INTRODUCTION
The Siddha Medicine, a traditional medicine originating from ancient Tamil Nadu, India, has been a cornerstone of healthcare for centuries. Siddhars established it. With its roots in the Dravidian culture and philosophy, Siddha medicine is a holistic approach that integrates physical, mental, and spiritual well-being. To treat the 4448 ailments listed in the Siddha literature, this medical system is primarily divided into two classes: 32 varieties of Aga marunthugal (Internal Medicine) and 32 types of Pura marunthugal (External Medicine), depending on the source of drug intake. This encompasses many of Siddha's classic internal and external medications and specialities, such as Varmam, Siddhar Yoga, Kaayakalpam, and Vaadham (Janani & R, 2017). Varmam medicine stands out as a cornerstone of Siddha Medicine, a gift from Siddhars for the betterment of humanity. Siddha medicine offers a treasure trove of tried-and-true remedies, both internal and external, with Varmam standing out for its exceptional efficacy in treating a range of health issues, particularly those affecting the musculoskeletal and nervous systems (Janani & R, 2017).
Varmam is a unique therapeutic approach in Siddha medicine that focuses on manipulating vital energy points, called varmam points, on promoting health and wellness. By applying precise pressure to these anatomically specific points, practitioners aim to stimulate healing and balance. This external therapy, introduced by Siddhars, involves the targeted stimulation of muscles, tendons, bones, and soft tissues to restore energy flow and prevent illness-like life-threatening symptoms, which may even result in death on vigorous stimuli. Each Varma has its specific time for resolution. It may be restored by an advanced therapeutic procedure called Adangal within a stipulated time (Janani & R, 2017).
In the context of Siddha medicine, Varmam treatment is considered a drugless therapy, relying solely on manual stimulation to prevent and manage certain diseases. This approach is time-consuming and cost-effective, making it a preferred method for many ailments. Varmam points are where the vaasi energy is stored and activated, crucial to the body's physiological functions.
History of Varmakalai
It is believed that Lord Shiva, the first Siddhar, taught the art of Varmam to his son, Lord Murugan. This lineage continues through Siddhar Agathiar, Nanthidevar, and their followers. The majority of the Varmam texts written in Tamil are attributed to Siddhar Agathiyar, Thirumoolar, Bogar, Therayar, Romarishi, and Ramadevar, and it is practised well in the Southern region of Tamil Nadu, especially Kanyakumari. The tradition of passing down the Varmam art through the master and disciple has kept it alive and thriving for centuries (Mohanaraj, 2008).
Classification of Varmam
There are two main classifications of Varmam. The first is based on geographical distribution (Kandam - 5) and the second on Aadharam- 6. In both classifications, there are a total of 108 Varmam points. These points are divided into upper limb (15), lower limb (14), area below the navel (9), area above the navel (45), and area above the neck (25). Varmam points are specific locations in the body that activate, regulate, and supply energy and functions according to the body's needs. The Varmam text “VarmaVilvisai” lists 8000 Varmam points, while Kumbamuninarambarai describes 251 points. Most Varmam texts mention 108 Varmam points, 12 being paduvarmams and 96 being thoduvarmams.
The text “Varma Chinthamani” explains that there are 828 Varmam points distributed across three body regions (kandam) - Vatha region (navel to foot, containing 190 varmams), pittha region (area between navel and base of the neck, containing 366 varmams), and kabam region (area above the head, containing 182 varmams) (Figure 1). Paduvarmams are directly linked to brain energy and are major energy storage points. According to the text “Pingala nigandu17”, the term ‘padu’ signifies the brain. Thoduvarmams, on the other hand, are connected to paduvarmams. The term ‘thodu’ means touch, indicating that one varmam point is connected to another through touch. Each paduvarmam is linked to eight thoduvarmams, totalling 96 thoduvarmams. These serve as minor energy storage points. The total number of Varmam points, which amounts to 108, includes two terminologies - Varmam and Kaalam. Varmam refers to static energy, while Kaalam refers to kinetic energy (Mohanaraj, 2008).
Other types of Varmam mentioned in the texts include vathavarmam (64), pithavarmam (26), and silaethumavarmam (6). Varmam literature also describes patchivarmam (related to astrology-panjapatchi), odukki varmam, thattuvarmam, etc. (Mohanaraj, 2008) .
