February 05, 2014


                                 Dr.Bhat.A.Rangaprasad -Sarve janah Sukhino Bhavanthu || Sarve santhu Niramayah ||

Sciatic pain is referred as Grdhrasi in Ayurveda, where in, the pain originating from the region of Kati (waist) gets referred or travels down to the Sakthi (Thighs), Janu (Knees), Gulpha Ankles) and to the Pada (foot) gradually, causing much agony to the patient.

The causes for the occurrence of sciatic pain are many. But the commonest causes are Lumbar Spondilitis or Spondilolisthesis, Lumbar Strain, Sacro ilitis etc.

The following marmas are afflicted with the stagnation {Aavarana} of doshas in case of Grdhrasi. Katikataruna – Nitamba – Kukundara – Lohitaksha ­– Urvi – Ani – Janu – Indrabasti – Gulpha – Kurcha – Talahrdaya – Ksipra. In my experience either all the marmas (very rare phenomenon) or a certain group of marmas (common phenomenon) are found to be involved.


Katikataruna marma: - this category of Asthi marma measuring half angula (1 cm) is present near the margins of pelvic bone, a few centimeters away from the Lumbo-sacral joint. Best posture to palpate this marma, would be prone or standing posture. Structures beneath this tenderful point approximate to the sacro-iliac joint ligaments, iliac bone, & iliac artery.

Nitamba marma:-
The hip region is referred as by the word Nitamba. It is located on the 2 pelvic bones on either side. Its length is half angula (1 cm) and falls under the category of Asthi marma. Make the patient lie down in prone posture. By drawing an imaginary line from scrotum to femoral joint, probe your fingers along that line until you find the highest point of tenderness, somewhere around the mid of this line which can be justified to be the  Nitamba  marma. Underneath this point, the entry of Sciatic nerve into the femoral region exists.

Lohitaksha: - Injury to this marma as per Sushruta leads to profuse bleeding (lohita) there by giving an appearance of red colored round or oval spot in this point on getting injured, resembling the appearance of red shot eye ball (as seen in case of opthalmitis), hence should’ve been named Lohita (red colored) Aksha (eye).It is Sira marma of ½ angula (1cm approx.) in length. It is present near the crease of the thigh. Start probing with the index finger, downwards from the crease, somewhere near the inguinal canal, the highest point of tenderness could be elicited. It is @ this point the femoral vessels exit to the lower limbs. One can hence understand the impact of injury to this spot leading to massive haemorrhage. Position of patient should be standing erect or supine.

Urvi marma: - The very presence of this marma in the region of thigh (Uru) becomes the reason for its nomenclature as Urvi. This Sira marma measuring 1 angula (1 1/2cm approx.) in length is present in the medial aspect of the thigh, nearly somewhere @ the mid of knee & groin. Make the patient sleep in supine posture. Make sure that the leg is flexed little bit so as to relax the thigh muscles, such that poking of the thigh muscles with the fingers would be possible. Then starting from the medial aspect of knee, over the medial compartment of the thigh,   probe your fingers slowly along the margins of biceps femoris, & locate the tenderness caused by the Urvi marma @ the middle of the thigh. Structures assumed to be beneath this vital point is the femoral artery. Most of the times, this artery becomes palpable in lean persons.

Ani marma: - The 3 angula (3 to 4 ½ cm approx.) length, Snayu marma lies above the janu marma on the medial side, falling near the medial border of Poppliteal fossa. Structures beneath this spot are the tendons of biceps femoris & other flexor muscles along with femoral artery and nerve. This marma plays an important role in persons of severe sciatica who complain that their knees are giving out, when manipulated properly makes the patient stand straight & walk steadily as firmness around the knee joint is restored.

Indrabasti marma: - This falls under the category of mamsa marma, measuring 2 angulas in length. It is present in the posterior compartment of leg, somewhere near the mid-point of Janu & Gulpha. As with my experience it most of the time gets elicited @ the end portion of calf muscle. Patient may be positioned in prone or sitting posture with crossed leg. Structures beneath this vulnerable point are etc Gastrocnemius muscle, Sciatic nerve, Tibial artery.

Gulpha marma: - Gulpha falls under the category of Sandhi marma and measures 2 angula in length. It is better palpable on the medial and lateral aspects of the ankle joint, where the tarsal ligaments are attached to the bone.

Kurcha marma: - The 4 angula Snayu marma is situated in the dorsal aspect of the foot, just 2 angulas above the Kshipra marma vertically. Interosseous muscles, ligaments & a branch of Tibial artery are the structures approximate to it. Posture of patient is either supine or sitting.

Talahrdaya: - In the hrdaya bhaga (central portion) of tala (sole) this talahrdaya marma is present. It is a marma measuring ½ angula (1 cm approx) in length. Due to the presence rigid plantar aponeurosis, pressing with one finger or thumb mayn’t be helpful in the proper determination of this marma. Hence, one has to press with both the thumbs approximating with each other, slowly from the heels, towards the region of fingers along the mid-line of the sole. Position of patient should be supine. The tenderness would be elicited best @ the centre of sole. Structures beneath this Talahrdaya marma are - Lumbrical muscles, plantar aponeurosis, Arch of anastomosis of veins etc.

