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Introduction

The knowledge of Marma, Sira, and Dhamani is essential for understanding the anatomical and surgical principles described in Ayurveda. Among these, Marma are considered vital points of the body where the structures such as muscles, vessels, ligaments, bones, and joints meet. According to Ayurvedic classics, injury to these vital points can produce severe complications including pain, deformity, loss of function, or even death. Therefore, detailed knowledge of Marma Sharira is of great importance, particularly from a surgical and clinical perspective.1 Acharya Sushruta, regarded as the father of surgery, has described Marma in detail in Sushruta Samhita. In surgical procedures such as Agnikarma, Ksharakarma, Raktamokshana, and Siravyadha, precise knowledge of Marma Sthana is essential to avoid complications and ensure safety during intervention. In conditions involving trauma, identification of the injured Marma, associated anatomical structures, and resulting deformities is necessary for proper diagnosis and management. Thus, the study of Marma plays a significant role in both treatment and surgical practice in Ayurveda. The term Sira is derived from the root “Sarana”, which means movement or flow from one place to another.2 Sira are described as channels through which blood circulates throughout the body. According to Ayurvedic texts, Sira are formed from the Snehamsha of Mamsa and Meda along with the influence of Vata, undergoing a process known as Mrudu Paka.3 Sira are considered synonymous with terms such as Srotas, Marga, Khan, Nadi, and Dhamani in certain contexts, though classical authors have also distinguished them based on structural and functional differences.4

According to Acharya Sushruta, Sira resemble the delicate fibers present in the leaves of a tree, being thicker at their origin and gradually becoming finer as they branch out. These vessels distribute blood throughout the body similar to irrigation channels supplying water to different areas of a garden or agricultural field. The total number of Sira in the body is described as 700, which originate from the Nabhi (umbilicus) and spread in all directions throughout the body. Nabhi is therefore considered the Mula Sthana (root) of Sira, and it is surrounded by numerous vessels similar to spokes surrounding the hub of a wheel.5,6

Among these 700 Sira, 40 are described as Mula Sira, which are further classified according to the Dosha they carry:7

• Vatavaha Sira – 10
• Pittavaha Sira – 10
• Kaphavaha Sira – 10
• Raktavaha Sira – 10

These Sira further divide and branch extensively to nourish the entire body and assist in physiological functions such as flexion, extension, contraction, and dilation. According to Acharya Vagbhata, Sira and Dhamani divide into numerous minute channels and may reach up to 2,99,650 branches, illustrating the extensive vascular network within the body.8 The concept of Dhamani is also an important anatomical entity described in classical Ayurvedic texts. Acharya Sushruta explains that Dhamani are thick, pulsating channels responsible for the transportation of Rasa and Rakta. Although the terms Sira, Dhamani, and Srotas are sometimes used interchangeably, Sushruta distinguishes Dhamani due to their pulsatile nature, which resembles the function of arteries described in modern anatomy.

Ayurveda correlates the circulatory system with structures such as Hridaya (heart), Sira, and Dhamani, where the heart acts as the central organ responsible for circulation. According to Sushruta, 24 Dhamani originate from the Nabhi, of which 10 travel upward (Urdhvagami), 10 downward (Adhogami), and 4 laterally (Tiryaggami). Acharya Charaka, however, describes their origin from the heart. The upward moving Dhamanis are responsible for functions related to sensory perception and speech, the downward moving Dhamanis assist in excretory activities, while the transverse Dhamanis are distributed throughout the body.9

In modern anatomical terms, the structures described as Sira and Dhamani may correspond to veins, arteries, capillaries, lymphatic channels, and nerve structures. The cardiovascular system consists primarily of arteries, veins, and capillaries that transport blood, oxygen, nutrients, and hormones throughout the body. Arteries are thick-walled vessels that carry oxygenated blood from the heart to different organs, where oxygen bound to hemoglobin is delivered to tissues through capillary networks. Understanding the structural and functional significance of Sira and Dhamani Marma is therefore important for correlating classical Ayurvedic anatomy with modern medical science. A critical study of these vital structures may help clarify their anatomical identity and clinical relevance, especially in the context of surgical procedures, trauma management, and therapeutic interventions described in Ayurveda.10

Aim and Objectives

Aim: To study the concept of Sira Marma and Dhamani Marma described in Ayurvedic classics and analyze their clinical significance with correlation to modern anatomy.

