Become A Member

Background: Chronic musculoskeletal pain is a leading cause of disability. Ayurveda describes 107 Marma points, vital sites where muscles, vessels, ligaments, bones and joints meet, and two related therapeutic approaches: Viddha Karma (therapeutic puncture with a needle) and Marma therapy (manual stimulation of Marma points). These practices share features with acupuncture and dry needling, which have a substantial evidence base. Objective: To review the classical concepts of Marma and Viddha Karma, their current clinical use in pain, the emerging evidence from Ayurvedic trials, and the relevant evidence from acupuncture and dry needling. Methods: Narrative review of Sushruta Samhita and of clinical trials, trial protocols, systematic reviews and mechanistic studies. Results: Sushruta classifies Marma by structure, region and the consequences of injury, and describes Vedhana (puncture) as one of the eight surgical procedures. Modern Marma therapy and Viddha Karma are used for low back pain, sciatica, neck pain, frozen shoulder and knee pain. A small three-arm randomised trial in cervical spondylosis found that Marma therapy, transcutaneous electrical nerve stimulation and their combination all improved pain, disability and mobility, with the combination best. A randomised trial of Marma therapy against physiotherapy in lumbar disc herniation with radiculopathy has been completed with results awaited. An individual patient data meta-analysis showed that acupuncture is superior to sham and usual care for chronic pain, and meta-analyses support dry needling for some musculoskeletal conditions. Conclusion: Marma therapy and Viddha Karma are plausible, low-cost pain treatments with emerging but limited evidence. Standardised point selection, sham-controlled trials and validated outcome measures are needed.

KEYWORDS: Marma; Viddha Karma; Marma therapy; pain management; acupuncture; dry needling; Sushruta; musculoskeletal pain