presentations by Sharon
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Ayurvedic Reflexology -
an exciting connection

ICR Conference Amsterdam, Netherlands 2005






Summary
This paper introduces the concept of Ayurvedic Reflexology. This is a dynamic modality that the author believes illuminates the roots of contemporary reflexology. Some of the history and philosophies of Ayurveda are discussed. Particular attention is paid to body massage. Padabhyanga, and the principles associated with its application are discussed in some detail. Padabhyanga is compared with reflexology.

Techniques of kasa bowl work and the dynamic marma therapy are discussed, as well as how these can be integrated into current reflexology practices.  Some of the correlations between reflex areas and the marma points are presented, with regard to the outcomes when these areas are energised. 
    
The author hopes this presentation will inspire many of you to investigate the possibilities that Ayurvedic Reflexology has to offer. Ayurvedic Reflexology is a new term which describes a dynamic healing modality that successfully integrates traditional Ayurvedic massage techniques with the knowledge of contemporary Reflexology.

Ayurvedic Reflexology - an exciting connection

By Sharon Stathis


I’ve titled this presentation Ayurvedic Reflexology – an exciting connection, and the question I ask is this. Has the Reflexology that we practise today, emerged from the discipline of Ayurvedic medicine? Johari, when discussing reflex points on the feet, states  “A physician who studied these points while he was visiting India determined the connection of these points with internal organs and thus began foot reflexology as it is known in the West.” 1 I wonder if he was referring to Dr. William Fitzgerald? 

Of course, hand reflexology has an important place within our practice of reflexology, and is certainly not neglected in Ayurvedic Reflexology. Ayurvedic Reflexology on the hands  is discussed and explained in my textbook titled Ayurvedic Reflexology, soon to be published. With the time we have available here I would like to focus on foot work, and in particular marma therapy. So little is known about marma therapy in the West.

According to Atreya Smith “Marmas are similar to the pressure points used in reflexology and acupressure. In fact, it is the system of marmas that is the origins of these systems and acupuncture. Their use in the context of the Ayurvedic system greatly enhances their results.” 2

I believe the practice of marma therapy will expand and develop in the near future, particularly among vibrational (energy-based) therapy practitioners such as reflexologists. The work that we do is powerful, as stated by Paramahansa Yogananda in his teachings. With reference to energy-based healing he states “Vibratory energy can reach the electronic factors of the atoms, the building blocks of matter, where gross chemicals cannot penetrate.” 3

As we explore the intricacies of Ayurvedic foot massage, called Padabhyanga, we will be looking at similarities that are shared with Reflexology. We will also look at the differences, and I will be explaining how these two systems can be easily integrated.

Some of you might be asking “Why do we need yet another form of Reflexology, there are so many already?”  It is because Ayurvedic Reflexology is a significant addition to our knowledge base. This form of reflexology is dynamic. It is uncomplicated and easy to apply. It is easily integrated into current practices. It is also safe, effective and feels wonderful. I’ve been using it for four years in my clinical practice, and now use it routinely. 

We all have a working knowledge of reflexology, but there are probably few here today that understand the complexities of Ayurvedic medicine. To understand Ayurvedic Reflexology, we need to take a look at the principles on which Ayurveda is based. 
       
What is Ayurveda?
History and Philosophy
Ayurveda means ‘the science of life”. It is the traditional healing system of India, still practised in many Indian households today. Written records of Ayurvedic medicine date back approximately 4,000 years. However, well before that time, the knowledge of Ayurveda was passed on through the spoken word and by observation. 

Ayurveda is a truly comprehensive healing system.  Ayurveda explains the totality of the relationship between the whole being (physical, mental, emotional and spiritual aspects) and the universe.  It views the human being as a microcosm of the macrocosm . That is, the human body is a small model of the universe, composed of the same five elements (Panchamahabhutas) common to all of Nature. The energy or life-force of Nature is referred to as ‘Prakruti’.
 
The five Panchamahabhutas (elements)
Prithvi.........earth      
Apah...........water             
Tejas...........fire          
Vayu............air            
Akash..........ether    
 
The three Doshas (body energies)
The body is composed of three body temperaments (forces or energies) called ‘doshas’.  The great sages of Ayurveda developed the concept of the doshas to differentiate between living and non-living things. Doshas are regarded as the biological units of the living body. Usually one or maybe two of the doshas will predominate in each of us at any given time, displaying specific physical, mental and emotional characteristics that relate to the dominant dosha(s). Each dosha consists of a pair of elements combined to form a dynamic life force with specific characteristics. 

The doshas and their associations are:
Vata
Vata is a combination of air & ether             
Vata qualities are described as cold, light, irregular, mobile, quick and dry.
Vata is associated with dryness and wind dominance. 
Vata is responsible for movement occurring within the body.