Historical Proofs of Varmam
Varmam leaves its mark in the manuscripts of Tholkappiam, an ancient document that serves as the foundation for Tamil language and literature from the period ranging from 5000 BC to Tholkappiam. It is during this era that the term 'Vali Aatral' is coined. There exist approximately 120 textbooks under the banner of Varmam. These textbooks contain around 30,000 verses dedicated to varmam and its components, many of which are preserved on palm-leaf manuscripts. The content of these texts is deeply rooted in the traditions of siddhars, including Agasthiars, Bogar, Ramadevar, Thirumoolar, and Theraiyar (Mohanaraj, 2008).
Varmam as a Treatment for Illnesses
Varmam is believed to be energy storage points that flow through specific energy channels or streams. The correct stimulation of these points (mathirai alavu (pressure) – 1/4, 1/2, 3/4, 1) is thought to aid in treating various illnesses. Individuals with a profound understanding of applying Varmam in a standard method, through the analysis of Vatham, Pitham, and Kabam, are believed to be able to treat diseases effectively. Varmam Internal medications are given in various forms as kanji, kudineer, chooranam, thylam, illagam etc., Varmam External applications are given in the form of procedures like Ottradam, Poochu, Nasiyam, Oothal, Naasigabaranam, Kombukattal, Murichal, Thaarai, thadaval, and Potanam etc.,
Musculoskeletal injuries are a pervasive and debilitating issue, affecting a significant portion of the global population and resulting in substantial economic and social burdens. According to the World Health Organization, musculoskeletal disorders account for 21.3% of years lived with disability globally. These injuries can result from various factors, including sports participation (Hägglund, Waldén, & Ekstrand, 2013), occupational activities (Buckle & Deveraux, 2002), and everyday life. The economic burden of musculoskeletal injuries is substantial, with estimated annual costs exceeding $200 billion in the United States alone. Furthermore, musculoskeletal injuries can have long-term consequences, including chronic pain, reduced mobility, and decreased quality of life (Vos et al., 2010). therefore, it is essential to investigate the causes, prevention strategies, and treatment options for musculoskeletal injuries to mitigate their impact on individuals and society.
Varmam procedure plays a major role in managing Traumatological conditions like Enbu murivu. Various external procedures have been practiced widely for Enbu murivu (Musculoskeletal disorders). Nowadays, more Enbu murivu cases (Musculoskeletal disorders) have been reported.
The collection of Varmam literature regarding Enbu murivu may be useful for further research study, clinical activities, and exploration of Varmam management. So, reviewing the literature regarding Varma external therapy literatures for Enbu murivu paves the way for future research and Clinical practice safely and cost-effectively.
MATERIALS AND METHODS
A comprehensive review of 25 Varma literatures was conducted, and relevant data was extracted and organized into tables.
Source of Books
The review of Varma Literatures (Source of books) gave valuable insights into External applications used in Enbu Murivu management. The List of External Applications collected from the Varma Literature (Source of books) is in Table 1 (Kannanrajaram & Mohanaraj, 2011; Kannanrajaram, 2007; Kannanrajaram, 2007; Kannanrajaram, 2007; Kannanrajaram, 2008; Mohanaraj, 2008; Mohanaraj, 2009; Mohanaraj, 2010; Mohanaraj, 2010; Mohanaraj, 2015; Mohanaraj, 2018; Thiyagarajan, 1995; Thiyagarajan, 1995).
Table 1
Source of Varma Literature.
Types of External Preparations
The Types of External Preparation like Poochu, Ottradam, Ennai, Thaarai, Thuvaalai, Pasai, Thalam, Pottanam, and Nasiyam were collected after a review of Varmam literature (Figure 2). A list of the number of formulations was given in Table 2 (Kannanrajaram, 2007; Kannanrajaram, 2007; Kannanrajaram, 2008; Mohanaraj, 2008; Mohanaraj, 2009; Mohanaraj, 2010; Mohanaraj, 2015; Mohanaraj, 2018; Nagarajan et al., 2018; Thiyagarajan, 1995; Thiyagarajan, 1995).
EXTERNAL APPLICATIONS AND THEIR INDICATIONS
The names of External Application, Indications and Reference books for each type of preparations were given below (Kannanrajaram, 2007; Kannanrajaram, 2007; Kannanrajaram, 2008; Mohanaraj, 2008; Mohanaraj, 2009; Mohanaraj, 2010; Mohanaraj, 2015; Mohanaraj, 2018; Thiyagarajan, 1995).
Poochu (Anointing)
Poochu, also known as liquid poultice or anointing. It is the topical application of medicated oil or herbal juices and decoctions after gently warming the affected area. It can also be prepared by dissolving herbal powders or tablets in juices or oils and then using them. Typically, it is applied slowly to the affected areas and then gently smeared for a few minutes or until the heat subsides. This procedure includes purification, lubrication, local healing, analgesia, and anti-inflammatory properties. It also removes toxins from the skin while dilating all body channels to cleanse and improve peripheral circulation.