Ksipra marma: - Kshipra is one of the most sensitive & useful marma used in the marma healing procedure for many diseases, other than Sciatica. As of my rough study it has got some viable connection with the Cardiac plexus too. It is a Snayu marma of ½ angula (approx. 1cm) in length, located between the thumb & 2nd toe. To palpate this marma adduct the above two fingers & carefully probe the space from its lower end, moving upwards to find the most tenderful spot. Best posture to elicit this is supine posture.

Concept of Marma chikitsa :
Due to the stagnation of doshas around any 1 or 3 or almost all of the above marmas, the flow of cosmic energy (Pranic energy or Prana vayu) from Shat chakras to the destinated part (over here the leg) will be affected or blocked. On manipulating the marma point, we are actually trying to displace or disperse the doshas, blocking the pathway of the cosmic energy. On having displaced either partially or completely, the symptoms of (Sciatic pain) starts receding gradually or immediately respectively. Based on the concept of energy, and as per my view, the energy actually starts flowing from Agna chakra to Muladhara chakra (Sacral plexus) in downward direction (i.e. from a region of higher concentration to a region of lower concentration). For this reason, manipulation of proximal marmas (hitherto-- katikataruna) followed by other marmas in the downward direction reaching the distally affected marma (hitherto­­--Kshipra marma). When done in the above manner the patient gets a faster relief from the pain. Whereas, if distal marmas are manipulated first, followed by the marmas present proximally ending in Katikataruna, it is observed that—{a}either the pain gets relieved very slowly or {b} the pain gets localized in any of the marmas present in the middle, causing severe agony to the patient. On having displaced either partially or completely, the symptoms ( Sciatic pain) starts receding gradually or immediately respectively.

Marmas to be manipulated with utmost care: --




Undue or much pressure exerted on these marmas may result in, as from my experience severe localised pain & tenderness, increased vascularity (if a patient with an h/o thrombosis in leg, any cardiac or valvular impediments etc., this may pose a danger to the quality of life or even may endanger his life), ligamental sprain, limping gait, shock etc., respectively.

Conclusion: -- 
To conclude, when the above marma points are manipulated by a technically sound physician, who has mastered the knowledge of the anatomical position of the structures involved; who has the ability to implicate and analyze the physiology or patho-physiology of the diseased portion of the body, will be the blessed person in the earth to humbly give relief to his patients suffering from Sciatica. My vast experience in treating the patients of sciatica is one of the contributing and inspiring factors for having written this article, for the sole purpose of spreading the awareness and benefit of Marma chikitsa. Sarve Janah Sukhinoh Bhavanthu (Let the humanity live in peace and health).

The above article had been written by the author in Articlesbase.com at the following link http://www.articlesbase.com/alternative-medicine-articles/synopsis-of-management-of-grdhrasi-sciatica-with-marma-chikitsa-895610.html


Ram Sharma said...

Energy flows from Muladhara Chakra, serpentine wise in the direction of sahasrara chakra through Sushumana nadi. Yogis are interested to awake Kundalini shakti residing in Muladhara chakra. Is it true ?

drrangaprasadbhat said...

Dear Ram Sharma ji,

I think you are raising this question, up on my statement which reads " as per my view, the energy actually starts flowing from Agna chakra to Muladhara chakra (Sacral plexus) in downward direction (i.e. from a region of higher concentration to a region of lower concentration)", as in my blog.

Sir, it is just an hypothesis from my end and the leel of my understanding to state so.

So, far so now, the yogic mUla granthAs I had referred, as up to the current day, I could not find a substantiating evidence to support my line of thought. But it is my gut feeling based on the scientific knowledege up on how Human system works, the higher neurological center lying in the brain..!

With regards to the classical yogic texts, especially the ones that which explains the HaTha yoga, all of them in a synchronising manner, mentions in importance the basic chakra, i.e the mUlAdhAra only.

It is as of my little knowledge, understood that awakening of KunDalini, is in a way related to Moksha of the Atman from one's mortal physique. And that by doing meditation based on the HaThayoga principle the energy is elevated from the basic chakra to the respective higher levels of the chakra, and maintained at status quo in that chakra for a quite period of time, holding the energy.

As a matter of fact energy, in the sense the mahA prAna circulates by it's will along all the chakras in a serpentine fashion through the inter twining IdA & pingala nAdis and the intermediating the sushumna, forming a nodal point of energy level.

It is through the practice of haTha yoga, the yogin (I mean the one who practices it in want of Moxa & Realisation) tries to control the Maha praNa, hold in each chakrAs for a few time period (I am not awre of the specific mAtra of time period it is adviced to hold the mahAprAna at each junctions), and then release it to experience the elevation of the inert energy at each of the chakras.

There are words like drinking Amrta (nothing but the mahA prAna as of my understanding) which are interprested by many scholars as Nectar mentioned in the Sanskrit verses of yogic texts.

OM plays an important role in the principle of nAda; bindu; kalA which are supposed to be certain stages of mixing up of energy at specific nodal or inter nodal junctions of the nADis. (I need further scholarly study to be done over this line).

Hence, based on these deep researches (of course theoretically and not practically, since I do not practice haThayoga) and based on the exposure to the science of human anatomy and physiology, was that specific thought of mine expressed in my blog.

Sir, in case you could post your knowledge regarding this topic, based up on your understanding, that would be highly appreciable and welcome with a pleasure.

P.S: I beg your pardon, for the late reply, since was held up with some work and was not into blogging for a while.

Warm regards,
Dr.Bhat, Chennai.

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