The 26th chapter of Madhava Nidana deals with Shula, Parinama Shula, Annadrava shula which is Colic and Peptic ulcers. Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.
Types of Shula —
दोषैः पृथक् समस्तामद्वन्द्वैः शूलो अष्टधा भवेत् |
सर्वेष्वेतेषु शूलेषु प्रायेण पवनः प्रभुः || १ ||
dōṣaiḥ pr̥thak samastāmadvandvaiḥ śūlō aṣṭadhā bhavēt |
sarvēṣvētēṣu śūlēṣu prāyēṇa pavanaḥ prabhuḥ || 1 ||
There are eight types of shula; one from each dosha, one from the combination of all the three, one each from the combination of two doshas and the eighth from ama. However, the vata is the predominant causative dosha in all the types. 1
Vata Type of Shula —
व्यायामयानादतिमैथुनाच्च प्रजागराच्छीतजलातिपानात् |
कलाय – मुद्गाढकि – कोरदूषादत्यर्थरूक्षाध्यशनाभिघातात् || २ ||
कषाय – तिक्तातिविरुढजान्न – विरुद्ध – वल्लूरक – शुष्कशाकात् |
विट् – शुक्र – मूत्रानिलवेगरोधाच्छोकोपवासादतिहास्य – भाष्यात || ३ ||
वायुः प्रवृद्धो जनयेद्धि शूलं हृत्पार्श्व – पृष्ठ – त्रिक – बस्तिदेशे |
जीर्णे प्रदोषे च घनागमे च शीते च कोपं समुपैति गाढं || ४ ||
मुहुर्मुहुश्चोपशम – प्रकोपी विड्वात संस्तम्भन – तोद – भेदैः |
संस्वेदनाभ्यञ्जन – मर्दनाध्यैः स्निग्धोष्णभोज्यैश्च शमं प्रयाति || ५ ||
vyāyāmayānādatimaithunācca prajāgarācchītajalātipānāt |
kalāya – mudgāḍhaki – kōradūṣādatyartharūkṣādhyaśanābhighātāt || 2 ||
kaṣāya – tiktātiviruḍhajānna – viruddha – vallūraka – śuṣkaśākāt |
viṭ – śukra – mūtrānilavēgarōdhācchōkōpavāsādatihāsya – bhāṣyāta || 3 ||
vāyuḥ pravr̥ddhō janayēddhi śūlaṁ hr̥tpārśva – pr̥ṣṭha – trika – bastidēśē |
jīrṇē pradōṣē ca ghanāgamē ca śītē ca kōpaṁ samupaiti gāḍhaṁ || 4 ||
muhurmuhuścōpaśama – prakōpī viḍvāta sanstambhana – tōda – bhēdaiḥ |
sansvēdanābhyañjana – mardanādhyaiḥ snigdhōṣṇabhōjyaiśca śamaṁ prayāti || 5 ||
Factors that generate dryness inside the body include the following:
- Over indulgence in physical exercises, riding, sexual intercourse
- Keeping awake at nights
- Drinking cold water
- Ingestion of eatables articles like peas, green gram, pigeon peas (tuvar dal) koradusha and others, and
- Over eating
Factors such as
- An injury
- Taking eatables that are astringent, and bitter
- Germinated grains
- Incompatibles
- Dried up flesh and
- Leafy vegetables
The colic disorder could occur due to
- To suppression of urges of feaces, semen, urine, flatus;
- Grief , starvation or fasting
- Excessive laughing and speaking
All these activities make for morbid increase in Vata in the body that generates colic. Subsequently, pain is found in
- The region of heart, flanks, back, waist and urinary bladder.