Pitta
Pitta is a combination of fire & water             
Pitta qualities are described as hot, light, mobile, subtle, penetrating, soft and oily.
Pitta is associated with heat and bile dominance.
Pitta is responsible for heating processes occurring within the body.

Kapha
Kapha is a combination of water & earth      
Kapha qualities are described as cold, heavy, static, smooth, slow, soft and oily.
Kapha is associated with moisture and phlegm (mucus) dominance.
Kapha is responsible for lubrication and cohesion in the body.

The word Dosha means “that which changes”. These dynamic energies are in a state of constant change and balance. When in equilibrium, the doshas support healthy physiological and psychological function, but when vitiated (disturbed), the major body constituents (dhatus) will be affected, and disease will be the unwanted outcome. It is considered that an imbalance of Vata dosha is a major contributor to disease processes.

Although the three doshas are active in all parts of the body, there are concentrations of each dosha in particular areas. There are some variations regarding this information in different texts.
  
The primary locations of each dosha are:
Vata.............colon 
Pitta.............small intestine and stomach
Kapha..........lungs (and respiratory passageways) and stomach

Each of the three doshas is divided into five subdivisions called subdoshas. Each subdosha influences specific body functions. Dr. Randolph Stone of Polarity Therapy fame, related the five Vata subdoshas to the five longitudinal zone lines on the soles of the feet.  He said that physically working these lines would help to balance Vata and stimulate the flow of Prana in the body. 4 Prana refers to the vital life force circulating within the body.

The seven Dhatus (body constituents)
The body is composed of seven major constituents called dhatus. The dhatus are formed from the food we eat. They are responsible for body structure and function, and are influenced by the doshas. The subject of the dhatus is not the main point of this paper. However, it is interesting to look at the way in which the body tissues are described in Ayurvedic medicine. 

The dhatus and their associations are:
Rasa.................plasma, lymph and hormones
Rakta................blood tissue (cells)
Mamsa..............muscles
Medha...............fat
Asthi.................bones, teeth, hair and nails
Majja................ marrow (bone marrow and nerve tissue)
Shukra...............reproductive tissues and  fluids

As previously stated, the dhatus are directly affected when the doshas become imbalanced. Healthy living practices including healthy thoughts, good nutrition, exercise, regular internal detoxification and ongoing rejuvenation activities are the Ayurvedic way of keeping the doshas in balance and the dhatus in a state of optimal function.

Ayurvedic philosophy views disease as a helpful message that some negative patterning in our life needs to be changed. An Ayurvedic principle is that a healthy, strong immune system will not allow disease to manifest in the body. Therefore considerable emphasis is placed upon the maintenance of the immune system i.e. upon disease prevention rather than cure. 

A healthy immune system is dependant upon the successful elimination of wastes (malas) and toxins (ama) from the body. The body produces three major wastes which must be effectively excreted to maintain wellness. In Ayurveda, examination of the elimination processes is used to help diagnose disease.

The three Malas (waste materials)
Purisha...........faeces
Mutra..............urine
Sweda.............sweat

Ayurvedic medicine relies on Nature to provide all the necessary ingredients to heal a sick body, and then to keep it healthy. The healing and wellness programs of Ayurveda utilise plant oils, aromatic oils, herbs, minerals, gemstones, heat, cold, colour, sound and taste. The goals of Ayurveda embrace freedom from disease, personal happiness and fulfilment in all areas of life, and a harmonious and respectful relationship with nature.

Each individual has a unique constitution which is present at birth. This is known as Pre-natal Prakruti.  In Ayurveda, this is the most important factor to be regarded when diagnosing dosha imbalance and recommending treatment.  Also important is the functional Doshic Prakruti which relates to the predominance of the doshas at any given time.

Prana and its movement in the body
Within Ayurvedic philosophy, wellness and the ability to heal are dependant upon the unimpeded movement of energy within the body. This energy or vital life force is called Prana.

There are several types of energy centres or pathways that facilitate the circulation of Prana throughout the body. They are primarily the chakras, the nadis and the marma points. These centres and pathways connect the physical body to the mind and to higher consciousness

Chakra is a Sanskrit word for ‘wheel’ or ‘disk’ and indicates movement. The chakras are interconnected energy centres.  Seven of these align with the midline of the body and are referred to as the major chakras. Due to their positioning along the spinal column, they have a considerable influence on the nervous system. They also have a strong influence on the endocrine system.

Nadis are fine energy pathways which form a network throughout the body. There are fourteen major nadis. They all emanate from the first chakra at the base of the spine, and distribute Prana from the chakras to the various body areas.  

“Two special nadis supply Prana to the right and left sides of the body and the arms and legs. Many different marmas occur in the field of these two nadis, which are very important for marma therapy. They are connected to both the navel and heart chakras, which govern the hands and feet as motor organs and the flow of energy through them.” 5  These nadis primarily end at the tips of the thumbs and big toes. 

