An anatomical study of Guda Marma and its clinical importance

Sapna Anand; Rita Marwaha; Nisha Bhalerao; Pooja Tekam

An anatomical study of Guda Marma and its clinical importance

Anand S.^1*, Marwaha R.², Bhalerao N.³, Tekam P.⁴

DOI:

^1* Sapna Anand, Post Graduate Scholar, Department of Rachna Sharir, Pt. Khusilal Sharma Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.

² Rita Marwaha, HOD & Professor, Department of Rachna Sharir, Pt. Khusilal Sharma Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.

³ Nisha Bhalerao, Reader, Department of Rachna Sharir, Pt. Khusilal Sharma Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.

⁴ Pooja Tekam, Post Graduate Scholar, Department of Rachna Sharir, Pt. Khusilal Sharma Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.

Nowadays owning to the sedentary life style with almost negligible or irregular physical activities as well as improper diet, frequency of several diseases and disorders has increased significantly. Guda (Anus) thus is implied in context of disease since ages and plays a very important role in the physical wellbeing of human body. The terminal part of large intestine and Moola of Pureeshava Srotas is known as Guda. It is one of the Karmendriyan. Charak has mentioned that Guda is one of the Koshtangas. Guda is defined as the passage through which excretion of faeces takes place and is located in the pelvic region and Charaka recognized two parts in it i.e., Uttara Guda and Adhara Guda. It is one among nine Bahirmukhasrotas located in pelvic region. Total length of Guda is 4½ Angula. There are 3 sphincter situated inside the Guda placed one above the other at a distance of 1½ Angula from each other and are named as Pravahini, Visarjini and Samvarni. Pureeshdhara Kala is related to Guda and it is Moola of Pureeshvaha Srotas and also is Sadhyopranhara Marma. Guda thus is implied in context of disease since ages and plays a very important role in the physical wellbeing of human body. Objective of the study are comprehensive literary review of Guda Marma with correlation of anatomical features described in Ayurveda to contemporary science. Data related to Guda Sharira and diseases were collected from various classics.

Keywords: Guda, Anus, Pureeshvaha Srotas, Sadhyopranhara Marma, Guda Marma

Corresponding Author	How to Cite this Article	To Browse
Sapna Anand, Post Graduate Scholar, Department of Rachna Sharir, Pt. Khusilal Sharma Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India. Email:	Sapna Anand, Rita Marwaha, Nisha Bhalerao, Pooja Tekam, An anatomical study of Guda Marma and its clinical importance. J Ayu Int Med Sci. 2023;8(2):86-91. Available From https://jaims.in/jaims/article/view/2283

Introduction

Ayurveda is the science which deals with the health of human being. The ancient texts of traditional science described Rachna Sharir as important aspect of Ayurveda which plays significant role for understanding structural concept of human body.

Ayurveda classics described ‘’Maryanti Iti Marmani’’, it means Marma are the vital points of the body which show several fatal signs and symptoms on traumatic injury.

The term Marma is generated from Sanskrit phrase ‘‘Mriyete Asmin Iti Marma” means there is possibility of death or serious damage to health when these vital parts got injured.

Acharya Sushrut mentioned in Sharir Sthan 6^th Chapter ‘Pratyek Marma Nirdesh Sharia’ Marma are the point where Mansa, Sira, Snayu, Asthi and Sandhi conjoin together.^[1]

They are also the sites where not only Tridosh (Vata, Pitta, Kapha) are present but their subtle forms like Prana, Soma, Maruta and Teja^[2] are also present with Sattva, Raja, Tama and Bhutatama.^[3]

Guda Marma

Guda is located in the Madhya Shareera, in the trunk region. It is in continuity with Sthula Antra (Large Intestine). Like the large intestine, Guda is also a site of Apana Vata.^[2]
Injury to Guda Marma is said to take away the life immediately.

Categories in which the Guda Marma is included

1. Madhya Shareera Gata Marma, Udara Gata Marma (Madhya Shareera = present in the middle portion of the body, trunk, Udara = abdomen).

2. Mamsa Marma - It is predominantly made up of Mamsae., muscle tissue. The other elements namely Sira (blood vessels), Asthi (bone), Sandhi (joints) and Snayu (ligaments, tendons, nerves) are also present but in a lesser proportion.

3. Dhamni Marma - According to Acharya Vagbhata It is predominantly made up of Dhamnie., blood vessels.

4. Sadhyo Praanahara Marma - (Sadhyo - Immediate, Pranahara - life taking) Guda Marma possesses a threat to life immediately after getting injured.

