Volume-10 | Issue-1 | January - 2020 | PRINT ISSN No. 2249 - 555X | DOI : 10.

36106/ijar
Original Research Paper
Ayurveda

CADAVERIC STUDY OF KURPARA MARMA

MD Scholar (Final Year), Department of Rachana Sharir, Ch. Brahm Prakash Ayurved
Dr. Sahil Mehta Charak Sansthan, New Delhi
Dr. Mukesh Associate Professor, Department of Rachana Sharir, Ch. Brahm Prakash Ayurved
Kumar Sharma* Charak Sansthan, New Delhi *Corresponding Author
ABSTRACT Acharya Sushruta in Sushruta Samhita widely discusses the anatomy and provides important anatomical conceptual
information. One such concept described by Acharya Sushruta is Marma. Marma's are explained as the vital points in the
body. Marma means the conuence of Mamsa, Sira, Snayu, Asthi and Sandhi. Injury to these vital points may lead to death, disability and disease.
There are a total of 107 Marma in the human body. Acharya Sushruta classied marma into ve types i.e. Mamsa, Sira, Snayu, Asthi and Sandhi
Marma. Kurpara Marma is one among the twenty Sandhi Marma mentioned by Acharya Sushruta. It is a vaikalyakara marma and located at the
junction of bahu and prabahu i.e. elbow joint. So cadaveric dissection of elbow joint in relation to kurpara marma can be carried out in order to x
the exact location of kurpara marma and to nd out its components. This article describes anatomical location and contents of Kurpara Marma and
applied anatomy related to it with the help of cadaveric dissection.

KEYWORDS : Anatomy, Sushruta, Dissection, Marma, Kurpara.