Marma points are sensitive, energy centres of varying size and function. They are located at the skin surface and within internal organs. They are connected to the nadis, and can be treated to influence the flow of Prana to the various body tissues via channels called srotas. Marma points are discussed in detail below. 

Purification procedures
There are five Ayurvedic purification procedures (Panchakarma) which provide internal detoxification. These procedures are administered to treat disease and achieve and maintain perfect health.  Traditional Ayurvedic medicine recommends that internal cleansing be carried out several times a year as a form of prophylaxis. Panchakarma procedures include Vamana, Virechana, Basti, Nasya and Raktamokshan.

Panchakarma (internal detoxification) procedures
Vamana...............vomiting
Virechana............purging
Basti....................rectal & vaginal enemata
Nasya..................nasal inhalation
Raktamokshan.....blood letting

Pre-detoxification procedures (Poorvakarma) are  carried out prior to purification and are dependant on correct health diagnosis by an Ayurvedic doctor (Vaidya). At this time food intake is usually restricted or even stopped (as in fasting), to facilitate the elimination of toxins and improve digestion.  Poorvakarma procedures include Snehan and Swedan.

Poorvakarma (pre-detoxification) procedures 
Snehan is the internal and/or external application of oil to the body (oleation). Usually plant oils are used for massage, but occasionally Ghee (clarified butter) is used. Herbalised oils are often used and are chosen according to the diagnosis made. Massage with oil is used to stimulate the circulation, free up and tone muscles and joints, stimulate metabolism and help draw toxins to the skin surface where they can be eliminated.

Swedan is the application of fomentation to the body (sweat therapy). This usually follows the massage and is used to remove the accumulated toxins.  Many methods of steam application can be used, including steam tents and poultices.

During Poorvakarma therapy, significant emphasis is placed on diet and lifestyle. In short, anything that stresses the body should be avoided. A calm and ordered lifestyle will enhance the effectiveness of the treatment.
Massage

Massage is probably the oldest form of medical treatment.  It was used by ancient cultures to achieve relaxation, for social bonding, as part of beauty therapy, and formed part of ritualistic programs.  “The Persian and Greek (Unani) systems of massage strongly influenced the basic forms of massage in the West.  Many common elements can be found between Persian and Greek massage and Ayurvedic massage;” 6

Ayurvedic massage improves the flow of Prana within the body. Massage is an integral part of the Ayurvedic system of healing.  It is routinely administered in many Indian homes by family members, and has many uses. It promotes healthy growth in the young, helps adults maintain health and vigour, and is an aid in  preventing the onset of degenerative diseases in the aged. Within a clinic setting, massage is used therapeutically to detoxify, tonify and help in the treatment of various forms of illness.

There is considerable diversification throughout India in the application techniques and protocol associated with body massage. If the massage is part of a treatment program for dosha imbalance, the massage strokes will need to suite the dosha type involved. The amount and type of oil that is used will also vary. In a clinical setting, massage is gender matched for psychological comfort i.e. males will massage male clients, and females will massage female  clients.

Here are some words of wisdom for practitioners. “The stillness of mind (practitioner) is the fundamental element  needed for a successful massage.  Stillness allows the technique to flow uninhibited from you. It allows you to merge with your client into a deep rapport of 'beingness'. In this state the prana flows effortlessly to your patient. In this state a quality that is not possible to cultivate, can arise. This quality some call love, some call it the divine.” 7

Govindan states that “Even if a person has misused and abused Nature’s gift for a long time, massage can help us to restore the body to its normal condition of health, vitality, youth, stamina, and awareness.” 8 
   
Sushruta, an Ayurvedic surgeon from the classical period of Ayurveda, stated that the head, ears and feet are the most important areas to work with. 
               
Padabhyanga as previously stated, is Ayurvedic massage of the feet. Padabhyanga is a focus for this paper
.
Padabhyanga
Within India the feet have a special significance. “In India, people touch the feet of elders to obtain their blessings and to receive the loving energy transmitted through their feet.  Scriptural verses praise the lotus feet of the guru; meditation on the guru’s feet is said to bring peace and destroy all sin.” 9      
Padabhyanga (Ayurvedic foot massage) has a very special place within Ayurvedic tradition. It includes a combination of various massage techniques, kasa bowl work and marma therapy (Marma Chikitsa). I will explain each of these components below.

Padabhyanga can be used as a stand alone therapy, or in conjunction with full body massage. It lends itself well both for professional clinical practice and for home use.  It is widely recommended that padabhyanga be performed in the home as a daily ritual, especially before retiring at night.