Measurement & effect of injury in Guda Marma

Pramana : 4 Angula
Effect of Injury : Tatra Sadhyo Marnam (Su.Sha.6)
Injury leads to immediate death, due to below causes;

1. Vata disturbance

2. Vata-Varcha Sanga

3. Mala Ati Pravritti

Sthulantrabaddhah Sadhyoghno Vidvatvamno Gudah II (A.H.Sha.4)

Anatomy of Guda Marma

Acharya Sushruta declaims that muscles play salient role in the emergence of Guda Marma but Acharya Vagbhata propound that vessels are the key elements for its eventuality.^[6]
Acharya Charaka divides Guda into two parts:

Uttar Guda
Adhar Guda

The part of gastrointestinal tract (rectum) which holds the fecal matter before its ejection is acknowledged as the Uttar Guda and the one (anus) which assists in defecation is avowed as the Adhar Guda.^[10]
The father of surgery Acharya Sushruta recommended Adhr Guda as paramount
According to him the part of gastrointestinal tract that is approximately 4½ Angul in length and append with large intestine is known as the Guda.

It (rectal part) comprises of 3 obliquely transverse folds (Houston's valves) at the distance of 1½ Angul each named as Pravahini, Visarjani and During contraction these folds overlap each other and transmogrify into 4 Angul.
These transverse folds are just like convolutions of shell arranged on each other and their colour is quite similar to the elephant’s palatine. The terminal end of the anal canal i.e., anus is about at 1½ Yav (barley) from lower hairline.

Modern perspective: Structures falling in the area of Guda Marma - Anus, Anal canal, Rectum, Sphincter muscles of anus, Levator ani muscles, Inferior hemorrhoidal vessels, Nerve plexus supplying anus and surrounding tissues.^[12]

Anal canal

Location - Extraperitoneal, between the anorectal junction and anus
Length - around 4cm

It is divided into three anatomical zones:-

1. Columnar,

2. Intermediate and

3. Cutaneous.

The dentate (pectinate) line divides the anal into upper (two-thirds) and lower (one-third) parts,
each one being supplied by completely different neurovascular structures.
The functions of the anal canal include the maintenance of fecal continence and defecation.
This is achieved with the help of the anal sphincters and the neighboring puborectalis muscle.

Blood supply

Above dentate line. (superior 2/3) - superior rectal artery

Below dentate line (inferior 1/3) - middle and inferior rectal arteries.

Venous drainage

Above dentate line. (superior 2/3) - superior rectal vein followed by hepatic portal circulation
Below dentate line (inferior 1/3) - middle and inferior rectal veins followed by the vena cava circulation.

Innervation

Above dentate line. (superior 2/3) - inferior mesenteric plexus, pelvic splanchnic nerves, inferior hypogastric plexus.
Below dentate line (inferior 1/3) - pudendal nerve

Clinical importance

Internal Hemorrhoids

Internal hemorrhoids lie inside the rectum.
Patient usually can't see or feel them, and they rarely cause discomfort.
But straining or irritation when passing stool can cause.

Primary & Secondary Piles

Primary Piles: Enlargement of 3 main radicles of superior rectal veins in anal columns, usually occur at 3 (left lateral), 7 (right posterior) & 11 ‘O’ clock (right anterior) position

Secondary Piles: Any other location

External hemorrhoids

These are under the skin around anus. Signs and symptoms might include:
Itching or irritation in anal region
Pain or discomfort
Swelling around anus
Bleeding

Anal Fissure

Elongated ulcer in mucosa due to tearing of anal valves
In people suffering from chronic constipation
Extremely painful (lower part of canal)
Mostly posterior midline, may occur in anterior midline (superficial external sphincter does not encircle anteriorly & posteriorly)

Anal Abscess: An anal abscess is an infected cavity filled with pus near the anus or rectum.

Causes

Small glands just inside the anus are part of normal anatomy.
If the glands in the anus become clogged, this may result in an infection.

When the infection is serious, this often leads to an abscess. Bacteria, feces, or foreign matter can also clog the anal glands and cause an abscess to form.

On the basis of location

Sub mucosal abscess
Subcutaneous abscess
Ischiorectal abscess
Pelvirectal abscess

Anal Fistula

An anal fistula is an infected tunnel between the skin and the anus, the muscular opening at the end of the digestive tract.
Most anal fistulas are the result of an infection in an anal gland that spreads to the skin.^[13]

Ways to stimulate the Guda Marma

Guda Marma show its positive effects in all the diseases related to the excretory system thus helps in proper excretion of the excreta.
Stimulation of Guda Marma can be done by application of Vasti Karma, Ganesha Kriya, Ashvini Mudra, Mooladhara Bandh along with Mahamrityunjay Mantra imparts miraculous results.
Marma which inhabits in Guda activates the Mooladhara Chakra where Kundalini force resides. This Chakra is present at the base of our body that's why it is designated as Aadhar Chakra or Muladhara Chakra.
Whole of the Kundalini power in annular form hibernates within the Mooladhara Chakra that is situated 2 Angul above the termination of anus.
A special technique is used to commence with stimulation of Guda Marma.
To initiate, sit in the Vajrasana with eyes closed along with relaxed mind and body both.
Keep your backbone straight and then make a fist of the right hand and place it on the region below the navel while the other hand over the fist.
During inspiration bend forward so that pressure is automatically applied over the fist as a result the fist presses the small intestine that activates the guda marma.

