Guda (गुदम्)

Guda (गुदम्) in Samskrit refers to the anus and rectum. These are the end parts of the large intestines involved in the process of defecation. It is the excretory organ. In Ayurveda Guda is included under the bahirmukha strotasa (बहिर्मुखस्त्रोतसम् । external orifices) and also as the chief organ of the purishavaha strotasa (पुरीषवह स्त्रोतसम्) i.e. system dealing with transport of feces. Despite being a part of cleansing system guda has got some special importance in terms of the energy channels. As per yogashastra (योगशास्त्रम्), Muladhara chakra (मूलाधार चक्रम्)Root chakra) is situated at this site while as per Ayurveda, it is a vital point (मर्म । marma). Therefore this end part of the gut has immense importance when it comes to health and life.

परिचयः ॥ Introduction

Guda refers to the anus and rectume. It is known to be the marma (vital point) and specifically a sadhyopranahara marma (a type of marma or vital point which if injured will cause death or serious deformities). It is stated as bahyastrotas (a type of channel) or an external opening channel in the shareera. Guda is also one among the dashapranayatana (ten seats of prana).

According to charaka acharya Guda is one the 15 koshtangas, which precisely means a part or an entity of koshta (inner core-part of the body corelated with gut and connected organs).

निरुक्तिः ॥ Etymology

The term Guda is made up of and derived from 2 parts as below,

Gu- mala (waste matter/ fecal matter)

Da - to give/ excrete

Therefore, that which excretes mala or stool is termed as guda.

Guda is also termed as an organ which is controlled by apana vata (अपान वातः a type of vata dosha responsible for excretion of stools among other functions) and is a channel through which along with the fecal matter, the accumulated bowel gas is also expelled out.

गुदशारीरम् ॥ Anatomy

Structure, development and function of Guda have been studied in detail in Ayurveda.

In the process of embryogenesis i.e. development of fetus in womb, guda is said to be originated from matruja bhava (मातृज भावः) which means it has its roots in maternal factors.

Acharya Sushruta explained the location of the guda as in the gudasthivivara which is corelated with the pelvic cavity and near the paurusha (prostate) and bastishira which is the neck of the bladder.

The total length of guda is four and half anguli pramana (अंगुली प्रमाणम् । anguli pramana is the length equal to the transverse length of one’s own middle phalanx of middle finger).

Internally guda has three valis (वली । Folds) which are corelated with folds, which are pravahani (प्रवाहिणी), visarjini (विसर्जिनी) and samvarini(संवरणी). These are situated one over the other with a distance of one and half angula (अंगुली).

Acharya sushruta states the colour of guda resembles gajataalu (गजतालु) means the palate of an elephant which is reddish black in colour.

Guda is mamsa (मांस । muscle) dominant marma(मर्म).

Since it is one among the bahirmukha srotas, It is the root of purishavaha strotas (precisely a channel concerning with excretory pathway ).

There are 8 siras (सिराः। corelated with veins) present in the central area of shroni (श्रोणी । pelvic region), which supply blood to guda and two dhamani (धमनी । corelated with arteries) supplying blood to the guda in the downward direction.

गुदगताः विकाराः ॥ Diseases pertaining to Guda

There are certain medical conditions that primarily affect guda or develop in guda. Arsha (Hemorrhoids/piles), Bhagandara (Fistula-in-ano), Parikartika (Fissure -in-ano) are the diseases primarily affect and develop in Guda. Other diseases like atisara (diarrhea), pravahika (Dysentery), Grahani (conditions like IBS or Ulcerative colitis etc) also affect guda as a organ to certain level and might lead to some signs and symptoms in this region. The diseases that primarily affect guda are described in brief here,

अर्श ॥ Arsha

Arsha is corelated with haemorrhoids. When these are found in guda region they are known as gudarsha (hemorrhoids in ano) or piles described in western medicine. When in guda, Arshas are located in the guda valis (the three folds present in the guda region).

स्थानम् ॥ Location

Alike Guda region, arshas can also be found in mukha (oral cavity), talu (palate), nasa (nose), karna (ears) etc

भेदाः ॥ Types

Fundamentally arshas are of two types,

1.     Sahaja (सहजानि । congenital)

2.     Kalaja (कालजानि । acquired)

Arshas are classified again, on the basis of dominance of a single dosha.

1.     Vataja arshas (due to aggravation of vata dosha)

2.     Pittaja arshas(due to aggravation of pitta dosha)

3.     Kaphaja arshas(due to aggravation of kapha dosha)

4.     Tridoshaja arshas(due to aggravation of all the three doshas at the same time)

रुपाणि ॥ Signs and symptoms

Clinical features of Gudarshas are described in brief below,

• Sahaja arshas – weakness , emaciation since birth, irregular bowel movements, pain in the stomach region, change in stool color (pale yellow, white, reddish etc), suffers from dysentery, constipation from time to time, frequent dizziness and laziness.
• Kalaja arshas – Due to gudarshas, agni is affected it becomes weak and that ultimately affects overall metabolism. Disturbed metabolism leads to emaciation, weakness, loss of energy, discharge through anus, difficulty in defecation and many other symptoms like coughing, breathlessness, vomiting, swelling, sneezing etc. Therefore gudarshas located in anal region have the potential to cause signs and symptoms across all body systems and have wide rage of signs and symptoms.