 “According to the Indian scriptures, diseases do not go near one who massages his legs and feet from knee to toes before sleeping, just as snakes do not approach eagles.” 10 
      
Benefits of padabhyanga include:
• helps calm the mind
• promotes quality sleep
• promotes blood circulation in the feet and legs
• nourishes the skin on the feet and prevents cracking
• aids foot health (alleviates pain, improves muscle tone and strength)
• helps maintain eyesight and hearing
• helps prevent sciatica
• helps calm and maintain the vata dosha
Contraindications to Padabhyanga

I have been unable to source any material regarding contraindications that specifically relate to Padabhyanga.

Lubricants
Plant oils, ghee and fine powders are used in Ayurvedic treatments to facilitate massage techniques and enhance the therapeutic effect. Massage oil is always warmed before application, preferably over water. Massage oils should be cold pressed, kept in dark glass bottles and stored in a cool place to maintain quality. 

If the massage is part of a treatment program for dosha imbalance, the amount and type of oil will be specific to the required result e.g. more oil is required for an excess of Vata dosha, less for Kapha, and a very small amount for Pitta. Ghee is excellent for high Pitta conditions and when inflammation is present. It is preferable to use a small amount of light oil if the client is experiencing an accumulation of wastes and toxins in the digestive tract (Ama).

Traditionally, the oil is allowed to remain on the skin surface for approximately twenty to thirty minutes before removal. At the completion of the procedure, oil is removed from the body by heat application and washing. This is done to remove any residues of wastes and toxins.

Although the base oils have their own therapeutic properties, they are also used as suitable vehicles for the addition of herbs and aromatic oils to help obtain the desired healing effect. I consider the use of essential oils to be invaluable in this work. For a more detailed explanation of commonly used aromatherapy oils in Ayurvedic treatments, I would suggest you refer to the text “The Magic of Ayurveda Aromatherapy” by Farida Irani.

Some of the base oils recommended for different dosha types are listed below. I have found some of the information regarding base oils to be contradictory. Oils used for Vata will essentially be calming in effect. Oils for Pitta will be cooling in nature, and warming oils will be required for Kapha. The following is a suggested list of suitable base oils.

Dosha____Main Massage Oils
Vata..............sesame, almond, olive, ghee
Pitta..............coconut, sunflower, safflower, ghee
Kapha...........mustard, safflower, apricot, sesame (small amounts)” 11

Sesame oil is considered tri-doshic in quality i.e. suitable for Vata, Pitta and Kapha. It is the most commonly used oil for Ayurvedic massage. 
Sesame oil is rich in fat soluble vitamins. It has a high mineral content and excellent keeping qualities. It is a powerful antioxidant and serves as a suitable base for making herbalised and medicated oils.

Sesame oil is considered very sattvic (harmonising) in quality.  It’s therapeutic properties include: easy absorption, deep penetration, skin nourishment, improved complexion, increased muscle tissue strength,brain stimulation, stress and fatigue reduction.

Ghee is not an oil. It is clarified butter. Apart from its use in cooking, it is used extensively in internal and external Ayurvedic treatments. It nourishes the tissues of the body, increases the agni (metabolic fire), and provides a vehicle for the absorption of herbs into the body. Ghee is considered sattvic in quality, and because of its cooling properties, is suitable for use with Pitta related disorders.

Herbal powders are sometimes used in massage, depending on the dosha imbalance, and are preferred when obesity is present.
   
Massage techniques 
Within India, Padabhyanga is primarily a stand alone therapy used for maintenance and prophylaxis. The massage techniques used in Padabhyanga are predominately friction movements such as rubbing and stroking. They are usually applied vigorously to stimulate local circulation and energy flow. 
If the massage is part of a treatment program for dosha imbalance, the strokes will need to suite the dosha type involved.  Strokes which are harmonising (sattvic) and activating (rajasic) are usually used for maintenance therapy. Sattvic touch is gentle and light while rajasic touch is firmer and stronger but not too deep or too painful.

Emphasis is placed on rubbing bony prominences and joint areas, as this is where Vata and Prana are stored.  Of course, overworking these areas is contraindicated if the joints are inflamed. Massage strokes on the foot are usually firmer in the direction of the toes.  This adheres to the principle that leg energy circulates in a downward direction towards the earth.

The Kasa bowl
Metals are extensively used in Ayurvedic treatments. The authentic Kasa bowl that I use contains metals that relate to the dhatus (body constituents).  The metals that predominate in the kasa bowl are copper and zinc.

The rounded surface of the warmed and well oiled bowl is rubbed on the plantar surface in circular and lengthwise stroking movements. Care needs to be taken over bony prominences. 

Using the bowl on the plantar surface helps draw toxins from the body. It also helps balance foot and body temperature. The kasa bowl adds an extra dynamic when used on the marma points.  Clients report that they really enjoy the unique sensation that Kasa bowl work imparts.

Marma therapy (Marma Chikitsa)
History and Philosophy
Marma means ‘sensitive’ or ‘vulnerable area’.  Marma points were commonly mentioned in ancient Ayurvedic texts.  However, valuable information on marmas was lost as a result of foreign invasion, including British colonial rule In India.  Today there is a resurgence of interest particularly in the West, probably due to the popularity of yoga and its associated practices.