Poochu is classified into two types based on its physical properties: water-based and Oil-based. Duration: 15 to 20 minutes. The list of names of external applications, indications, ingredients, and reference books for Poochu is given in Table 3.
Table 3
Poochu- External Applications, Indications, Ingredients and Reference Books.
Ennai (Medicated Oil)
Ennai (Medicated Oil) is made by boiling base oil with raw drugs or herbal juices and heating until the drugs are dehydrated, transferring the therapeutic active chemicals to the oil. It can be administered in both an internal and external manner. The list of Names of External Applications, Indications, Ingredients and Reference Books of Ennai is given in Table 4.
Table 4
Ennai- External Applications, Indications, Ingredients and Reference Books.
Ottradam (Fomentation)
Ottradam is called a Fomentation, which is prepared and administrated as follows. The required plant parts, grains, and others are put together in a vessel/container, fried, boiled, or heated and then tied in a sterile cloth as a bag (kizhi). The bag is applied over the affected area in the trained manner (compressing and releasing) gently for a few minutes or till the heat subsides. This fomentation procedure involves purification, local healing, analgesic and anti-inflammatory action. It also removes toxins through the skin and dilates all body channels for cleansing and improving peripheral circulation.
Types: According to the physical nature of ottradam, it is classified into three
1. Liquid-based like kashayam, oils
2. Semisolid based karkam
3. Solid-based stones or vessels.
Duration: 20 – 30 minutes
The list of names of external applications, indications, ingredients, and reference books for Ottradam is given in Table 5.
Table 5
Ottradam- External Applications, Indications, Ingredients and Reference Books.
Thuvaalai
Thuvalai is described as poochu in ancient Siddha texts. It is a simple procedure adapted for balancing disarranged humours, as explained by Therayar in his book Therayar Thaaru. The list of names of external applications, indications, ingredients, and reference books for Ennai is given in Table 6.
Table 6
Thuvaalai - External Applications, Indications, Ingredients and Reference Books.
Thaarai
Thaarai therapy, medicated oil is steadily poured on the affected body part of the patient at a prescribed rate. There are different types of Thaarai, each of which cures a different health issue. The herbal oil mixture used in each is also different. The method of treatment is chosen based on the nature of the illness. Thaarai is generally administered throughout 30 to 90 minutes. The list of names of external applications, indications, ingredients, and reference books for Thaarai is given in Table 7.
Table 7
Thaarai - External Applications, Indications, Ingredients and Reference Books
Nasiyam (Nasal Drops)
Nasiyam is called a liquid nasal application. It is a method of instilling liquid into both nostrils. Fresh plant parts are crushed, filtered, boiled, filtered, or prepared fatty oil is instilled into nostrils. Watery drops are faster than oily drops in their function during Nasiyam therapy. It is advisable to use watery drops like plant juice, salt-dissolved water in acute conditions and oily drops in chronic conditions.
Generally, Nasiyam is performed in the morning for Vaadha diseases, in noon for Pitha diseases and in the evening for Iya diseases. The dose should be appropriate: less than four drops and not more than eight drops. Nasiyam is done gently by slowly instilling the drops one by one. The physical nature of drops is neither hot or cooler; it should be a little warmer. The list of names of external applications, indications, ingredients, and reference books for Nasiyam is given in Table 8.
Table 8
Nasiyam - External Applications, Indications, Ingredients and Reference Books.
Pasai (Cream/Oinment)
Pasai is called an embrocation application, cream, or ointment. Pasai medicines are semi-solid fatty oils or gums or resins-based applications. It is a mixture of medicated powder with specified oil and melted honey bee wax. Pasai is generally prepared by adding honey wax with a few medicinal powders. Its physical properties are almost similar to wax or gum. The list of names of external applications, indications, ingredients, and reference books for Pasai is given in Table 9.
Table 9
Pasai - External Applications, Indications, Ingredients and Reference Books
Pottanam (Medicated Pouch)
Perspiration is inducted using heated packs of herbal powder. The list of names of external applications, indications, ingredients, and reference books for Pottanam is given in Table 10.
Table 10
Pottanam - External Applications, Indications, Ingredients and Reference Books
Thalam
Thalam, herbal paste or medicated oil will be covered over the affected area. Generally, it is an effective therapeutic remedy for problems relating to the nervous system and mental disorders. The list of names of external applications, indications, ingredients, and reference books for Thalam is given in Table 11.