चिकित्सा ॥ General management

Gudarshas treatment has been discussed in detail in Ayurveda. The different types of treatments applied here are discussed in brief here,

• Oil application locally on guda
• Pottali or application of medicated poultice as a method of fomentation after oil application
• Sechana or pouring of medicated decoction over the affected region
• Sitz bath with herbal decoction like triphala (a combination of three powders), or medicated buttermilk etc.
• Application of medicated ointments
• Raktamokshana (bloodletting procedure)
• Internal administration of medications like takrasrishta, pippalyadi ghrita, abhayaarishta etc
• Basti karma. (Panchakarma therapy wherein herbal decoction or oil is administered through anal region)
• Kshar karma (application of alkali) and agni karma (thermal cauterization)

भगंदरः ॥ Bhagandara

Bhagandara in guda region is a condition which can be corelated with Fistula-in-ano.

Bhagandara is a painful draining track or canal with one opening present in and around guda, vasti(urinary bladder), bhaga(genital region).

भेदाः ॥ Types

There are five types of bhagandara

1. Vataja or shataponaka bhagandara
2. Pittaja or ushtragreeva bhagandara
3. Kaphaja or parisravani bhagandara
4. Sannipataja or shambhukavarta bhagandara
5. Agantuja or unmargini bhagandara

पूर्वरूपाणि ॥ Premonitory symptom

Certain signs and symptoms that manifest before actual Bhagandara is developed are known as Purvarupas or premonitory symptoms of Bhaganadara and they are as below,

‘तेषां पूर्वरूपं गुदकण्डूदाहशोफागुदायामश्चेति सर्वेषां सामान्यम्’ (sush.nida.4.4 gaydas vyakha)

Meaning: Itching, burning sensation, edema in the guda or anal region are the general premonitory symptoms of bhagandara.

रूपाणि ॥ Symptoms

Symptoms or clinical features of Bhagandara according to dosha dominant types are listed in short below,

1. Vataja or shataponaka bhagandara – Aggravated vata dosha causes severe pain, blisters with frothy and reddish discharge, multiple openings and oozing of urine, stools etc through it.
2. Pittaja or ushtragreeva bhagandara – aggravated pitta dosha ripens the lesion faster, the shape of the blister resembles neck of the camel, foul smelling and ushna(heated)discharge is present.
3. Kaphaja or parisravani bhagandara – aggravated kapha dosha causes mild pain, and the blisters are hardened with dense and white discharge along with itching.
4. Sannipataja or shambhukavarta bhagandara – aggravated three doshas causes various kinds of pain, heavy discharge of various colour etc.
5. Agantuja or unmargini bhagandara – external injury leads to agantuja bhagandara, which if neglected can cause pain and build of microrganisms.

चिकित्सा ॥ General management

Raktamokshana(bloodletting), agnikarma(thermal cautery),kshara karma(alkali application) etc are certain general management protocols in the successful treatment of bhagandara.

परिकर्तिका ॥ Parikartika

Parikartana means cutting. Thus parikartika refers to the cuts in the guda or anal region that are popularly known as anal fissures. Also, when there is cutting and piercing type of pain in the guda region region it is known as parikartika. It is a vata dosha dominant disorder of the guda, which affects dhatus like tvak (skin), mamsa(muscle) and rakta(blood). (sush.nida.1.25-26) ?

रुपाणि ॥ Symptoms

Common signs and symptoms of parikartika are,

• Sharp cutting pain
• Pain before and after defecation.
• Blood filled mucous discharge
• Discomfort in anal region

Parikartika as a symptom of other diseases

Parikartika is found as a symptom in various disorders and as an ill effect of certain inappropriately done panchakarma methods.

In relation with Disease	As side effect
Udawarta or purishaja udavarta which precisely means reverse movement or pathological movement of vata dosha. Fissure occurring due to injury to the guda region due to formation of hard stools. (sush.utta.55.8)	Niruha basti vyapad – niruha basti is a type of basti method which includes administration of medicated decoction through anal route, thus as an ill effect of the medication parikartika is seen.(sush.chik.36.37)
Atisaara – in vata dosha type of atisara, spasm of the sphincters occurs leading to fissures. (char.chik.19.5)	Basti netra vyapad – basti therapy is administered through a certain instrument which is conical and round with soft edges, thus if any defect in the mouth of the instrument can cause fissures or parikartika over the anal region. (char.sidd.5.5/comm))
Jwara – in jeerna jwara which is type of fever, wherein due to unclear bowel, parikartika is seen as a symptom. (char.chik.3.186)	Excessive administration yapana basti(a type of basti therapy) therapy can cause parikartika along with other disorders. (char.siddh.12.30)
Arsha, certain kinds of arshas affects the guda vali or the anal spincters, leading to the formation of both arshas and parikartika. (sush.nida.2.9)	As virechana vyapad - ill effect after inappropriately done virechana or purgation procedure. (sush.chik.34.16/dalhana comm)
In grahani roga which is corelated with irritable bowel syndrome, wherein vata dosha is involved, parikartika is seen as a symptom. (char.chik.15.62)