As with other Ayurvedic practices, there are regional differences within India regarding information about marma points. This includes the spelling, the location and the size of individual points and regions. There are also different philosophies regarding the methods of treating the marmas. I found it difficult when sourcing information for this paper, as some of the factual information regarding marma points was contradictory or, at best, confusing.

Marmas can be used in two ways, destructively and constructively. Destructive use could involve a sharp, well directed blow to a marma, or piercing of a marma point to inflict pain, cause disability or even death. In ancient times these methods were used by hunters to overpower their prey, and by warriors to conquer their enemy.  Warriors would use sacred sounds (mantras) and shields to protect their marmas from injury. The marmas of horses and elephants used in battle were also protected.  Some of the traditional martial art forms in India still utilise marma knowledge today. 

The knowledge of marmas is now used constructively by professionals for diagnosing and addressing disease processes.  It is also used by the lay person as part of self-help treatment, and is used prophylatically for health maintenance.

What are marmas?
In both ancient and modern texts, the definitions of marmas are many and varied.   They (marmas) “are primarily ‘energetic centres’ where the life-force accumulates and flows. Treating them is more a means of treating Prana (the electricity running through the body) rather than simply working on physical tissues and organs (the light bulbs that carry the electricity)”. 12

The marmas interact with the chakras via the nadis, and with the internal organs via the srotas. The specific influence on body function, and individual relationships with the internal organs, varies between marma points.

Why are marmas treated?

Marma therapy is used to detoxify, tonify and rejuvenate. The significance of marma therapy cannot be overestimated. Effective marma therapy impacts upon all factors associated with the chakras, including the nadis. 

 “Treating them can release negative emotions and remove mental blockages, including those of a subconscious nature (like addictions). This means that there is an important psychological side to their treatment.” 13  

To demonstrate how profound this therapy is, Frawley et al states that “Through working on marma points, we can control our Prana. Through Prana we can control our sensory and motor organs, and eventually our entire mind-body complex,” 14 

Marma therapy helps maintain doshic balance by alleviating dosha excess. “Marma points are traditionally used in combination with Indian massage but can be used alone or with other methods.” 15
 
Symptoms of dosha excess at marma points:
Vata...........skin feels cold and dry, rough skin, sharp pain
Pitta............skin feels hot and damp, reddened oily skin, rashes, burning pain
Kapha..........skin feels cold and damp, pale skin, swelling, congestion, dull ache 16

Benefits of marma therapy include:
•  removal of energy blockages that impact on all aspects of health
•  improving flow of energy
•  releasing and eliminating stored wastes and toxins
•  releasing stored negative emotions
•  helping with stress reduction (calming the mind and emotions)
•  treating specific health issues
•  maintaining health
•  aiding prophylaxis
•  assisting rejuvenation therapy

Methods of Marma treatment
Marma therapy is dynamic, and warrants respect and sensitivity during its application.  If the therapist is focussed, the healing process will be enhanced.  It is recommended that a suitable lubricant is used when massaging marmas, as excessive friction can vitiate (disturb) the doshas.

With regard to Padabhyanga, Frawley et al suggest that marma therapy will be more effective if the feet are massaged first, to open the energy in the local area.17  As a general rule, an area is vigorously massaged before marma therapy to stimulate energy flow, and gently massaged afterwards to quieten and calm the area.

The methods for treating marmas are quite diverse. They include:
gentle massage, holding or massaging with pressure (Mardana), prana therapy (Prana Chikitsa), applications of vegetable oils (Snehana), aromatic oils (aromatherapy), medicated oils (Tailas), herbal pastes (also internal herbal remedies), colour, gemstones, medicated alkalis (Kshara-karma), heat (Agni-karma) and cold, marmapuncture (Suchi-karma) and blood-letting (Sira Vedha).  The use of yogic practices such as meditation, specific breathing techniques (Pranayama), and chanting of mantras (Mantra Chikitsa) can also help to clear and energise marmas.

Therapeutic touch, which facilitates the flow of Prana, and aromatherapy are commonly used methods of administering marma therapy. “Aromatherapy for marma points is both one of the most powerful forms of aromatherapy as well as one of the best forms of marma therapy.” 18 The oils can be used directly on the marma points without the administration of general massage to the surrounding area.

