E-ISSN:2456-3110

Review Article

Shoola Vyadhi

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Clinical understanding of Shoola Vyadhi

Jambavathi S.1*, Shailaja S V.2
DOI:

1* S Jambavathi, Assistant Professor, Department of Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Center, Bengaluru, Karnataka, India.

2 V Shailaja S, Professor and HOD, Department of Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Center, Bengaluru, Karnataka, India.

Shoola Vyadhi is a condition which occurs as an Upadrava (complication) of Gulma Roga or it occurs alone as a single disease.[1] Shoola can be considered as colicky type of pain in the abdomen. Its Nidana (cause), types, Lakshana (clinical features) and Chikitsa (treatment) has been dealt in detail in Sushruta Samhita.[2] Here an attempt is made to understand the Shoola Vyadhi and its treatment explained in the Samhita and its clinical aspects.

Keywords: Shoola Vyadhi, abdominal colic

Corresponding Author How to Cite this Article To Browse
S Jambavathi, Assistant Professor, Department of Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Center, Bengaluru, Karnataka, India.
Email: 		S Jambavathi, V Shailaja S, Clinical understanding of Shoola Vyadhi. J Ayu Int Med Sci. 2022;7(1):260-266.
Available From
https://jaims.in/jaims/article/view/1645

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-26 2022-01-28 2022-02-04 2022-02-11 2022-02-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by S Jambavathi, V Shailaja Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Jambavathi S. et al: Clinical understanding of Shoola Vyadhi

Introduction

Shoola Vyadhi is explained in Uttaratantra of Sushruta Samhita in Gulma Pratisheda Adhyaya. Gulma is considered as a round mass like Granthi which occurs between Hrudaya and Basti which is either moving or stagnant.[3]

When Gulma left untreated gives rise to Upadrava (complication) which is termed as Shoola.[4] Shoola can also occur alone as an individual disease without preceded by Gulma.[5]

Shoola as Upadrava of Gulma: Shoola which occurs as Upadrava of Gulma is characterised by pain as if a nail has been struck in.[6]

It is classified again based on the Dosha involved.

Vataja Shoola[7] Vinmutrasamrodha (retention of faeces and urine) Kruchrochwasa (difficult breathing) Sthirangata (compactness in body)
Pittaja Shoola[8] Trishna (thirst) Daha (burning sensation) Bhrama (giddiness) Annasya Vidagdhaparivruddhita (increase in pain during semi-digestion of food)
Kaphaja Shoola[9] Romaharsha (Horripulation) Aruchi (anorexia) Chardi (vomiting) Bhukta Vruddhi (increase in pain just after taking food) Jadangata (stiffness in the body)

Chikitsa

Vataja[10]

Haritaki, Saindhava, Sauvarchala, Bida Lavana, Yavakshara, Hingu, Tumburu, Pushkaramula, Yavani, Haridra, Vidanga, Amlavetasa with Ushna Amla Kanji

Pittaja[11]

Vidari, Triphala, Shatavari, Shringataka, Gudasharkara, Gambhari, Mahuyashti, Parushaka, Chandana with warm milk.

Kaphaja[12]

Vacha, Ativisha, Devadaru, Haritaki, Maricha, Indrayava, Pippali, Pippalimula, Cavya, Shunti, Yavakshara and Chitraka with Ushna Jala.

Vataja[13]

  • Seka
  • Avagaha
  • Pradeha
  • Abhyanga
  • Bhojana

Pittaja[14]

  • Shishirodaka For
  • Poornana
  • Bhojana
  • Dharana

Kaphaja[15]

  • Vamana
  • Unmardana
  • Sweda
  • Langhana
  • Kshapana Kriya

Vina Gulma Shoola

Nidana (causative factors)[16]

This include Vata Mutra Purisha Nigraha (Suppression of flatus, urine, and faeces), Ati Bhojana (over-eating), Ajeerna (indigestion), Adhyashana (eating before previous food is not digested), Ayasa (exertion), Virrudha Ashana (incompatible food), Paneeya Paanaat Kshutkale (intake of water while hungry), Viruda Sevana (use of germinated seeds), Pishtanna (use of floury edibles), Shushka Mamsa (dried meat).