Objectives:

1. To collect and review references related to Sira, Dhamani and Marma from Ayurvedic texts.
2. To understand the structure, classification and functions of Sira and Dhamani.
3. To correlate Sira and Dhamani Marma with modern anatomical structures, and to study their clinical importance in surgical procedures and trauma management.

Materials and Methods

This study was carried out through a literary review of classical Ayurvedic texts and modern anatomical literature. References regarding Sira, Dhamani and Marma were collected mainly from Sushruta Samhita, Charaka Samhita, and Ashtanga Hridaya. Relevant commentaries and modern anatomy textbooks were also consulted. The collected information was compiled, analyzed, and compared with modern anatomical concepts to understand the anatomical correlation and clinical significance of Sira and Dhamani Marma.

Sira Marma

The term Marma is mentioned in both classical and non-classical Ayurvedic literature and is considered as ancient as the Vedas. In Ayurveda, Marma refers to the vital spots of the body, where injury can produce severe consequences such as pain, disability, or death. According to Sushruta Samhita, Marma are the sites where Mamsa (muscle), Sira (blood vessels), Snayu (ligaments), Asthi (bone), and Sandhi (joints) meet. Due to the presence of vital life force (Prana), trauma to these regions can result in serious complications. The total number of Marmas described is 107, which are classified into five types based on the predominant structure involved.

Among these, Sira Marma refers to those vital points where blood vessels play a predominant role. Injury to these points mainly results in excessive bleeding, severe pain, and loss of consciousness. Acharya Sushruta explains that four types of Sira are present in the body and they are usually located near Marma regions. These Sira provide nourishment to important structures such as Snayu (ligaments), Asthi (bones), and Mamsa (muscles) and thus help in maintaining normal physiological functions of the body. When Marma is injured, Vata becomes aggravated and obstructs the Sira, producing severe pain and progressive loss of consciousness. In modern anatomical understanding, every structure of the body receives blood supply and nerve supply through neurovascular bundles, which include arteries, veins, and nerves. Similarly, in the concept of Sira Marma, these neurovascular components are broadly included under the term Sira because of their role in maintaining tissue nutrition and vitality.

Origin of Sira

According to classical Ayurvedic texts, all Sira originate from the Nabhi (umbilicus) and spread throughout the body in different directions. The Nabhi is considered the Mula Sthana (root) of Sira and is described as the seat of Prana. Sira surrounding the umbilicus are compared to the spokes of a wheel around the hub, indicating their radial distribution throughout the body.

Number and Distribution of Sira

Acharya Sushruta has described 700 Sira in the human body. These vessels nourish and lubricate the entire body and facilitate physiological actions such as flexion, extension, contraction, and dilation. Their branching pattern is compared to small irrigation channels distributing water across a large field or the veins of a leaf spreading from its central rib.

Among the 700 Sira, 40 are Mula Sira, classified according to the Dosha they carry:11

Each group further divides to form a network of 175 Sira, thus making a total of 700 Sira in the body.

Doshanusara Sira Sankhya

Distribution of Sira in Different Body Regions

Urdhvajatrugata Sira (Above the Clavicle)

A total of 41 Sira are present above the clavicle.

Koshtagata Sira (Trunk Region)

A total of 34 Sira are present in the trunk.

Shakhagata Sira (Extremities)

Each extremity contains 100 Sira, thus totaling 400 Sira in all four limbs.

Among these, certain Sira known as Avedhya Sira (not suitable for puncturing) are located deep inside and should be avoided during procedures such as Siravyadha.

Functions of Sira

According to Sushruta Samhita, Sira play an important role in maintaining physiological balance in the body by carrying different Doshas and Rakta. Each type of Sira performs specific functions related to the Doshas.12

• Vatavaha Sira:Vata moving through its own Sira helps in the proper performance of all bodily activities, including movement, coordination, and mental functions. When aggravated Vata accumulates in these Sira, various Vata-dominant diseases develop in the body.
• Pittavaha Sira:Pitta circulating through its Sira is responsible for maintaining skin complexion, taste perception, digestive power (Agni), and overall health. When Pitta becomes aggravated and accumulates in these Sira, disorders related to Pitta Dosha arise.
• Kaphavaha Sira: Kapha moving through its Sira provides lubrication to the body, stability to joints, and strength to body tissues. When Kapha becomes aggravated and accumulates in these channels, various Kapha-related diseases occur.
• Raktavaha Sira: Rakta circulating through its Sira provides nutrition to body tissues, maintains skin colour, and supports tactile sensation. When Rakta becomes vitiated and accumulates in these Sira, Rakta-related disorders develop.