The fingers or palms of the hands are used for Pranic healing.  As a general rule it is best to use the thumb when treating the marmas as the thumb projects the main pranic power of the hand. “A practitioner with good Prana can achieve good results even without a great deal of technical skill or much time spent in treating a marma point” 19

Pranayama can be used to augment the process. “Your breathing is critical in all forms of massage, but most important when you work on the marmas as they are direct doors to the prana of the patient.” 20 
       
I was taught that a simple and safe way to work marmas, is to use light, brisk, circular rotations with a well oiled thumb. When using the left hand, the thumb works in a counterclockwise direction, and clockwise when using the right hand.  I firstly work each point in a counterclockwise direction (left hand), followed by a clockwise direction (right hand). I augment my own marma work with essential oils, heat (kasa bowl), pranayama, mantras and visualised colour.

Atreya states “In general, clockwise movements give and stimulate a marma (or the body) and a counter clockwise movement liberates and dispels blocked or stagnant prana. Some practitioners use only clockwise movements.” 21 

Miller and Miller suggest to use “small, gentle, clockwise circles, moving outward then back inward, slowly increasing pressure, outward, inward, in ever increasing and decreasing circles. Perform about five circles going out and five circles coming back: do this three times”. 22  
 
To help maintain health, self-treatment is recommended. “Many marma points, particularly those on the extremities of the body, are easy to reach for self-treatment with massage, acupressure, massage oils or aromatic oils.  You can do this on a daily or weekly basis to aid energy circulation or to counter chronic ailments.”  23

The marmas located in the extremities occur on both sides of the body. As a general rule, when treating foot or leg marmas, the corresponding marmas on both limbs are treated in the same session.  The same rule would apply when applying marma therapy to the hands.

To treat for a specific therapeutic result, it is recommended that the marma(s) be massaged twice daily for at least three to five minutes. 24 It is traditional practice that no more than five marmas are treated at one time. 
 
Where are marmas located?
Marmas are located at the junctures of the five organic principles that relate to muscles, ligaments (tendons), bones, joints and vessels (arteries, veins, nerves and lymphatics).  Two or more of these structures are present at any marma point.

The body contains 107 major (primary) marmas. The size of the marmas varies. Small sites are referred to as ‘points’ and the large ones as ‘regions’.  Joints, which house vata and prana, are considered marma regions. Internal organs also contain marmas.
 
The finger width of the person receiving the marma treatment is used to measure the location and size of the individual marmas. This finger-width measure is referred to as ‘anguli parimana’. Marma size varies from half an anguli to four anguli. Because of individual differences, the precise location of a marma point can vary from person to person.

The three most important marma regions in the body are located in the head (Adhipati Marma), the heart (Hridaya Marma) and the lower abdomen (Basti Marma). The points of interest to the reflexologist, of course, are located on the hands and feet. Frawley et al states that “Therapeutic regions, like marmas on the arms and legs, are the most important for treatment purposes.”  25 

Marmas occurring in the feet
There are five marma points occurring in each foot, in a total of eight locations. I have provided a brief overview here of their location, size and benefits of massage. Comprehensive information is available regarding marmas and their associations in various texts on the subject. I have also included an important leg point that is easily accessible to reflexologists. The most important marma occurring in the feet is Talahridaya (see below). It is through this marma point that Prana passes to and from the earth.  It is our ‘earthing’ or ‘grounding’ point.

The marma points in each foot and lower leg are:
1 Gulpha marma   
location (2 sites)       immediately inferior to the medial & lateral malleoli, over the subtalar joint
size                     2 anguli
benefits of massage           
stimulates the reproductive system;promotes healthy joints, bone growth and foot movement; helps reduce excess fat
Gulpha maintains functional movement of the feet by influencing the health of the foot joints.

Kurcha marma   
location (2 sites) dorsal and plantar surfaces – main site is beside head of 1st metatarsal, approximately two anguli proximal to Kshipra
size                     4 anguli
benefits of massage           
promotes visual acuity; stimulates overall sensory acuity; aids digestive processes by improving Agni (digestive fire); firm massage aids mental acuity and helps relieve stress

Kshipra marma
location (2 sites) distal webbing between first & second toes on the dorsal and plantar surfaces (the webbing between the other toes is also important)
size                     1/2 anguli
benefits of massage      
stimulates heart and lung function and the lymphatic system; firm massage aids the flow of Prana in the lower limbs

Kurchashira marma  
location (1 site) plantar surface -  at the midpoint of the mid tarsal joint (Johari identifies two extra sites on the dorsal surface.)
size                     1 anguli
benefits of massage           
promotes a healthy muscular system and aids body posture; helpful for digestion and reproductive function due to its connection with the endocrine system
Kurchashira has considerable influence on the muscles of the feet.

Talahridaya marma
location (1 site) slightly distal to the centre of the sole of the foot (not accessible from the dorsal surface)
size                     1/2 anguli
benefits of massage           
stimulates heart and lung function; promotes circulation in lower abdomen and legs; is very calming; can release negative energy; firm massage helps strengthen the immune system
Talahridaya controls the feet as a motor organ, and the earth element for the whole body.