Table 11
Thalam - External Applications, Indications, Ingredients and Reference Books
DISCUSSION
Varmam medicine, a branch of Siddha Medicine, offers a unique approach to managing musculoskeletal disorders, making its documentation essential for advancing healthcare. Musculoskeletal conditions, such as osteoarthritis, rheumatoid arthritis, and bone fractures, are prevalent and debilitating, affecting millions worldwide. Varmam medicine, focusing on manipulating pressure points and using external medicines, provides a cost-effective treatment that enhances patients.
The literature documentation of Varmam medicine is vital for several reasons. Firstly, it allows for the systematic study and evaluation of its efficacy in managing musculoskeletal disorders. By documenting Varmam practices, researchers can design studies to assess its impact on pain, inflammation, and functional ability. Secondly, documentation facilitates the standardization of Varmam techniques and formulations, ensuring consistency and quality in its application.
Furthermore, documenting Varmam medicine can lead to discovering new therapeutic targets and treatment strategies for musculoskeletal disorders. By exploring the traditional knowledge and practices of Varmam, researchers may uncover novel mechanisms of action, such as the role of pressure points in modulating pain and inflammation. This can lead to the development of innovative treatments that combine the best of traditional and modern medicine. In conclusion, the literature documentation of Varmam medicine is crucial for unlocking its full potential in managing musculoskeletal disorders and improving patient care. The review yielded 60 external applications for Enbu Murivu, categorized into nine types: Poochu, Ottradam, Ennai, Thaarai, Thuvaalai, Pasai, Thalam, Pottanam, and Nasiyam. Each application has specific indications, and reference textbooks are provided. In this Literature review, 25 Varmam texts were reviewed. Among 25 Varmam books, Varma Odivu Murivu Sarasoothiram, Sigichai Murivu Saari, Varma Naalu Mathirai, Varma Saari, Varma Kannadi And Varma Aani had more number of formulations.
Many of the drugs (herbs) used in the external preparations have anti-inflammatory, analgesic, and Anti-spasmodic properties that aid in the better healing musculoskeletal disorders. Drugs like Chukku (Zingiber officinale) (Ezzat, Ezzat, Okba, Menze, & Abdel-Naim, 2018; Mashhadi, 2013), Veliparuthi (Pergularia daemia) (Sridevi, Sembulingam, Sembulingam, Srividya, & M, 2015), Kurunthotti (Sida cordifolia) (Franzotti et al., 2000), Elumichai pazha saaru (Citrus limon) (Galati et al., 2005), Kasthuri manjal (Curcuma aromatic) (Sudharshan, Kekuda, & Sujatha, 2010), Milagu (Piper nigrum) (Tasleem, Azhar, Ali, Perveen, & Mahmood, 2014) and Katrazhai (Aloe barbandensis) (Devaraj & Karpagam, 2011) possess Anti – Inflammatory Activity. Drugs like Chukku (Zingiber officinale) (Pagano et al., 2021), Kalipaakku (Areca catechu) (Khan et al., 2011), Kasakasa (Papaver somniferum) (Abarna, Nandhini, & Krishnaveni, 2023), and Amukkara (Withania somnifera) (Uthirapathy, 2021) has analgesic properties. Drugs like Chukku (Zingiber officinale) (Ghayur, 2008; Yassin, El-Rokh, El-Shenawy, Sm, & Ibrahim, 2012), Sathakuppai (Naseri & Heidari, 2007) and Vasambu (Acorus calamus) (Gilani, Shah, Shaheen, & F, 2006) has antispasmodic activity. As they possess Anti-Inflammatory, Analgesic, and Anti-Spasmodic properties, they would have better-reduced swelling and inflammation and better healing of trauma.
CONCLUSION
In conclusion, this study has compiled a comprehensive collection of Varma external applications for Enbu Murivu from various Siddha Varma literature, highlighting the significance of traditional knowledge in Orthopaedic care. This research's findings demonstrate Varma therapy's potential in promoting fracture healing, reducing pain and inflammation, and improving overall patient outcomes.
The documentation of these external applications contributes to preserving traditional Varma practices and provides a foundation for further research. Future studies can build upon this work to investigate the efficacy and safety of Varma therapy in clinical settings, explore its mechanisms of action, and develop standardized treatment protocols.
Integrating traditional Varma knowledge with modern medical practices may reveal new possibilities for preventing and treating bone fractures, ultimately improving the quality of life for individuals affected by these injuries. This research is a stepping stone for further exploration and collaboration between traditional practitioners and modern healthcare professionals.
