ANATOMICAL DISTRIBUTION OF SHUSHKA AND ARDRA ARSHA ACROSS CLASSICAL GUDA VALIS: A CROSS- SECTIONAL PROCTOSCOPIC STUDY

Abstract

Background: Classical Ayurvedic texts describes three functional Guda Valis within the anorectal region: Pravahini, Visarjaniand Samvarani. Arsha is broadly correlated with hemorrhoidal disease and is clinically classified as Shushka (non-bleeding piles) and Ardra Arsha (bleeding piles). Whether these phenotypes show site- specific distribution across the Guda Valis has not been evaluated in a clinical cohort. Objective: To assess the anatomical distribution of Shushka and Ardra Arsha across the three Guda Valis and examine associations with grade and anatomical position. Methods: This is Single-centre cross-sectional study included 80 patients aged 25-50 years with clinically diagnosed Arsha. Participants undervent structured Ayuvedic assessment, inspection, digital rectal examination and proctoscopy. The primary analysis tested the association between Guda Vali location and Arsha type. Pearson chi-square, Fisher exact and Monte Carlo chi-square tests (10,000 simulations for sparse multi-category tables) were used, with a two-sided significance level of 0.05. Results: Ardra Arsha was present in 54/80 participants, while 26/80 had Shushka Arsha. The predominant location was Samvarani Vali (71.3%), followed by Visarjani(26.3%) and Pravahini (2.5%). Distribution of Shushka and Ardra Arsha did not differ significantly across the Valis. Vali location was associated with grade of Arsha. Grade distribution differed between Shushka and Ardra groups, although the pattern was not a monotonic shift toward advanced grades. Burning was reported in 20/54 Ardra cases and 4/26 Shushka cases. Conclusion: In this clinic-based sample, Guda Vali location did not distinguish bleeding from non-bleeding Arsha. However, the marked concentration of cases in the Samvarani Vali and the association of Vali location with special presentation and grade support the clinical relevance of anatomical mapping. Multicentre studies using a standardized proctoscopic atlas, assessor- reliability testing and objective imaging are needed.