Indrabasti marma 
location (1 site) centre of the calf near the insertion of the gastrocnemius muscle into the achilles tendon, approx. six anguli below the popliteal crease
size                     1/2 anguli
benefits of massage           
firm massage stimulates digestive fire (Agni) and promotes healthy digestive function (particularly small intestine);  aids leg circulation due its influence on the inguinal lymph nodes and associated lymphatic vessels

As you can see from the above, many of these marmas influence peripheral circulation and foot function. This information is invaluable for Reflexologists working with clientele who are experiencing problems in this area. The incorporation of appropriate marma massage into reflexology sessions can be most helpful in enhancing the therapeutic outcomes.
      
Footnote
I have made some minor changes from my previous publications in the section titled “Marma therapy”. These changes include the spelling of the marma points. The various meetings that I had with Dr Avinash Lele in Pune earlier this year provided the information for these changes. Dr Lele is an Ayurvedic surgeon who specialises in marma therapy. He is director of the International Academy of Ayurveda in Pune, and co-author of the book Ayurveda and Marma Therapy. He teaches worldwide. 

Similarities between specific marma points and reflex areas
Gulpha marma is located over the subtalar joint. It is situated in the reproductive, hip and lower back reflexes. Stimulation of the medial and lateral gulpha points influence the functioning of the reproductive organs.  Gulpha also has significant influence on the skeletal system.

Kurcha marma is a large marma region found in the chest reflex area. Eunice Ingham advocated that a helpful reflex area for the eyes is to be found at the base of the toes. Stimulation of the Kurcha point aids visual acuity.

Kshipra marma is situated in the distal webbing between the first two toes (and the other toes). This is the upper chest reflex area, and is also an important reflex area for the lymphatic system. Kshipra influences heart and lung function and the lymphatic system.

Kurchashira marma is located on the pelvic (heel) line of the plantar surface, in the vicinity of the ovary and small intestine reflex areas. Kurchashira influences the reproductive and digestive systems through its influence on the endocrine system. 

Talahridaya marma is located near the part of the upper abdominal reflex area that many reflexologists refer to as the ‘solar plexus’. This is situated immediately below the heart and lung reflexes. Talahridaya has a significant influence on heart and lung function. Massaging Talahridaya can help release negative energy and have a very calming effect.

Similarities between Reflexology and Padabhyanga
Reflexology and Padabhyanga:
•  are performed on the feet to all foot surfaces
•  are a form of energetic medicine
•  embrace an holistic approach to healing and health maintenance
•  are used for relaxation purposes
•  help address specific body dysfunction
•  promote healthy body tissue, organ and system function 
•  encourage homeostasis
•  are used for prophylaxis
•  can be applied in the home environment
•  form part of clinical practitioner programs
•  use the hands as the predominant tool for application
•  utilise a combination of hand techniques which include the use of fingers, knuckles and palms 
•  gentle applications are safe for the elderly, frail, sick, pregnant and for children

Differences between Reflexology and Padabhyanga
•  Reflexology can include work on the hands, whereas Padabhyanga is confined to the feet.
•  Reflexology is not gender specific. The application of Padabhyanga in a clinical setting requires the therapist and client to be the same sex.   
•  Reflexology relies on the personal preference of the reflexologist as to which foot is the first to be worked in a session. With Padabhyanga, if the client is female, the left foot is worked before the right, and conversely for a male. (In an Indian clinical setting where there are two practitioners, both feet are worked at the same time.) 
•  Powder, lotions and creams are the common lubricants used in Reflexology. Vegetable oils, sometimes medicated, and often including aromatic oils, are the choice for Padabhyanga. Ghee and fine powders can also be used.
•  Reflexology application utilises a combination of brisk, medium and slow hand movements. Overall, Padabhyanga is very brisk. 
•  Within Western culture, ‘thumb walking’ in its various styles, is a popular technique used for the application of Reflexology. Padabhyanga techniques do not include thumb walking.
•  Reflexology methods vary according to the particular style learnt e.g. Ingham, Chris Stormer, Inge Dougans, Bill Flocco. Padabhyanga begins at the heel/ankle area and works towards the toes. The hand strokes are firmer in the direction of the toes with the first strokes applied to the lateral side of the foot.
•  Reflexology focuses on working ‘reflex’ areas on the feet that relate to specific body tissues, organs and systems. Padabhyanga, through marma therapy, focuses on working marma points (or regions) to influence specific mind-body function. 

Ayurvedic Reflexology - putting Reflexology and Padabhyanga together
Ayurvedic Reflexology is not a complicated procedure. The philosophy and techniques of padabhyanga can be easily integrated into current reflexology regimes. The benefits of Ayurvedic Reflexology are the sum total of those relating to padabhyanga (as listed) and the known benefits of reflexology. The contraindications to Ayurvedic Reflexology are the same as to Reflexology. Obviously, appropriate medical knowledge of the client is obtained before commencement of the procedure, and any contraindications or special needs identified and considered throughout the procedure. 