INTRODUCTION the bond of union between epiphysis and the diaphysis. The problem
Literal meaning of ayurveda is science of life. This science deals with affecting the joint could be intra articular or extra articular. TB arthritis,
the whole life with healthy and unhealthy individuals. The Marma is rheumatoid arthritis are some of the common intra articular problems.
one of the exclusive concept of Ayurveda which has been well While tennis elbow, golfers elbow, students elbow are some of the
developed by keen observations, especially at the time of surgical extra articular problems of elbow. Supracondylar fracture, dislocation
procedures because of its fatal traumatic effects. These are very special of elbow, fracture of head of radius are some of the common elbow
and vital points in the body, special because they are the sites of prana1 injuries.
(Life). Acharya Sushruta in Pratyeka marma nirdesha sharira
adhyaya2, Acharya Charaka in Trimarmiya siddhi adhyaya3 and Knowledge of Kurpara sandhi marma is very important in sports too
Trimarmiya chikitsa adhyhaya4, Vagbhata in marmavibhagiya5 have because there are certain sports in which there is always a possibility of
made classical description throwing light on every aspect of marma. Kurpara sandhi marma injury specially in tennis, badminton and
The term marma is dened as “marayati iti marma” that structure in the cricket for example - Tennis elbow, Golfers elbow, Student elbow,
body where if any injury or trauma is made causes death6. Marma is Supracondylar fracture. For understanding the location and structure
constituted by the conuence of Mamsa (Muscle), Sira (vessels), of Marma in relation to elbow joint and for management of trauma to
Snayu (ligament), Asthi(bone), sandhi (joints)7. There are 107 marma this Marma one should know the exact anatomical structure which
in the human body mentioned by Acharya Sushruta. Kurpara Marma is comes under Kurpara Marma. So, this study needs to explore the
one of the delicate and vital point of the body located in both upper anatomical structures of Kurpara Marma and its specic location
limbs which is described in the area of Kurpara sandhi (elbow joints). It according to ayurvedic texts and modern anatomy.
is exactly located at the junction of the bahu (arm) and prabahu
(forearm). Structurally it is described as Sandhi Marma8, situated in RESEARCH QUESTION
urdhvashakha (upper extremities). Kurpara sandhi marma 1. What is the exact location and the structural components of
prognostically comes under Vaikalyakar Marma having predominance Kurpara Marma ?
of saumya elements, vikal means deform or cripple, so when Kurpara 2. What type of effect occurs on injury to Kurpara Marma ?
marma get injured Sushruta said it causes loss of function of forearm
("Kurparakhye kuni")9. Kurpara marma is devoid of mamsa, sira and HYPOTHESIS
snayu and contains mainly asthi and sandhi predominantly so damage Since it is a descriptive study, hypothesis is not stated.
to these structures at elbow joint results into temporary or permanent
disability of elbow joint or loss of function. Description of location and AIM
injurial effects of Kurpara marma are similar to the structure of elbow To x the location of Kurpara Marma and to identify its structural
joint and its clinical anatomy. components.
Elbow joint connects the arm to the forearm. It is a synovial joint of the OBJECTIVES
hinge variety between the lower end of humerus and the upper end of 1. To identify the proximity of anatomical structures to Kurpara
radius and ulna10. Superior surface of the head of radius articulates with Marma.
capitulum of humerus and trochlear notch of the ulna articulates with 2. To study the clinical anatomy of Kurpara Marma and to prove its
trochlea of the humerus. The elbow joint is continuous with the vaikalyakara effect in the light of Sushruta Samhita and Modern
superior radio ulnar joint. In full exion the fossae present Anatomy.
immediately above the capitulum and trochlea receive the head of
radius and coronoid process of the ulna and in full extension, a deep MATERIALS REQUIRED
fossa which is present posteriorly receives the olecranon process. For structural study of Kurpara Marma :
There are commonly two separate articular surface in the trochlear a. Cadaver with well formed elbow joint.
notch, one on the olecranon and the other coronoid process. The elbow b. Scalpel
joint is stable because of the wrench shaped articular surface of the c. Surgical Scissor
olecranon and the pulley shaped trochlea of the humerus. The elbow d. Plain & toothed forceps
joint is capable of exion and extension. Elbow joint is commonly e. Retractors
injured in childhood. Elbow dislocations are common and mostly are f. Camera
of posterior side. Posterior dislocation usually follows falling on the
outstretched hand. Posterior dislocation is common in children METHODOLOGY
because the parts of the bones that stabilize the joint are incompletely Ÿ Review of literature : All relevant references were collected in
developed. Avulsion of the epiphysis of the medial epicondyle is both Ayurved & Modern Science.
common in childhood because medial ligament is much stronger then Ÿ Experimental work : Cadaveric dissection in the region of
INDIAN JOURNAL OF APPLIED RESEARCH 1
 Volume-10 | Issue-1 | January - 2020 | PRINT ISSN No. 2249 - 555X | DOI : 10.36106/ijar
Kurpara Sandhi i.e. Elbow Joint which contains Kurpara Marma. Ÿ All anatomical structures as dened by Acharya Sushruta in
(Dissection was done according to the Cunningham's manual of denition of Marma were explored and self-observation is
practical anatomy) established.
Ÿ Clinical Anatomy : Applied aspect of Elbow joint along with its
contents were critically analysed in order to prove the STRUCTURES FOUND IN THAT REGION
vaikalyakara effect of Kurpara Marmaghata. Ÿ Mamsa in Kurpara Marma
a) Bicipital Aponeurosis
Inclusion Criteria b) Brachialis
Ÿ Selection of cadaver strictly well preserved Kurpara Sandhi region c) Brachioradialis
without any deformity or abnormality. d) Flexor carpi ulnaris
Ÿ Cadaver of all age group, sex, race, religion having well formed e) Flexorcarpi radialis
elbow joint. f) Palmaris longus

Exclusion Criteria Ÿ Sira in Kurpara Marma

Ÿ Cadaver with poor preservation, maldeveloped elbow joint, a) Bifurcation of Brachial Artery into radial and ulnar artery.
amputated upper limb, congenital deformities will be excluded. b) Ulnar Nerve
c) Radial Nerve
OBSERVATION d) Median Nerve

Ÿ Snayu in Kurpara Marma

a) Radial Collateral Ligament
b) Ulnar Collateral Ligament

Ÿ Asthi in Kurpara Marma

a) Trochlea & Capitulum
b) Upper end of Radius & Ulna
c) Olecranon process
d) Coronoid process

Ÿ Sandhi in Kurpara Marma

a) Humero-ulnar joint
b) Humero-radial joint
c) Radio-ulnar joint

Clinical Anatomy of Kurpara (Elbow Joint)11

Ÿ Tennis Elbow : Occurs in tennis players. Abrupt pronation with
fully extended elbow may lead to pain and tenderness over the
lateral epicondyle which gives attachment to common extensor
origin. This is due to
a) Sprain of radial collateral ligament.
b) Tearing of bres of the extensor carpi radialis brevis.
c) Recent researches have pointed out that it is more of a
degenerative condition rather than inammatory condition.

