What Are Marma Points? A Bonesetter’s View

By Eswar Kumar · 9 August 2026

Marma (Sanskrit marman) are anatomical points named in the classical Ayurvedic texts. The Sushruta Samhita defines a marma as a sannipāta — a confluence — of five kinds of tissue: muscle, vessel, ligament, bone and joint, at which the prāṇa or life-breath is said especially to reside. It counts 107 of them.

What most pages about marma will not tell you is what that chapter is for. It is not a treatment manual. It is a catalogue of danger: for each point the text records what happens when it is injured — immediate death, delayed death, disability, or lasting pain — and instructs the surgeon to keep the knife away. Pressing a marma to produce a health benefit is a much later development, and it is not what the classical chapter describes.

This article separates three things usually mixed together: what the texts say, how a working bonesetting lineage uses the word, and what has never been shown. It is educational, not medical advice, and it makes no claim that touching any point on the body treats, heals or relieves anything.

What the classical sources say

The source is the sixth chapter of the Sharira Sthana — the anatomical section — of the Sushruta Samhita, titled Pratyeka Marma Nirdesha Shariram, roughly “the specification of each vital spot.” For what that text is and how much of it belongs to bonesetting at all, see the Sushruta Samhita and bonesetting.

The chapter opens by fixing the number: saptottaraṃ marmaśatam, “a hundred marmas plus seven.” It then does something worth noticing. It enumerates the same 107 points three times over, on three different principles, and each enumeration adds up.

  • By tissue predominance (6.4): eleven mamsa (muscle), forty-one sira (vessel), twenty-seven snayu (ligament and sinew), eight asthi (bone), twenty sandhi (joint). The text adds, flatly, that there are no other kinds.
  • By consequence of injury (6.8): nineteen sadyaḥ prāṇahara, killing at once; thirty-three kālāntara prāṇahara, killing after an interval; three viśalyaghna, which kill when an embedded weapon is withdrawn; forty-four vaikalyakara, causing lasting impairment; eight rujākara, causing pain.
  • By region (6.5): eleven in each limb — forty-four in all — twelve across chest and abdomen, fourteen in the back, thirty-seven above the collarbone.

This is a text preoccupied with wounds. Verse 6.30 instructs that surgical work be carried out avoiding these sites, and that a marma is to be shunned. Verse 6.33 carries the line most often quoted from the chapter — marmāṇi śalyaviṣayārdham udāharanti, the marmas are declared to be half the subject matter of śalya, the surgical science. Not half of massage. Half of surgery. (Verse numbering shifts between printed editions; some cite this as 6.35.)

The other authorities agree on the total and disagree about the anatomy. Charaka also gives 107, singling out three — heart, bladder and head — as the trimarma. Vagbhata, in the Ashtanga Hridaya, keeps 107 but sorts it into six categories rather than five, splitting off nine dhamani (arterial) marma and revising the rest down: ten muscle, thirty-seven vessel, twenty-three ligament, eight bone, twenty joint. Points Sushruta files under one tissue, Vagbhata files under another. The number is stable across the tradition; the classification is not.

107 or 108?

You will see 108 everywhere online, usually unexplained. Both numbers are real and they come from different traditions.

107 is the Ayurvedic figure, stated outright in Sushruta and repeated by Charaka and Vagbhata. 108 belongs mainly to the South Indian systems. The Tamil Siddha varmam tradition counts 108, divided into twelve padu varmam and ninety-six thodu varmam. Kerala Tourism’s own account of kalari chikitsa states that “there are 108 marmas in the human body” and notes explicitly that the northern tradition counts 107. Other varmam schools give still other totals.

Popular Ayurvedic writing reconciles the two by nominating a 108th — most often the mind, sometimes the skin. Those glosses are modern. Sushruta names no 108th point and no candidate for one; the three enumerations each close at 107 and the text says there is nothing else in the category. It is fair to note that 108 recurs as an auspicious number throughout Indian religious counting — a japa mala is strung with 108 beads — though nobody has shown that this is why the southern traditions settled on it. The short version: 107 is what the Ayurvedic texts say, 108 is what the Tamil and Kerala traditions say, and a page giving you 108 while citing the Sushruta Samhita has not read the Sushruta Samhita.

Marma in bonesetting practice vs marma in spa menus

The version of marma most people meet is a treatment-menu item: a scented oil massage, talk of unblocking prāṇa and balancing doshas, and a list of conditions it is said to help. That genre cannot afford scepticism, because scepticism is bad for bookings.

The version inside a bonesetting lineage is a different object. There, a marma is a specific location found by hand and pressed hard with the fingers or thumb, in a fixed sequence attached to joint work — a landmark in a manual procedure rather than a ritual. Nothing is diffused, nothing is balanced, and the practitioner is generally making no claim about energy at all. Whether that pressure accomplishes anything is a separate question, addressed below.

