Siddha and Varmam

The Siddhars

Why Tamil medicine calls its founders the perfected ones

Siddha takes its name from siddhi, attainment, and from the Siddhars, the sage-physicians of the Tamil land. The tradition counts eighteen of them and places Agastya, Agathiyar, at their head. It holds that they gathered in the Pothigai hills of the far south and set the medical texts down.

No scholar can place Agastya in a century, and the eighteen are a traditional roster rather than a documented guild. The figure still explains the shape of the medicine. Its authority runs through people said to have perfected their own bodies first.

That premise produced an unusual posture toward the flesh. Tirumular devotes the Tirumantiram to the body as the dwelling of God, and records the turn in himself, from contempt for the flesh to care for it. He is counted among the eighteen Siddhars and among the sixty-three saints of Tamil Shaivism. A tradition that reveres the body learns it point by point.

Siddha, the name

An old practice under a label fixed in the 1920s

The Usman Committee, appointed in colonial Madras on 10 August 1921, recognized Tamil Siddha as distinct from Sanskrit Ayurveda. That recognition fixed Siddha's identity as a separately named system. Kanagarathinam and Lourdusamy, writing in Medical History in 2023, place the emergence of that separate identity in the 1920s and 1930s.

The practices under the label are older. Most surviving varmam manuscripts run from the fourteenth to the eighteenth centuries. Scholars place Tirumular's Tirumantiram anywhere from the early centuries CE to around the eighth. Palm-leaf texts resist dating, and the counts of verses and points vary between copies.

The medicine is demonstrably old, and the banner raised over it is a twentieth-century act of definition. Tamil physicians made that definition deliberately, in the ferment of Dravidian politics, to mark an inheritance as their own.

Mukkutram

Health as a working proportion of three humours

Siddha reads the living body as mukkutram: vatham the moving air, pitham the transforming fire, kapham the binding water. Health is their right proportion in a given person. Disease is the same constitution running out of ratio with itself. Siddha holds that every cell carries all three at once.

Beneath the humours the tradition counts ninety-six thathuvam, the principles from which a person is composed. The list runs from the five elements and the five senses to the ten vital channels and the ten vital airs. It takes in the psychophysical centers, the three bindings, and the states of consciousness. The Siddha classics treat this small body as a mirror of the world entire.

Running through that fabric is vaasi, the life carried on the breath. The postgraduate varmam syllabus keeps a unit on the biomechanism of vaasi and lists its synonyms as pranan, saram, swaasam, vaayu, kaatru. Season, food, soil, temperament, and breath are read together. The physician assesses the whole person before the site of the complaint.

Varmam

One hundred and eight points, named one at a time

Varmam holds that the life of the body gathers at particular sites where a hand can reach it. The classics describe about a thousand such sites and treat one hundred and eight as the key set: twelve padu varmam, the grave points, and ninety-six thodu varmam, the points answering to touch. The undergraduate medical curriculum lists all one hundred and eight by name, drawing on sources that carry their verse counts in their titles: Varma Kannadi 500, Varma Odivu Murivu Sara Soothiram 1200.

The tally follows the body. The ninety-six fall into three regions: twenty-two in the head and neck, thirty-seven in the trunk, thirty-seven in the extremities. The manuscripts place each site where muscle, bone, tendon, vessel, and nerve meet. Physicians located them by working the body and recording what followed.

Modern anatomy finds structure under them. Thilartha varmam at the glabella sits over the infratrochlear branch of the nasociliary nerve, the procerus blending into the medial frontalis, and the angular artery and vein. The classics do not agree on the exact spot, mid-glabella in some texts and a finger breadth higher in others. Variant readings run right through the manuscript tradition.

Mathirai

The measure of how much pressure to apply

Varmam specifies the dose. Mathirai is the unit of varmam pressure, defined in India's postgraduate syllabus in terms of force and depth, and examined alongside irai. Siddha teaches no point without one.

The 2025 review of thilartha varmam sets out the grades for a single point. One eighth of a mathirai is directed at poor memory, difficulty learning, and low motivation. One quarter is directed at headache, respiratory and ocular complaints, and stress. One half is directed at nasal blockage, insomnia, snoring, and uterine disorders.

That is one location, three amounts, three different stated consequences. Some texts prescribe a rapid three-finger pluck at the point. Others prescribe continuous pressure synchronized to the pulse. The Unified Model of Tone reads this as control of input quality: where, how deep, how long, and in what rhythm.

Varmam, struck and healed

Varma kalai and varma maruthuvam, one body of knowledge

Varma kalai, the art of the vital points, is the martial side of varmam, in which adepts learn to guard their own points while reaching an opponent's. Varma maruthuvam, vital point medicine, is the therapeutic side, covering manipulation, massage, the setting of fractures, and methods of revival.

The manuscripts classify how a point may be affected: by touch, by blow, by pressure, by massage. They state plainly what follows a point wrongly struck or wrongly treated. The postgraduate syllabus carries a full set of prognostic categories for varmam injury, sorting cases as curable, incurable, and fatal.

A discipline that holds harm and repair in one hand has to be exact about site, dose, and consequence. Roman Sieler's ethnography, published by Oxford University Press in 2015, places the living heartland of the art in Kanyakumari district and the neighboring south of Kerala. The leading teachers there, the acans, train apprentices by demonstration.

Thokkanam

Nine named movements of the hand, at three depths

Thokkanam is Siddha's own manual therapy, one of the thirty-two external treatments and prescribed above all for vatha disorders, the diseases of disturbed air and movement. The classical source is the Theran Tharu of the Siddhar Theraiyar. The National Institute of Siddha describes it as manipulation performed by the physician's hands in nine different ways, in five postures, with or without medicated oil.

The nine each carry a name: thattal, tapping; irukkal, deep kneading; pidithal, grasping; murukkal, twisting; kaikattal, flexion; azhuthal, pressing; izhuthal, traction; malathuthal, supination and extension; asaithal, shaking.

The Theran Tharu also codes the intensity. Mandam presses to the skin and the fat beneath it. Mathimam presses to the fascia and the superficial muscle. Sandam presses to the deep muscle and in some cases to the bone. The physician chooses the depth before the hand moves, so the dose belongs to the prescription.

Siddha today

Siddha as a regulated profession today

Siddha is a statutory medical system in India, governed since 2020 by the National Commission for Indian System of Medicine, which replaced the Central Council of Indian Medicine. Varmam is a recognized postgraduate specialty with its own MD syllabus. The undergraduate degree gives forty taught hours to the one hundred and eight points alone.

A 2021 case report in the Journal of Ayurveda and Integrative Medicine documents a sixty-year-old woman with adhesive capsulitis, the frozen shoulder Siddha calls kumbavatham, treated for fifteen days with varmam and thokkanam. A 2025 case series in Bioinformation reports ten patients with cervical spondylosis treated over twelve sessions.

Siddha practitioners are the authorities on their own practice, and the hereditary acans of the far south hold knowledge that no register records. Siddha holds the body to be one fabric run by vaasi, and holds that skilled touch at named places, in named amounts, reaches it.

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