabutha in materialistic and philosophical arena Sri Ramana Maharshi has stated that the Hrdaya is the 17 very embodiment of the whole body. He further states that in macrocosm, soorya mandala is the centre and in microcosm, the hrdaya is the centre. As Dr. Banerjee in his book The nervous system, $Indian Philosophy has observed. The term hrdaya is used in different context to mean different entities. However hrdaya means one of the following. a. Place of Atma (Soul) and Chethana (Consciousness). b. Place of chitha (Feeling) Cheta (Knowledge). C. Place of all sense of perception. d. Place of all intellect. 97

nbh nh Place of life. f. Place of sleep. g. Place of memory. h. Place of nerve. 3. Vasti This is situated in a very strategic position between the rectum scrotum and the perineum. The channels of urine, semen and the prominant role it plays in the fluid metabolism bestows a prominant role among the other marmas. The term vasthi is derived from the root Vas Achadane meaning to cover. Vasthi is a thin film of tissue, the function of which is to cover or contain urine. Its proximity to the peritoneal cavity and probably the rapid spread of infection on rupture and also its slow rate of healing are the challenges the surgeon faces during operative intervention. To sum up it should be noted that though there are 107 marma points spreaded all over the body, the marma points seen on the siras, hrdaya and vasthi need more care and stress while treating an injury. Another point worth realising is Charaka classification was done on the light that he himself was more a physician than a surgeon. Hence stress over the Trimarma should be on medical treatment rather than the surgical treatment. 98