Abstract

AN ANATOMICAL REVIEW OF GUDA MARMA WITH SPECIAL REFERENCE TO SADYAPRAṆAHARATVA

*Dr. Vishal Wasudeorao Hend, Dr. Sushama Ramdas Pakade, Dr. Sharada Sambhaji Gosavi

Abstract

The Guda is classified as Sadyapranahara Marma by Sushruta. This term is generally considered to indicate a location where an injury would lead to instant death. However, such an interpretation cannot be applied to all clinical scenarios as minor injuries around the anal region and anorectal surgery procedures are seldom life-threatening. Also, within the same chapter of Sushruta Samhita, it is mentioned that the outcome of an injury to a Marma depends on the location of injury as well as the severity of the injury. This review examines the above-mentioned classical texts in combination with the anatomy of anorectal surgery and literature on serious rectal and anal traumas. Trauma to this area has the potential to cause pelvic vessel injury, rectal injury, sphincter injury and damage to the adjacent structures. It may cause life-threatening bleeding, shock, infection, peritonitis or sepsis. There havebeen several reports of fatal complications arising due to both immediate death due to massive hemorrhage as well as delayed death due to rectal perforation. The concept of perineum region is also emphasized by Siddha Varmam as well as Chinese acupuncture. However, they differ greatly from that of Guda Marma. It is suggested that the term Sadyapranaharatva be interpreted to mean high potential for fatal outcomes in case of severe trauma to this Guda Marma region.

Keywords: Guda Marma; Sadyapranahara; anorectal trauma; Marma injury; surgical anatomy; Varmam; acupuncture.