During expiration comeback to the normal position i.e. by releasing the pressure from the intestines. Repeat this activity 15-20 times in a single cycle and accomplish it in three cycles during morning, noon and evening.

Precautions regarding Guda Marma

Some safeguards are mentioned in Samhitas to protect the Marma from any type of anguish.

In rectum Kshar Karma or (use of alkalies), Agni Karma or (cauterizing), Shstravcharn or (use of sharp instruments) should be done very attentively.
Otherwise our ignorance may expedites into impotency, swelling, burning sensation, unconsciousness, flatulence, diarrhoea, dysentery or even the death of a person

Discussion

In Guda Marma, beneath structures are arterial, venous and nerve plexus -its injury leads to sudden death.

Acharya sushruta declaims that muscles play salient role in the emergence of Guda Marma so it comes under the category of Mamsa Marma and according to modern science underlying structures of Guda Marma are Sphincter muscles of anus, Levator ani muscles.

Acharya Charaka divides Guda into two parts: Uttar Guda and Adhar Guda. The part of gastrointestinal tract (rectum) which holds the fecal matter before its ejection is acknowledged as the Uttar Guda and the one (anus) which assists in defecation is avowed as the Adhar Guda. As in modern, part of rectum above the middle Houston valve act as reservoir of faeces and below middle Houston valve help in defecation.

According to Acharya Vagbhata It is predominantly made up of Dhamani i.e., blood vessels. Above dentate line. (superior 2/3) - superior rectal artery below dentate line (inferior 1/3) - middle and inferior rectal arteries.

According to modern Diseases related to Guda are Hemorrhoids - Internal and External, Anal Fissure, Anal Fistula , Anal / Perianalabscess.

According to Ayurveda the diseases of related to Guda are Arsha, Parikartika, Bhagandara, Nadivrana, Gudabhramsha, Sanniruddhaguda,

Guda Vidradhi etc. Guda is one of the Sthana of Vata i.e., Apanavata and best Chikitsa of Vata is Basti Karma. Basti is administered in the Guda.

Conclusion

Anal canal is one of the important and vital organ (part) of our body. It serves in excreting the contaminants, waste substances of metabolism and toxins of our body. Thus, it helps in keeping our body clean, safe and healthy Guda is a Marma and is also an important Karmendriya (functional and motor organ) which participates in Mala Utsarga i.e., excretion of unwanted wastes and it is related to many diseases which shows that it is clinically very importance. So, its health is of our prime importance. Otherwise, our ignorance may expedites into impotency, swelling, burning sensation, unconsciousness, flatulence, diarrhoea, dysentery or even the death of a person.

Reference

1. Sharma SP. Shareera Sthana chapter 7 verse 24 Astanga Sangraha with Sashilekha Sanskrit commentary of Indu. 2nd ed. Varanasi (India): Chaukambha Orientalia; 2008; p.326.

2. Sushruta Samhita Dalhana Acharya Virachita Nibhandhasangraha vyakhya, Vaidya Yadavaji Trikamaji Acharya, Choukhambha Surabharati Prakashana, Varanasi, reprint 2010. Page no: 369.

3. Acharya YT. Shareera Sthana chapter 6 verse 26 Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya. Reprint ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010.;p.55.

4. Bhaskar Govind Ghamekar, Sushruta Samhita, Ayurveda sandipika, Hindi, vyakhya, 3rd edition 1997, Meherechandre Lakashamendas (Sanskrit) 6/44.

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9. Sushruta Samhita with Hindi commentary by Kaviraj Ambikadutta Shastri, Part-1, page no. 67, Sharir Sathan 6/8, by Chaukhambha Sanskrit Sansthan, 2011.

10. Caraka Samhita of Agnivesha revised by Caraka and Drdhabala with an introduction by Vaidya Samrata Sri Satyanarayana Sastri, Chikitsa sthana part 2 published by Choukamba Bharati Academy, Varabasi reprint:2001, pg no:716 pp:1208.

11. Caraka Samhita of Agnivesha revised by Charaka and drdhabala with an introduction by Vaidya samrata Sri Satyanarayana Sastri, Siddhisthana, part 2, published by Choukamba Bharati Academy, Varanasi reprint:2001, pg no:1050 pp:1208.

12. William, L. P., & Warwick R. (1980). Editor. Gray’s Anatomy. 36th ed. Edinburgh: Churchill Livingstone, 1578, 1358, 1359, 288-292, 293-314.

13. Romanes, G. J., (1996). Editor. Cunningham’s Manual of Practical Anatomy, 15thed. New York: Oxford university press, 2, 298, 11-77, 200-210, 3, 346, 3-27, 35-92, 135-165.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-12-27	2022-12-29	2023-01-05	2023-01-12	2023-01-19
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Review Article

Guda Marma

Journal of Ayurveda and Integrated Medical Sciences