Samprapti (pathology)[17]

Due to various Nidana (causative factors) the Vayu gets aggravated in Koshta which produces Shoola. Patient will have Vedana (pain) on Nirucchvasa (holding breadth).

Types

1. Vataja Shoola

Features: Pain increases in empty stomach, Prastabda Gaatra (rigidity), difficult breathing, difficulty to pass Vata (flatus), Mutra (urine) and Pureesha (stools)[18]

Treatment

  • To control Vata Swedana with Payasa, Krushara, Pishita
  • Snigdha Ushna Bhojana
  • When Vataja Shoola the Ruksha patient should be fed with Snigdha Bhojana.
  • He should be served with well processed Ghrtapura (gheura sweet) and Varuni for drinking[19]

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Probable clinical conditions: Duodenal ulcer[20]

2. Pittaja Shoola

Features: Trushna (thirst), Daha (burning sensation), Mada (narcosis), Murcha (fainting), severe pain and liking for cold and relief by cold[21]

Treatment

  • Patient is made to drink cold water and asked to vomit until he gets relief.
  • Should use all cold things
  • Mani, Rajata, Tamra filled with water is kept on the site of pain
  • Guda, Shali, Yava, Ksheera, Ghrita, Jangala Mamsa, Virechana[22]

Probable clinical conditions: Nil

3. Kaphaja Shoola

Features: Hrullasa (nausea) during pain, PurnaKoshtatva (fullness of abdomen), Guru Gatratva (heaviness in body)[23]

Treatment

  • In Kaphaja pain increases after meal
  • Vamana, Ruksha Sweda, Ushna Kriya
  • Pippali, Shunti[24]

Probable clinical conditions: Gastric ulcer[25]

4. Sannipataja Shoola

Features: Lakshana of all Shoola are seen

Treatment: It is Asadhya[26]

Probable clinical conditions: Nil

5. Parshwa Shoola

Features: Kapha situated in Parshwa (flank region) obstructs Vayu which produces Adhmana (distension), Gudagudayana (gurgling sound), needling pain and difficult breathing. The patient does not like to eat or sleep because of severe pain. This is known as Parshwa Shoola caused by Kapha and Vata.[27]

Treatment


  • Pushkaramula, Hingu, Sauvarchala, Bida, Saindhava, Tumburu, Haritaki, mixed with Yava Kwatha
  • Ghruta told for Pleehodara[28]

Probable clinical conditions: Renal colic[29], Biliary colic[30]

6. Kukshi Shoola

Features: When Vayu gets aggravated in Kukshi (belly) it causes Mandagni, the food taken is stagnated and does not get digested. The person with Ama Shakrut breathes deeply and has frequent attack of pain and does not get relief in sitting, lying or standing. This condition is called Kukshi Shoola caused by Ama due to Vata[31]

Treatment:

  • Vamana, Langhana, Deepana, Pachana
  • Nagaradi Kwatha
  • Virechana, Anuvasana Basti, Niruha Basti
  • Upanaha, Snehaseka, Dhanyamla Parisheka, Avagaha[32]

Probable clinical conditions: Pancreatitis[33], Intestinal obstruction[34]

7. Hrut Shoola

Features: Vayu mixed with Rasa and obstructed by Kapha and Pitta gets located in Hrudaya and causes pain creating severe difficulty in respiration. This is known as Hrut Shoola caused by Rasa and Vayu.

