† It is a S'náyu-Marma, and is of the Vaikalyakara class.
‡ They are S'irá-Marmas to the length of half a finger and of the Vaikalyakara class.
§ They are S'ira Marmas to the length of half a finger and of the Vaikalyakara class.
|| They are Sandhi-Marmas, to the length of half a finger and of the Vaikalyakara class.
¶ They are Asthi-Marmas to the length of half a finger.
$ They are S'náyu-Marmas, half a finger in length and of the Vis'alyaghna class.
An incision should be made at the spot a finger's width remote from the Urvi, Kurchcha-Sirá, Vitapa, Kaksha and a Párs'va-Marma; whereas, a clear space of two fingers should be avoided from its situation in making any incision about the Stanamula, Manivandha or Gulpha-Marma. Similarly a space of three fingers should be avoided from the Hridaya, Vasti, Kurchcha, Guda or Nábhi Marma; and a space of four fingers should be avoided in respect of the four Sringátakas, five Simantas and ten Marmas in the neck (Nilá etc.); a space of half a finger being the rule in respect of the remaining (fifty-six) * Men, versed in the science of surgery, have laid down the rule that, in a case of surgical operation, the situation and dimension of each local Marma should be first taken into account and the incision should be made in a way so as not to affect that particular Marma, inasmuch as an incision, even extending or affecting, in the least, the edge or the side of the Marma, may prove fatal. Hence all the Marma-Sthánas should be carefully avoided in a surgical operation. 81.
* They are S'irá-Marmas to the length of half a finger and of the Visályaghna class.
† They are Sandhi-Marmas to the length of four fingers and of the Kálántara-Pranahara class.
‡ They are S'irá-Marmas to the length of four fingers and of the Sadyah-Pránahara class.
§ It is a Sandhi-Marma, half a finger in length and of the Sadyah-Pránahara class.
The amputation of a hand or a leg may not prove fatal whereas a wound in any of the Marmas situated therein is sure to bring on death. The vessels become contracted in the case of a cut in the leg or in the hand of a man, and hence the incidental bleeding is comparatively scantier. Therefore it is that a cut in any of these parts of the body, however painful, does not necessarily prove fatal, like the lopping off of the branches of a tree. On the contrary, a man pierced into in any such Marmas, as the Kshipra or the Tala, suffers from excessive haemorrhage (from the affected part) and attended with an excruciating pain, owing to the derangement of the Váyu, and meets his doom like a tree whose roots have been severed. Hence, in a case of piercing or of injury to any of these Marmas, the hand or the leg should be immediately amputated at the wrist or at the ankle (respectively). 82.
* Some are of opinion that a surgical operation (in the case of the remaining fifty-six) should be made, leaving a space equal in measurement to the dimensions of a palm (from the affected part). Gayádása, having learnt from Bhoja, explains that a space of two fingers should be left (from the affected part) in making surgical operations of the ten marmas, namely, the two Gulphas, the roots of the two breasts, the four Indravastis, and the two Manivaudhas.
The medical authorities have described the Marmas to have covered half in the scope of Salya Tantra (Surgery), inasmuch as a person hurt in any of the Marmas dies presently (i.e., within seven days of the hurt). A deformity of the organ is sure to result from an injury to one of these Marmas, even if death be averted by a course of judicious and skillful medical treatment. 83.
The life of the patient is not to be despaired of even in the case of fracture or crushing of a bone of the Koshtha, Sirah and Kapála or perforation of the intestines etc , if the local Marmas are found not to be in any way hurt or affected. Recovery is common in cases of cuts (pierce) in the Sakthi, Bhuja, Páda and Kara or in any other part of the body and even where a whole leg or hand is found to be severed and carried away if the Marmas are not in any way hurt or affected. 84.
These Marmas form the primary seats of the Váyu, the Soma (lunar) and Tejas (fiery principles of the organism), as well as of the three fundamental qualities of Satva, Rajas and Tamas, and that is the reason why a man, hurt in any of the Marmas, does not live. 85.
An injury to a Marma of the Sadyah-Pránahara. class (in which death occurs within a day) is attended with the imperfection of the sense organs, loss of consciousness, bewilderment of Manah (mind) and Buddhi (intellect) and various kinds of pain. An injury to a Marma of the Kalántara group (of a person) is sure to be attended with the loss of Dhátus (blood etc.) and various kinds of supervening symptoms (Upadrava) which end in death. The body of a person, hurt in any of the Vaikalyakara Marmas, may remain operative only under a skillful medical treatment; but a deformity of the affected organ is inevitable. An injury to any of the Vis'alyaghna Marmas ends in death for the reasons mentioned above. An injury to any of the Rujákara Marmas gives rise to various kinds of pain in the affected organ, which may ultimately bring about a deformity of the same, if placed under the treatment of an ignorant and unskillful Vaidya (Surgeon). 86.
An injury to the adjacent part of a Marma, whether incidental to a cut, incision, blow (Abhigháta), burn, puncture, or to any other cause exhibits the same series of symptoms as an actually affected one. An injury to a Marma, whether it be severe or slight, is sure to bring deformity or death * 87.
The diseases which are seated in the Marmas, are generally serious, but they may be made to prove amenable with the greatest care and difficulty. 88-89.
* Gayádása does not read this verse.
Thus ends the sixth Chapter of the S'árira Sthánam in the Sus'ruta Samhitá, which treats of Marmas.