The pain exacerbated
- during or after the digestion of eatables,
- In the evenings
- During cloudy and
- Cold weather
It also results in the blockage to the movement of faeces and flatus. The pain increases or decreases on its own accord frequently. The pain is pricking or tearing in nature. It could be reduced through use of warm fomentation, oil massage, fatty and warm eatables and drinks. 2-5
Pitta type of Shoola —
क्षारातितीक्ष्णोष्ण – विदाहि – तैल – निष्पाव – पिण्याक – कुलत्थयूषैः |
कट्वम्ल – सौवीर – सुराविकारैः क्रोधानलायास – रविप्रतापैः || ६ ||
ग्राम्यातियोगादशनैर्विदग्धैः पित्तं प्रकुप्याशु करोति शूलम् |
तृणमोह – दाहार्तिकरं हि नाभ्यां संस्वेद – मूर्च्छा – भ्रम – चोषयुक्तं ||७ ||
मध्यन्दिने कुप्यति चार्धरात्रे विदाहकाले जलदात्यये च |
शीते च शीतैः समुपैति शान्तिं सुस्वादुशीतैरपि भोजनैश्च || ८||
kṣārātitīkṣṇōṣṇa – vidāhi – taila – niṣpāva – piṇyāka – kulatthayūṣaiḥ |
kaṭvamla – sauvīra – surāvikāraiḥ krōdhānalāyāsa – ravipratāpaiḥ || 6 ||
grāmyātiyōgādaśanairvidagdhaiḥ pittaṁ prakupyāśu karōti śūlam |
tr̥ṇamōha – dāhārtikaraṁ hi nābhyāṁ sansvēda – mūrcchā – bhrama –
cōṣayuktaṁ ||7 ||
madhyandinē kupyati cārdharātrē vidāhakālē jaladātyayē ca |
śītē ca śītaiḥ samupaiti śāntiṁ susvāduśītairapi bhōjanaiśca || 8||
The following things promote pitta and generate colic:
- Over indulgence in eatables that are alkaline, heat producing, very warm;
- Taking food items that cause burning sensation during digestion
- Taking oils, cow pea, oil cake, soup of horse gram;
- Eatables that are pungent and sour,
- Fermented beverages like sauvira, sura.
The disease has been also seen as being produced through
- Anger
- Exposure to fire; fatigue and
- Prolonged exposure to warm sun;
- Sexual intercourse and
- Irritating eatables.
It is relieved during the
- Cold season
- By the use of cold objects as well as by eating delicious sweet and cold food.
Some of the symptoms of this disease are —
- Thirst
- Delusion
- Burning sensation near the umbilicus
- Perspiration
- Fainting
- Giddiness and
- Localized burning sensation
Pain exacerbates during
- mid day, or midnight
- Digestion of eatables
- And in rainy weather
It is reduced by
- Cold Comforts
- Cold and sweet eatables and drinks. 6-8
Shleshma type of shoola —
आनूप – वारिज – किलाट – पयोविकारैर्मांसेक्षु – पिष्ट – कृशरा – तिलशष्कुलीभिः |
अन्यैर्बलासजनकैरपि हेतुभिश्च श्लेष्मा प्रकोपमुपगम्य करोति शूलम् || ९ ||
हृल्लास – कास – सदनारुचि – सम्प्रसेकै – रामाशये स्तिमितकोष्ट – शिरोगुरुत्वैः |
भुक्ते सदैव हि रुजं कुरुते अतिमात्रं सूर्योदये अथ शिशिरे कुसुमागमे च || १० ||
ānūpa – vārija – kilāṭa – payōvikārairmānsēkṣu – piṣṭa – kr̥śarā – tilaśaṣkulībhiḥ |
anyairbalāsajanakairapi hētubhiśca ślēṣmā prakōpamupagamya karōti śūlam || 9 ||
hr̥llāsa – kāsa – sadanāruci – samprasēkai – rāmāśayē stimitakōṣṭa – śirōgurutvaiḥ |
bhuktē sadaiva hi rujaṁ kurutē atimātraṁ sūryōdayē atha śiśirē kusumāgamē ca || 10||
The following things promote Kapha and in turns, generates colic pain:
- Over indulgence in eatables prepared out of flesh of animals of marshy land and those living in water, buttermilk and other milk products, mutton, sugar
- Eatables containing powders of sesame, blackgram and the like.
Symptoms of the disease include
- Oppression in the chest (nausea)
- Cough
- Debility
- Anorexia
- Salivation
- Pain near the stomach
- Fullness
- Loss of movement in the stomach.