Ÿ Student's Elbow : Also known as Miner's Elbow. It is

characterized by effusion into the bursa over the subcutaneous
posterior surface of the olecranon process. Students during
lectures support their head (for sleeping) with their hands with
CADAVERIC DISSECTION exed elbows. The bursa on the olecranon process gets inamed.
Dissection done on:- Ÿ Golfer's Elbow : It is the microtrauma of medial epicondyle of
The cadaver available in the Department of Rachana-Sharir in humerus, occurs commonly in golf players. The common exor
CBPACS. origin undergoes repetitive strain and results in a painful
1. Steps of dissection condition on the medial side of the elbow.
2. Layer wise structures found in that region. Ÿ Supracondylar Fracture : It is common in young age. It is
produced by a fall on the outstretched hand. The lower fragment is
Criteria for selection of dissection region - mostly displaced backwards, so that the elbow is unduly
Vagbhata mentioned : prominent, as in dislocation of the elbow joint. this fracture may
a) Vishama Spandana : Pulsation of Brachial Artery medially to cause injury to the median nerve. It may also lead to Volkmann's
elbow joint. ischaemic contracture caused by occlusion of the brachial artery.

b) Pain on pressure : Pressure to posterior to medial condyle of INFERENCE FROM CLINICAL ANATOMY
humerus because of presence of ulnar nerve. In almost all clinical conditions of elbow the major clinical feature is
functional deformity i.e. "Vikalta". Even after surgical repair in the
Three fully unidirectional extended fingers i.e. index, middle and ligament injuries there is some sort of pain and functional deformity
ring finger were kept from above downwards on the elbow joint left. That means injury to Kurpara Marma in the region of kurpara
that these three well close to each other. sandhi leads to Vikalta. That's why it is classied under Vaikalyakar
(Dissection was done following the steps given in Cunningham's Marma.
Manual of Practical Anatomy)
DISCUSSION
Cadaveric Study (Steps of dissection) Ÿ Kurpara Sandhi is a joint comprising of Prakoshtha & Praganda
The entire dissection was done in following steps- asthi which can be correlated to elbow joint. Angula pramana of
Ÿ Measuring and dening the Kurpara marma as dened by Acharya Kurpara Marma as mentioned by Acharya Sushruta is three (3)
Sushruta. angula. Upon analyzing the specied area in this joint, it comprises
Ÿ Drawing two horizontal planes each at a distance of one and a half of many anatomical structures (muscles, vessels, ligaments,
angula from the centre of patella. bones, joint). So all the structures present within the marked region
Ÿ Dissection initiated according to protocol laid by Cunningham's (three fully unidirectional extended ngers i.e. index, middle and
manual. ring nger kept from above downwards on the elbow joint that
Ÿ A section cut of Kurpara Sandhi was performed on the identied these three well close to each other) should be considered as
point. Kurpara Marma.
2 INDIAN JOURNAL OF APPLIED RESEARCH
 Volume-10 | Issue-1 | January - 2020 | PRINT ISSN No. 2249 - 555X | DOI : 10.36106/ijar
Ÿ According to the above research (cadaveric study) along with the
literary work done, the main clinical feature due to kurpara marma
aghata is "kuni", which means weakness (at forearm) and
functional deformity.
Ÿ One of the main clinical feature found in elbow joint injuries is
weakness and functional deformity. For example :- in
supracondylar and intercondylar fractures main clinical feature
even after repair or treatment is weakness of forearm.

RESULT
1. Kurpara Marma is the region marked between three fully
unidirectional extended ngers (i.e. index, middle and ring nger)
kept from above downwards on the elbow joint and the structures
present in this area comprises Kurpara Marma.
2. By critically analysing the clinical features of elbow joint injuries
and the features mentioned in Kurpara Marma Aghata it is found
that Kurpara Marma is a Vaikalyakar Marma.

CONCLUSION
Ÿ After detailed cadaveric study and analysis of all ayurvedic and
modern literature it can be concluded that the region within three
fully unidirectional extended ngers i.e. index, middle and ring
nger kept from above downwards on the elbow joint that these
three well close to each other comprises Kurpara Marma.
Ÿ All the structures observed under this area during cadaveric
dissection can be considered as the components of Kurpara
Marma.

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