Treatment: Treatment of Hridaya Vikara[35]

Probable clinical conditions: Myocarditis, Pericarditis[36]

8. Basti Shoola

Features: Vayu aggravated by suppression of Vega stays covering the Basti (urinary bladder) which produces pain in Vankshana (pelvis), groin and Nabhi (umbilicus). This is known as Basti Shoola caused by Vayu which produces retention of Vit (faeces), Mutra (urine) and Vata Samrodha (flatus)[37]

Treatment: Vamana, Langhana, Swedana, Pachana, Phala Varti, Kshara, Churna, Gutika[38]

Probable clinical conditions: Cystitis[39], Colic due to urinary bladder stones[40]

9. Mutra Shoola

Features: When aggravated Vayu located in Nabhi, Vankshana, Parshwa, and Kukshi, particularly pressuring on Medra, Antra takes over urine and creates pain. It is known as Mutra Shoola caused by Vayu.[41]


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Treatment: Vamana, Langhana, Swedana, Pachana, Phala Varti, Kshara, Churna, Gutika[42]

Probable clinical conditions: Colic due to urethral stone[43], Stricture urethra[44]

9. Vit Shoola

Features: In the person indulging in Ruksha Ahara, Vayu gets aggravated and obstructs Mala in Koshta, causes Mandagni and Strota Avarana produces pain in right and left Kukshi. It increases rapidly and moves all over with sound, severe Trushna and Bhrama, Murcha. Patient does not get relief after defecation and urination. It is very painful and called Vit Shoola.[45]

Treatment: Vamana, Langhana, Swedana, Pachana, Phala Varti, Kshara, Churna, Gutika[46]

Probable clinical conditions: Intestinal Obstruction[47]

10. Anna Shoola

Features: In spite of poor digestive fire, food is taken in excessive quantity, it stagnates in the abdomen and Vayu takes Ashraya there. It is not digested and produces severe pain associated with Murcha, Adhmana, Vidaha, Hritklesha, and Vilambika. The patient suffers from diarrhoea, vomiting, Kampa, Moha. This pain arises due to Ajeerna and is caused by defective food.[48]

Treatment: Vamana, Langhana, Swedana, Pachana, Phala Varti, Kshara, Churna, Gutika[49]

Probable clinical conditions: Gastroenteritis[50]

Discussion

Shoola Vyadhi explained by Acharya Sushruta can be considered as abdominal colic considering its clinical features where patient experiences severe pain.

Shoola which occurs as Upadrava of Gulma might be of obstructive pathology hence causing colicky pain.

Vataja Shoola has similarity in clinical features with duodenal ulcer where hunger pain is the predominant feature.

Kaphaja Shoola has similarity in clinical features with gastric ulcer where the pain starts on intake of food.

Parshwa can be considered as flank region based on the description. And Parshwa Shoola is similar to clinical features of renal colic or biliary colic where there is severe pain in flank region. Also Acharya Sushruta has explained only about bladder stone. So renal and ureteric calculi which produces colicky pain in flank can be contemplated here.

Kukshi can be considered as middle quadrants of the abdomen. Kukshi Shoola is similar to clinical presentation of pancreatitis and intestinal obstruction where patient experiences agonising pain and does not find relief in standing or sitting.

Hrut Shoola is the pain in pericardium. Hrut Shoola is similar to clinical features of pericarditis and myocarditis where patient experiences shortness of breath.

Basti Shoola is similar to clinical presentation of Cystitis and urinary bladder stones characterised by colicky pain in bladder.

Mutra Shoola is similar to Colic due to urethral stone or Stricture urethra both characterised by painful micturition.

Vit shoola has similar features to intestinal obstruction particularly large bowel obstruction

Anna Shoola is very similar to Gastroenteritis causing abdomen pain, vomiting and diarrhoea.

Conclusion

Sushruta Acharya having comprehensive knowledge has explained about the causes, clinical features and treatment of Shoola Vyadhi in detail. Shoola which occurs as Upadrava of Gulma and Shoola which occurs individually; both have more severity in pain compared to the other conditions which needs immediate care. Various treatment which gives quick relief are explained in Shoola Vyadhi Chikitsa. Various Acute and chronic abdomen conditions can be understood and treated on the principles of Shoola Vyadhi.

Reference

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Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)263
Jambavathi S. et al: Clinical understanding of Shoola Vyadhi
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