Although these Sira are classified according to the Dosha they carry, they do not carry a single Dosha exclusively. The aggravated Doshas often mix with each other and circulate together in the Sira, thereby affecting their normal seats and causing disease.

Characteristics of Different Sira

Classical texts also describe the physical characteristics of different Sira:

Vedhya and Avedhya Sira

Ayurvedic Acharyas classified Sira into Vedhya (puncturable) and Avedhya (non-puncturable) Sira, especially in relation to Siravyadha (therapeutic bloodletting).13

• Vedhya Sira: These are Sira that can be safely punctured during surgical procedures such as Siravyadha. Bloodletting through these vessels helps in removing vitiated Rakta and treating various diseases.
• Avedhya Sira: These are vital Sira that should not be punctured or injured, as trauma to them may lead to severe complications or even death.

The concept of Vedhya and Avedhya Sira is explained in detail by Sushruta, indicating the advanced knowledge of vascular anatomy in ancient Ayurvedic surgery.

Description in Classical Texts14

• In the Samhita period, Charaka described Vedhya Sira in conditions such as Unmada, Vishamajwara, and Apasmara, particularly in regions like Shankha Pradesh and Keshanta Pradesh.
• Later, Vagbhata also discussed Vedhya Sira in connection with specific diseases.

However, Sushruta provided the most detailed description of Siravyadha and Avedhya Sira in Ayurvedic literature. He mentioned 98 Avedhya Sira which must be carefully avoided during surgical procedures.

Distribution of Avedhya Sira

Among the total Sira present in the body:

• 16 Avedhya Sira are located in the extremities
• 32 Avedhya Sira are located in the trunk
• 50 Avedhya Sira are located above the shoulders

Certain specific Sira in the extremities such as Jaladhara, Urvi, and Lohitaksha are considered important Avedhya Sira and should not be punctured during Siravyadha.

Acharya Vagbhata further added that oblique, short, tortuous, or very narrow Sira should also be avoided during puncture. Thus, the classification of Vedhya and Avedhya Sira highlights the surgical precision and anatomical understanding present in ancient Ayurvedic science, particularly in procedures like Siravyadha and other surgical interventions.

Dhamani Marma

In Ayurvedic anatomy, Dhamani are described as important pulsating channels responsible for the transportation of Rasa and Rakta throughout the body. In the context of Marma Sharira, Dhamani play a significant role because injury to these vascular structures may lead to severe bleeding, loss of vitality, or even death. The concept of Dhamani is elaborately explained in Sushruta Samhita, where they are described as thick vessels associated with circulation and vital physiological functions.15

Development of Dhamani

Acharya Sushruta used the term “Nabhiprabhava”, indicating that Dhamani originate from the Nabhi (umbilicus) during the intrauterine period. In the fetal stage, the arteries and veins arise from the umbilical region and supply nourishment to the developing fetus. After birth, these vessels are described as being directly connected to the Hridaya (heart), which becomes the central organ responsible for circulation.16

From a modern embryological perspective, blood vessels develop between the endoderm and mesoderm layers of the yolk sac, eventually forming the vascular network responsible for circulation.

According to Ashtanga Sangraha, there are 24 Dhamani in the body. These vessels distribute nutrients throughout the body similar to irrigation canals supplying water to a large field. The Nabhi is surrounded by these Dhamani just as the hub of a wheel is surrounded by spokes. The Nabhi is therefore considered an important center of life and metabolic activity.

Similarly, Bhavaprakasha also describes 24 Dhamani, which originate from the Nabhi. Among them:

• 10 Dhamani move upward (Urdhvagami)
• 10 Dhamani move downward (Adhogami)
• 4 Dhamani spread laterally (Tiryaggami)

These vessels contain minute openings through which Rasa (nutrients) circulate throughout the body, comparable to the small pores present in the stalk of a lotus flower.

Later Ayurvedic scholars such as Charaka and Vagbhata shifted the concept of origin of Dhamani from Nabhi to Hridaya, emphasizing the role of the heart as the primary center of circulation.17

Number of Dhamani According to Different Acharyas

Correlation of Dhamani with Modern Structures

Some Ayurvedic scholars have attempted to correlate Dhamani with modern anatomical structures such as arteries and nerves.