- Heaviness of the head
- Colic pain is severe soon after taking eatables, in the mornings at sunrise, in shishira and autumn and at the onset of the spring. 9-10
Tridosha shula and amashula –
सर्वेषु दोषेषु च सर्वलिङ्गं विध्याद्भिषक् सर्वभवं हि शूलम् |
सुकष्टमेनं विष – वज्रकल्पं विवर्जनीयं प्रवदन्ति तज्ज्ञाः || ११ ||
sarvēṣu dōṣēṣu ca sarvaliṅgaṁ vidhyādbhiṣak sarvabhavaṁ hi śūlam |
sukaṣṭamēnaṁ viṣa – vajrakalpaṁ vivarjanīyaṁ pravadanti tajjñāḥ || 11 ||
During all the times, the colic disorder caused by the combination of all the three doshas together will have all the features in severe form, powerful
and hard to treat as is the case of poisoning. 11
Aamaja Shula —
आटोप – हृल्लास – वमी – गुरुत्व – स्तैमित्यकानाह – कफप्रसेकैः |
कफस्य लिङ्गेन समान लिङ्गमामोद्भवं शूलमुदाहरन्ति || १२ ||
āṭōpa – hr̥llāsa – vamī – gurutva – staimityakānāha – kaphaprasēkaiḥ |
kaphasya liṅgēna samāna liṅgamāmōdbhavaṁ śūlamudāharanti || 12 ||
The features identical to those of Kaphaja type found in colic due to indigestion (Aamaja shoola) are —
- Aatopa — gurgling in the intestines
- Hrullasa — Oppression in the chest (nausea)
- Vami — Vomiting
- Gurutva – Feeling of heaviness
- Staimitya — Loss of movement
- Aanaha — Distension of the stomach
- Kapha Praseka — Salivation
- Shoola – Colic
Shula caused by Two dosha combinations —
बस्तौ हृत्पार्श्व – पृष्ठेषु स शूलः कफवातिकः |
कुक्षौ ह्रुन्नाभिमध्येषु स शूलः कफपैत्तिकः || १३ ||
दाहज्वरकरो घोरो विज्ञेयो वातपैत्तिकः |
bastau hr̥tpārśva – pr̥ṣṭhēṣu sa śūlaḥ kaphavātikaḥ |
kukṣau hrunnābhimadhyēṣu sa śūlaḥ kaphapaittikaḥ || 13 ||
dāhajvarakarō ghōrō vijñēyō vātapaittikaḥ |
Due to morbid increase in kapha and Vata together, pain is found
- In the region of heart, flanks and back.
Due to Kapha and Pitta –
- Pain in the heart, umbilicus, and centre of the stomach.
In case of Vata and pitta doshas vitiating together, there is
- Severe pain accompanied with burning sensation and fever. 13
Prognosis of Shula —
एकदोषोत्थितः साध्यः, कृच्छ्रसाध्यो द्विदोषजः || १४ ||
सर्वदोषोत्थितो घोरस्त्वसाध्यो भूयुर्पद्रवः |
ēkadōṣōtthitaḥ sādhyaḥ, kr̥cchrasādhyō dvidōṣajaḥ || 14 ||
sarvadōṣōtthitō ghōrastvasādhyō bhūyurpadravaḥ |
Colic caused by the increase in any one dosha is easily curable. The one caused by combination of any two doshas is curable with difficulty while that caused by combination of all the three doshas is impossible to cure, as it is very severe and associated with several further implications. 14
Parinama Shula (Peptic Ulcer) —
Dosha based symptomatology of Parinama shula —
स्वैर्निदानैः प्रकुपितो वायुः सन्निहितस्तदा || १५ ||
कफ – पित्ते समावृत्य शूलकरी भवेद् बली |
भुक्ते जीर्यति यच्छूलं तदेव परिणामजं || १६ ||
तस्य लक्षणमप्येतत् समासेनाभिधीयते |
svairnidānaiḥ prakupitō vāyuḥ sannihitastadā || 15 ||
kapha – pittē samāvr̥tya śūlakarī bhavēd balī |
bhuktē jīryati yacchūlaṁ tadēva pariṇāmajaṁ || 16 ||
tasya lakṣaṇamapyētat samāsēnābhidhīyatē |
If the vayu is provoked and is associated with kapha and pitta, the sula generated is very strong. The Shoola that subsides after intake of food is called
parinama shoola.