Something needs saying that cuts against the tradition’s own marketing, though. Marma vocabulary is not universal in Indian bonesetting. The best-documented lineage in the peer-reviewed record is Puttur, in Andhra Pradesh, studied in 2011 in the Journal of Ayurveda and Integrative Medicine. Read that paper end to end and the word marma does not appear once. What it describes is palpation by hand, a herbal paste, bamboo splints and a bandage — no vital points, no prāṇa. The full account of that lineage is worth reading precisely because it is so plain.

Where marma and bonesetting genuinely fuse is in the lineages that grew out of martial arts, where knowing where to strike and knowing where to treat were the same body of knowledge. Kerala Tourism’s description of the kalari healer lists a skill set including “scholarship in Marmashastra”, experience in uzhichil (massage), and “dexterity in fixing dislocations of bones” — both crafts in one person. The Tamil varma vaithiyar occupies a comparable position. So the connection is real and documented, but regional and lineage-specific rather than a property of Indian bonesetting as such. For how many distinct traditions sit under that label, see what Indian bonesetting actually is.

What the points correspond to anatomically

Because the classical definition is itself anatomical — a place where five kinds of tissue meet — most marma land on structures any anatomist would recognise: neurovascular bundles, joint lines, tendon insertions, places where a nerve or large vessel runs close to the surface or crosses a bone.

Sushruta’s consequence categories track that geography closely. The points he lists as killing at once include the throat vessels, the temples, the heart, the bladder and the navel. Those causing lasting impairment are weighted towards joints and limb structures — knee, elbow, hip, shoulder blade, the sacroiliac region. Those that merely hurt are wrist and ankle. A modern trauma clinician would not order those three groups very differently.

One concrete example matters for bonesetting: Kukundara, which Sushruta classes as a joint marma of the back. A 2025 cadaveric dissection study at the Institute of Teaching and Research in Ayurveda, Jamnagar, dissected the region on four embalmed cadavers and placed the point at the shallow dimple beside the spine — the “dimple of Venus” — overlying the sacroiliac joint, with the sacroiliac ligaments beneath it and the lumbosacral trunk running close by on the deep surface. The classical injury sign recorded for Kukundara is loss of sensation and loss of movement in the lower body, which is roughly what damage in that neighbourhood would produce.

That is a genuine correspondence, and the strongest thing that can honestly be said for the system. But notice what has been established: that an ancient text named a real anatomical location and described real consequences of injuring it. That is a claim about where, not about effect. A point can be an accurate landmark and a useless treatment target at the same time, and the anatomy papers do not bridge that gap.

What is not established

This is the section the wellness pages omit, so it is worth being blunt.

  • That stimulating a marma produces any therapeutic or physiological effect. The clinical literature is close to empty. The one controlled study indexed on PubMed that I could find is a 2006 pilot of marma therapy in stroke rehabilitation in the Journal of Rehabilitation Medicine — not randomised, and it found no significant difference on its primary outcome measure. Its authors concluded there were grounds for a future trial, which is not the same as concluding anything worked. Twenty years on, a 2026 protocol in JMIR Research Protocols describes its own study as the first randomised controlled trial of marma therapy for lumbar disc herniation with radiculopathy. When a 2026 paper can still credibly claim to be first, the evidence base is not thin — it is essentially absent.
  • That prāṇa is a measurable thing collecting at these points. Prāṇa is a term inside a classical system of thought. Describing what a text says about it is not a claim that it exists.
  • That the points can be reliably located. That same Jamnagar paper tabulates five recognised authorities on where Kukundara is and gets five answers: the region of the ilium and sacrum, the lateral flank of the hip bone, the ischial tuberosity (twice), and the sacroiliac joint. One point, in the modern Ayurvedic anatomical literature, with roughly a hand’s breadth of disagreement about its position.
  • That marma are acupuncture points. Comparative papers propose correspondences — talahridaya with PC8, manibandha with PC7. Those are proposals. Neither system’s point map was derived from the other, and a proposed overlap between two maps is not evidence that either describes a mechanism.
  • That the practice carries no risk. The classical text’s entire thesis is that these locations are dangerous. It is a strange inversion to read a catalogue of places where injury kills or disables and conclude they are therefore good places to apply firm pressure. Several named marma sit over the carotid vessels, the brachial plexus, the femoral triangle and the abdomen.
  • That practitioners are regulated. The US National Center for Complementary and Integrative Health states there is no significant regulation of Ayurvedic practice or education in the United States and that no state requires a licence. Its summary of the wider evidence is that few well-designed trials and reviews suggest Ayurvedic approaches are effective, and that most such trials are small or poorly designed.