Preparation
•  Ayurvedic Reflexology is not limited by gender matching.
•  Have a bowl of salt water near the working area to receive negative energy that is flicked from the feet.
• Prepare yourself physically, mentally, emotionally and energetically before commencing.
•  Remain focused on your client’s needs, as well as your own wellbeing during the entire  procedure.
•  Place the client in a reclining chair or in the supine position on a suitable couch or massage table
•  Bathe the feet, if appropriate.
•  For a female, the left foot is worked first, and conversely for a male.
•  Flick any negative energy from the lower legs and feet into the bowl of salt water.

Summary of the procedure
•  Use warm oil as a lubricant and add essential oils if appropriate.
•  Gently and briefly, hold the first foot to be worked, between the palms of the hands.
•  Begin the session with mobilising techniques to loosen and stretch the joints and the connective tissues of the foot.
•  Starting on the lateral surface of the foot, and beginning at the heel/ankle area, work up to the toes, using a combination of brisk hand movements, utilising the thumb and the open palm. 
•  Use firmer strokes when working towards the toes.
•  Repeat the movements on the medial surface, followed by the dorsum (including the toes).
•  Work the Gulpha, Kurcha and Kshipra marma points on the dorsal surface.
•  Starting at the heel, use a combination of brisk hand movements on the plantar surface as you work up to the toes. These movements will include the open palm, knuckles and the thumbs.  
•  Use the thumbs to press firmly into the entire plantar surface. Work any tender areas with sensitivity and avoid harsh pressure on marma points.  
•  As you massage any area of the foot, focus on the reflex area and the part of the body it relates to.
•  If a reflex area requires extra work, do it while you are already working the area, and come back later in the procedure if more work is required there.
•  Before working marma points, the general area is briskly massaged to energise and promote receptivity.
•  Apply a warmed and well oiled kasa bowl to the entire plantar surface. Kasa bowl work is light and brisk and usually precedes marma therapy. The bowl can be used on a specific marma point.
•  Work the Kurchashira, Talahridaya, Kurcha and Kshipra marma points on the plantar surface.
•  Give extra attention to any marmas that have been identified as requiring extra work.
•  Once a marma has been worked, any further massage to that area is usually gentle and slow.  
•  Briefly and gently acknowledge all the marma points in the order in which they have been worked.
•  Use your favourite ‘finishing’ technique to complete the procedure on the first foot. 
•  Apply the procedure to the second foot and finish by placing the palms on both soles. 

Conclusion
As I have researched the connections between Ayurveda and contemporary reflexology, I have been excited by the interface between these two disciplines. It is with enthusiasm that I pass this knowledge on to fellow practitioners, knowing that they will be able to use this knowledge to further improve the therapeutic outcomes of their clinical practice.

References:
Johari, H. Ayurvedic Massage  Healing Arts Press, Vermont USA, 1996. p. 62.
Atreya (Smith) Secrets of Ayurvedic Massage  Lotus Press, Twin Waters USA, 2000. p. 58.
Irani, F. The Magic of Ayurveda Aromatherapy, Subtle Energies, NSW Australia, 2001. p. 50.  from the teachings of Paramahansa Yogananda (unsourced)
Morningstar, A. The Ayurvedic Guide to Polarity Therapy: Hands-on Healing Lotus Press,   Twin Waters USA, 2001. p. 121.
Frawley, D., Ranade, S., Lele, A. Ayurveda and Marma Therapy: Energy Points in Yogic Healing Lotus Press, Twin Waters USA, 2003. p. 47.
Johari, H. op.cit. p. 2.
Atreya (Smith). op.cit. p. 102.
Govindan, S. Ayurvedic Massage for Health and Healing Abhinav Publications, New Delhi India, 2000. p. 35.
Johari, H. op.cit. pp. 49-50.
Johari, H. op.cit. p. 62.
Frawley, D. et al. op.cit. p. 67.
Frawley, D. et al. op.cit. p. 29.
Frawley, D. et al. op.cit. p. 34.
Frawley, D. et al. op.cit. p. 41.
Miller, B., Miller, B. Ayurveda & Aromatherapy; The Earth Essential Guide to Ancient Wisdomand Modern Healing Lotus Press, Twin Waters USA, 1995. p. 175.
Frawley, D. et al. op.cit. p. 86.
Frawley, D. et al. op.cit. p. 66.
Frawley, D. et al. op.cit. p. 68.
Frawley, D. et al. op.cit. p. 65.
Atreya op.cit. p. 66.
Atreya op.cit. p. 68.
Miller, B. et al. op.cit. p. 175.
Frawley, D. et al. op.cit. p. 85.
Frawley, D. et al. op.cit. p. 66.
Frawley, D. et al. op.cit. p. 29.
©Sharon Stathis 2005