The symptoms of this Shoola are —
- Distension
- Gurgling noise in the intestines
- Blockage to the movement of faeces and urine
- Restlessness
- Severe suffering due to Vata
By use of fatty and warm eatables, the pain is reduced. 15-16
Pittaja Parinama Shula —
आध्मानाटोप – विण्मूत्रविबन्धाराति – वेपनैः || १७ ||
स्निग्धोष्णोपशमप्रायं वातिकं तद्वदेद्भिषक् |
तृष्णा – दाहारति – स्वेदं कट्वम्ल – लवणोत्तरम् || १८ ||
शूलं शीतशमप्रायं पैत्तिके लक्षयेद्बुधः |
ādhmānāṭōpa – viṇmūtravibandhārāti – vēpanaiḥ || 17 ||
snigdhōṣṇōpaśamaprāyaṁ vātikaṁ tadvadēdbhiṣak |
tr̥ṣṇā – dāhārati – svēdaṁ kaṭvamla – lavaṇōttaram || 18 ||
śūlaṁ śītaśamaprāyaṁ paittikē lakṣayēdbudhaḥ |
These symptoms are seen in Pittaja Parinama shula —
- Accumulation of gas
- Difficult urination
- Acute constipation
- Thirst
- Burning sensation
- Restlessness
- Perspiration and
- Pain increased by use of pungent, sour and salty eatables but reduced by cold eatables and comforts. 17-18
Kaphaja Parinama Shula Symptoms —
छर्दि – हृल्लास – सम्मोहं स्वल्प रुग्दीर्घसन्तति || १९ ||
कटु – तिक्तोपशान्तं च तच्च ज्ञेयं कफात्मकम् |
chardi – hr̥llāsa – sammōhaṁ svalpa rugdīrghasantati || 19 ||
kaṭu – tiktōpaśāntaṁ ca tacca jñēyaṁ kaphātmakam |
Symptoms of Kaphaja Shoola are —
- Vomiting
- Nausea
- Delusion
- Long continued mild pains being reduced by pungent and bitter
eatables. 19
संसृष्टलक्षणं बुद्ध्वा द्विदोषं परिकलपयेत् ||२० ||
त्रिदोषजमसाध्यं तु क्षीणमांस – बलानलम् |
sansr̥ṣṭalakṣaṇaṁ buddhvā dvidōṣaṁ parikalapayēt ||20 ||
tridōṣajamasādhyaṁ tu kṣīṇamānsa – balānalam |
In conditions of increase in two or three doshas together, appearance of features of two or three doshas are seen together. This is considered as impossible to cure and is associated with emaciation, loss of strength and digestion. 20
Annadrava Shula (Gastric ulcer) —
जीर्णे जीर्यत्यजीर्णे वा यच्छूलमुपजायते || २१ ||
पथ्यापथ्यप्रयोगेण भोजनाभोजनेन च |
न शमं याति नियमात् सो अन्नद्रव उदाहृतः || २२ ||
(अन्नद्रवाख्यशूलेषु न तावत् स्वस्थ्याश्नुते |
वान्तमात्रे जरत्पित्तं शूलमाशु व्यपोहति || १ || )
jīrṇē jīryatyajīrṇē vā yacchūlamupajāyatē || 21 ||
pathyāpathyaprayōgēṇa bhōjanābhōjanēna ca |
na śamaṁ yāti niyamāt sō annadrava udāhr̥taḥ || 22 ||
(annadravākhyaśūlēṣu na tāvat svasthyāśnutē |
vāntamātrē jaratpittaṁ śūlamāśu vyapōhati || 1 || )
There could be severe pain persisting throughout and not subsiding during or after digestion, with eatables or no eatables, use of comforts or no comforts in the colic known as annadrava shoola. Only after vomiting of
accumulated pitta gets reduced in this type. 21-22
इति श्रीमाधवकरविरचिते माधवनिदाने शूलपरिणामशूलान्नद्रवशूल निदानं समाप्तं || २६ ||
iti śrīmādhavakaraviracitē mādhavanidānē śūlapariṇāmaśūlānnadravaśūla nidānaṁ samāptaṁ || 26 ||
Thus concludes the chapter of Shoola and the like.
Source —
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I’m Dr. Malini Bhat MD (Ayu); an Ayurvedic Doctor and a health blogger. Follow me on social media to get daily health tips which you can easily adapt to a healthy lifestyle.