Exploring the Role of Marma Avacharana on Phana Marma in Restoring the Sense of Smell: A Review

Introduction

Marmas are made up of Satva, Raja, and Tamas, which are the Manasika Gunas (basic qualities of mind). Marma–Badha Varjana (avoiding trauma or diseases in Marma regions) is essential for protecting the Prana. [1] Trauma to Marmas can result in varying degrees of pain and disability, such as loss of function in sensory or motor pathways, with some cases leading to life-threatening complications. According to Acharya Susrutha, Vaikalyakara Marmas are Soumya Guna predominant. As Phana Marma is one of the Vaikalyakara Marmas, it can be considered as Kapha–Vata predominant. [2]

Phana Marma

The name “Phana” is derived from the Sanskrit word for the hood of a snake, symbolizing its shape, which narrows posteriorly from a broader anterior part, resembling a snake’s hood. [3] This shape correlates with the Marma’s anatomical positioning and its function in the sensory and respiratory systems.

The description of the location of Phana Marma comes from the Susrutha Samhita, which states, “Ghranamargam Ubhayata Strotomarga Pratibaddhe Abhyantaratah Phane.” This indicates that Phana Marma is located inside the nostrils and is associated with the Srotas within the nose. Dalhana further clarifies its location, noting its bilateral presence. [4] Acharya Vagbhata adds more detail by describing the connection of the Marma to the Shrotrapatha (auditory pathway). [5]

Based on the study conducted on the anatomical structure of Phana Marma, it is located near the nose, close to the posterior nasal aperture, measuring 2.5 cm vertically and 1.3 cm horizontally. It extends into the nasopharynx, with a maximum width of 3.5 cm, narrowing down to 1.5 cm at the pharyngo-esophageal junction. According to Acharya Vagbhata, this Marma is connected to the Shrotrapatha (auditory pathway), which can be seen on the lateral wall of the nasopharynx. This area also includes the opening of the eustachian tube, which connects to the middle ear. Therefore, the position of Phana Marma lies around the nasal cavity and extends to the nasopharynx. [6]

Phana Marma is categorized as a Sira Marma, meaning it has rich blood vessels. Due to its rich vascular supply, trauma to Phana Marma can lead to significant neurovascular complications affecting both olfactory and auditory functions. Some Acharyas even opine it is a Snayu Marma. Its size is about 1⁄2 Angula, which is roughly 0.93 cm or 3/8 inch. [7]

Phana Marmāghata

“Phana Marma trauma can result in Gandha Ajnana, observed in cases of nasal trauma, chemical exposure, or post-surgical procedures. This can occur not only from mechanical trauma but also from iatrogenic injuries during procedures like Chedana (excision), Bhedana (incision and drainage), or chemical injuries caused by Kshara or Agni Karma. These types of traumas can damage the Nasagata Siras, particularly the Vatavaha Siras, which are linked to normal motor functions and special senses like vision and smell. [8]

Ayurvedokta Gandha Jnana Prakriya

According to Ayurveda sensation of smell is generated through the Sannikarsha (contact) between the Indriya (sense organ), the Mana (mind), and the Aatma (soul). When Indriya–artha interacts with the Ghranendriya, it leads to the generation of the Ghranabuddhi (sense of smell) at the level of the nose. This information is then transferred and interpreted by the mind. Prana Vayu, with its moving quality (Chala Guna), is the primary mediator in this process. Any disruption in this sequence, particularly affecting Prana Vayu, can impair the sense of smell and may also affect other senses. [9] This aligns with the contemporary understanding of sensory processing, where the brain interprets sensory input, mediated by the olfactory nerve.

Pathway of Olfaction

The first step in the perception of smell occurs at the olfactory epithelium in the nose. However, the actual perception of smell takes place in the thalamus and hypothalamus, forming what is known as the olfactory pathway. [10]

Anosmia [11]

Anosmia is the complete loss of the sense of smell, which can be temporary or permanent. It can be classified into conductive anosmia and sensorineural anosmia based on the underlying cause. Conductive anosmia occurs when airflow carrying odour molecules is obstructed from reaching the olfactory receptors, often due to conditions like trauma, nasal congestion, polyps, or sinus infections.

Sensorineural anosmia- results from damage to the olfactory nerve, olfactory bulb, or central nervous system, caused by head trauma, viral infections, neurodegenerative diseases (e.g., Parkinson’s, Alzheimer’s), or toxins.

Anosmia can significantly affect taste perception and quality of life. If anosmia is neglected and not treated at the right time, it may even lead to complications like an increased risk of inhaling natural gas or harmful chemicals, and also food poisoning, as the person cannot distinguish between fresh and stale food.

Treatment depends on the cause, with options like decongestants, corticosteroids, surgery (for obstructions), and olfactory training (for nerve-related damage). Long-standing usage of these medications may result in rebound congestion, nasal irritation, dryness, and systemic side effects.

Marma  Chikitsa [12]

The general line of treatment includes Ghritapana, Parisheka, Lepana, Shodhana, and Shamana Chikitsa.

Parisheka [13]

Parisheka is effective for treating Vata and Vata–Kapha imbalances. Parisheka, a type of Drava Sweda, involves the steady pouring of medicated liquids such as oil, milk, Takra, Ghrita, or Kwatha over the affected area or the entire body. For optimal results, Parisheka should be performed with Ama Taila, especially in cases of Nasarogas like Pratishyaya, where it helps clear blockages and soothe inflammation. This treatment offers a deeply relaxing and rejuvenating experience, promoting balance and healing.

This study focuses on Marma Parisheka, an important treatment outlined in Ayurveda classics, which plays a key role in managing Marmāghata (trauma to Marma points). By evaluating the action of Parisheka, we seek to understand its potential in restoring the sense of smell and its therapeutic impact on Phana Marma, ultimately contributing to improved sensory and overall health.

Materials And Methods – Procedure of Marmaseka

Purva Karma

1. The patient is made to lie down comfortably with the head slightly tilted backward.
2. A mild steam inhalation may be given to open the nasal passages.
3. The medicated liquid is warmed to a suitable temperature (not too hot or too cold).

Pradhana Karma

1. The medicated liquid is poured gently over the nasal region from a height of 4 angula (around the nasal region) using a spouted vessel, cotton swab, or a sterile dropper.
2. The process lasts 10–15 minutes, allowing absorption of the medicinal properties.
3. The pictorial reference has been provided in the Figure no 1 and Figure no 2.