Studied is not the same as proven, and named in a classical text is not the same as either.

How the course teaches them

Eswar Kumar’s introductory online course covers marma points, and it is worth describing factually what that means.

The main recording is a workshop, roughly two hours, with a timestamped index. The marma segment begins around forty-eight minutes in with an introduction, then demonstrates three points in sequence — the belt line, the buttocks and the side — followed by a passage on building finger strength, because the points are worked with the fingers and thumbs rather than with oils or implements. Points reappear inside the treatment sequences: the sciatica sequence uses a foot point and a set of what the course calls vital points alongside ankle, hip and sacroiliac work. A question in the closing Q&A deals with a point on the hand.

The teaching consists of location and pressure inside a fixed manual sequence. There is no dosha assessment, no energy diagnosis, and no claim made about prāṇa. The course materials gloss the term as “marma (vital point) techniques” — a convenience for English-speaking bodyworkers, not a classical equation, and not an assertion that these are myofascial trigger points in the clinical sense. None of it is evidence that the points do what the tradition says they do.

The course issues no certificate and does not license or qualify anyone to practise on another person. That requires supervised in-person training and compliance with local law — an argument set out at length in whether bonesetting can be learned online.

When to see a doctor

Marma is a concept, not a diagnostic method, and no amount of palpation tells you what an X-ray tells you.

Seek qualified medical care immediately — and do not seek out hands-on point work first — for:

  • Suspected fracture — visible deformity, inability to bear weight, a crack or snap heard at the time of injury, severe pain over a bone.
  • Suspected or visible dislocation — a joint that is locked, misshapen or immovable.
  • Any acute trauma — road accidents, falls from height, crush injuries, or any blow to the head, neck or spine.
  • Numbness, tingling, weakness or loss of function in a limb, hand or foot.
  • A limb that is cold, pale, blue or pulseless, or pain that keeps escalating — possible compartment syndrome or vascular compromise, both surgical emergencies.
  • Open wounds, bone visible through skin, fever or spreading redness — infection risk.
  • Loss of bladder or bowel control, saddle numbness, or severe progressive back pain — a spinal emergency.

Firm pressure over the neck, throat, abdomen, armpit or groin is not a casual matter, whatever a point is called. If you are pregnant, have osteoporosis, a bleeding disorder, cancer, an infection, or take anticoagulants, discuss any hands-on therapy with your doctor first.

Frequently asked questions

How many marma points are there?

The Sushruta Samhita states 107, and enumerates them three times over — by tissue, by consequence of injury and by body region — with each list totalling 107. Charaka and Vagbhata also give 107. The figure of 108 comes from the South Indian traditions: Tamil Siddha varmam counts 108 as twelve padu and ninety-six thodu points, and the Kerala kalari tradition also counts 108. Sources citing Sushruta for 108 are citing the wrong text.

What is a marma point, exactly?

In the classical definition it is a site where five kinds of tissue meet — muscle, blood vessel, ligament, bone and joint — and where the life-breath is said especially to reside. That definition is anatomical rather than mystical, which is why most marma coincide with structures a modern anatomist recognises: neurovascular bundles, joint lines and tendon insertions.

Are marma points the same as acupuncture points?

No. They come from separate traditions with separate anatomies and separate theories, and neither point map was derived from the other. Published comparisons propose specific overlaps, such as talahridaya in the palm with the acupoint PC8, but a proposed correspondence between two maps is not evidence that either describes a real mechanism.

Does marma therapy work?

There is no good evidence that it does. The clinical literature consists of small, mostly uncontrolled studies; a 2006 non-randomised pilot in stroke rehabilitation found no significant difference on its primary outcome, and as recently as 2026 a trial protocol could still describe itself as the first randomised controlled trial of marma therapy for a musculoskeletal condition. Absence of evidence is not proof that it does nothing, but nobody is currently in a position to tell you that it works.

Is marma part of Indian bonesetting?

In some lineages, yes; in others the word never appears. The Kerala kalari and Tamil varmam traditions combine vital-point knowledge with manual treatment of bone and joint injuries in the same practitioner. By contrast, the 2011 peer-reviewed study of the Puttur bonesetting lineage in Andhra Pradesh describes palpation, herbal paste and bamboo splinting, and does not use the word marma anywhere.

Is it safe to press marma points?

Nobody has studied that properly, and the classical text is a catalogue of places where injury causes death or disability rather than a safety guide. Several named points sit over the carotid vessels, the brachial plexus, the abdomen and the femoral triangle. Firm pressure in those regions is not made safe by the fact that a text gave the spot a name.

Sources

This article is educational and is not medical advice. It describes what classical texts state and what practitioners do; describing a concept is not a claim about physiology. Bonesetting and manual techniques should only be practised after supervised, in-person training and in line with the laws where you live.