Thus, the concept of Dhamani Marma highlights the importance of major vascular and neurovascular structures in maintaining life. Injury to these vital vessels can produce severe consequences such as hemorrhage, loss of function, or death, which emphasizes their significance in both Ayurvedic surgery and modern clinical practice.

Classification of Dhamani

According to classical Ayurvedic texts, especially Sushruta Samhita, 24 Dhamani arise from the central region of the body and are classified into three groups based on their direction of distribution:

• Urdhvagami Dhamani – Carry nutrients and sensory functions to the upper parts of the body.
• Adhogami Dhamani – Responsible for functions related to digestion, excretion, and reproduction in the lower parts of the body.
• Tiryaggami Dhamani – Spread laterally throughout the body and are mainly related to sweating and tactile sensations.

Discussion

The present study highlights the anatomical and clinical importance of Sira Marma and Dhamani Marma described in classical Ayurvedic literature. The concept of Marma represents vital anatomical locations where important structures such as Mamsa (muscle), Sira (vessels), Snayu (ligaments), Asthi (bone), and Sandhi (joints) meet. According to Sushruta Samhita, injury to these vital points may lead to severe complications such as hemorrhage, loss of function, unconsciousness, or even death, which clearly indicates their clinical significance in trauma and surgery.18 The concept of Sira represents channels responsible for the circulation of Rakta and nourishment of body tissues. Classical texts describe 700 Sira distributed throughout the body, originating from the Nabhi and branching in multiple directions. This description resembles the extensive vascular network of arteries, veins, and capillaries described in modern anatomy. The classification of Sira into Vatavaha, Pittavaha, Kaphavaha, and Raktavaha indicates the physiological functions attributed to different channels involved in maintaining homeostasis within the body. The concept of Dhamani is closely related to arterial circulation. Acharya Sushruta described Dhamani as thick and pulsating channels responsible for the transportation of Rasa and Rakta. Although the origin of Dhamani is described as Nabhi during fetal life, later Acharyas such as Charaka and Vagbhata considered Hridaya as the main source of circulation. This concept corresponds closely with the modern understanding of the cardiovascular system, where the heart functions as the central pumping organ and arteries distribute blood to different parts of the body.19 The classification of Dhamani into Urdhvagami, Adhogami, and Tiryaggami indicates the directional distribution of vessels supplying various organs and tissues. The functions described for these Dhamani, such as sensory perception, speech, digestion, excretion, and sweating, suggest that ancient Ayurvedic scholars included both vascular and neural elements within the concept of Dhamani. This reflects the idea of neurovascular bundles in modern anatomy where arteries, veins, and nerves travel together to supply different regions of the body.20 The distinction between Vedhya and Avedhya Sira also demonstrates the advanced surgical knowledge present in ancient Ayurveda. The identification of 98 Avedhya Sira indicates the importance of avoiding injury to vital vascular structures during surgical procedures such as Siravyadha, Agnikarma, or other interventions. This shows that Ayurvedic surgeons possessed a practical understanding of vascular anatomy and its relevance to clinical practice. Overall, the classical descriptions of Sira and Dhamani reveal a sophisticated understanding of circulatory pathways and vital anatomical structures. When interpreted with modern anatomical knowledge, these descriptions appear to correspond with arteries, veins, capillaries, and associated nerves, which collectively maintain physiological functions of the body.

Conclusion

The concepts of Sira Marma and Dhamani Marma described in Ayurvedic classics represent vital anatomical structures essential for maintaining life and physiological balance. The classical descriptions provided by Sushruta indicate that injury to these structures can result in serious complications such as severe bleeding, loss of function, or death.

The distribution, classification, and functions of Sira and Dhamani described in Ayurveda closely resemble the modern understanding of the vascular and neurovascular systems of the body. The concept of Vedhya and Avedhya Sira further highlights the surgical importance of these structures and reflects the advanced knowledge of anatomy and operative precautions present in ancient Ayurvedic science. Thus, a critical study of Sira and Dhamani Marma not only enhances the understanding of classical Ayurvedic anatomy but also provides a bridge for correlating traditional knowledge with modern anatomical and clinical science. Such comparative studies may contribute to better interpretation of Ayurvedic surgical principles and their application in contemporary medical practice.