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Ksipra Etymology—The word Ksipra is derived from the root Ksip which means � To throw. � To cast. � Send/ despatch To place. To put on. � � To fix. � To insult. 221

â–� Sheegram, Amarakosakara says this as a synonym of Twaritham, Laghu which means immediate or sudden. Description The marma, known as the Ksipra is situated in the region between the first and the second toes - Angusta and Tarjani (Tarsal articulation), which being injured or pierced brings on death by convulsions. W The situation of this marma is in between the thumb and the index finger. Injury to this lead to clonic spasm of the hand and occasionally ends. in death. (P. V. Krishna Rao). This is similar to Kavali Extensor carpi radialis brevis longus tendon Extensor carpi ulnaris tendon Dorsal carpal arterial arch Extensor pollicis longus tendon Abductor pollicis longus tendon Abductor pollicis longus tendon Radial artery in anatomical snuffbox Extensor pollicis brevis tendon Dorsal metacarpal arteries Extensor carpi radialis longus tendon Dorsal carpal branch of ulnar artery Plate No. 28: The anatomical area of Kshipra 222

marma of Tamil. Similarly in the legs, the site of this marma is between the great toe and the second finger. This is a snayu marma. The prognosis is Kalanthara pranahara. It's extent is half anguli. Surface Anatomy The location falls in the space between the first and second metatarsal of the foot (or metacarpals of the hand) and nearer to the second metatarsal or metacarpal. Underneath this point a branch of the radial artery can also be felt with pulsation in the upper limb. This marma is better felt at the dorsum part of the palm or foot. Slightly adduct the toe and the second finger so that the space between the fingers Extensor retinaculum Dorsal digital branches of radial nerve Extensor carpi radialis brevis tendon Extensor carpi radialis longus tendon Radial artery 1st dorsal interosseous muscle Fascia (Cut) Lateral branch Dorsal carpal branch of radial artery Scaphoid bone Radial artery in anatomical snuffbox Insertion of abductor pollicis longus tendon Trapezium bone 1st metacarpal bone Insertion of extensor pollicis longus tendon Insertion of extensor pollicis longus tendon Plate No. 28a: The anatomical area of Kshipra 223

Extensor digitorum brevis and extensor hallucis brevis muscles Extensor digitorum longus tendons Lateral dorsal cutaneous nerve (continuation of sural nerve) cut Dorsal metatarsal arteries Dorsal digital arteries Extensor hallucis longus tendon Dorsal digital branches of deep peroneal nerve Extensor expansions Dorsal digital branches of superficial peroneal nerve Dorsal branches of proper plantar digital arteries and nerves Plate No. 28b: The anatomical area of Kshipra are widened. Move your hand by palpating with fingers in the intertarsal region from the space of tarsal articulation towards the distal tip. Apply little pressure and probe into the space where the point is relatively tender. Anatomical Structures corresponding to this marma Upper limb � Tendon of adductor pollicis muscle � Tendon of deep portion of flexor pollicis brevis. � Digital branch of median nerve. � First dorsal interosseus muscle. � Radial Artery and its branches. � Arteria princeps pollicis. � � Arteria palmaris radialis indicis. � Branch of deep palmar arch. 224

Discussion Lower limb � � � � � Combined Tendon of Adductor hallucis and Flexor and hallucis brevis. Transverse metatarsal ligament. � Bifurcation of the first dorsal metatarsal artery of plantar arch. � Lateral dorsal artery. Superficial stratum of digital slip of plantar aponeurosis. � Bifurcation of the first common digital nerve. � Plantar digital nerves of first cleft. � Bifurcation of the medial terminal branch of deep peroneal nerve. Lumbricals. � � Dorsal and Plantar Interosseous Muscle. Injury to this can lead to death by akshepaka (convulsions). This can only be explained by this wound getting infected there by leading to tetany, which might be very common then. After the advent of modern antibiotics this is well under control. Akshepaka. If injured may lead to death due to Akshepaka being a Vatha vyadhi. Samprapti of Vata Vyadhi is the sequel of injury. 225

Tamil varma sastra In Tamil literature it is termed as cuttu varma. This lies on the plantar side of the big toe (Odimurivu 41). The excessive heat generated after an injury has given this varma the name Suttu meaning heat.