Introduction

The fast-paced, stressful, and hectic modern lifestyle has adversely affected the digestive system, a vital biological system referred to as Annavaha Srotas in Ayurveda. Annavaha Srotas denotes the pathway through which food travels. This alimentary canal, encompassing processes such as Anna Adana, Anna Pachana, Sara Kitta Vivechana, and Rasa Shoshana, is crucial for overall well-being. In Ayurveda philosophy, Dehagni governs life, vitality, physical appearance, strength, health, as well as Oja, Teja, and Prana. Any disruption within the Annavaha Srotas or the Dehagni can lead to the accumulation of Ama, a toxic substance according to Ayurveda, at any level, adversely impacting health and vitality. Ajeerna, the formation of Ama-Visha, Annadrava Shoola, and Parinama Shoola represent subsequent stages in the digestive process, triggered by disruptions in the metabolic functioning of the digestive fire, leading to the generation of intermediate products. Modern research links peptic and duodenal ulcers respectively to Annadrava and Parinama Shoola. Parinama Shoola, also known as abdominal colic or Shoola, manifests during the digestion process, typically occurring around three to four hours post-meal, as food progresses through the intestines. Acharya Madhav Nidana described Parinama Shoola as an "Avarana Janya, Tridoshaja Vyadhi," while Annadrava Shoola is characterized by discomfort before and during digestion, alleviating after vomiting. The cause of Annadravashoola is attributed to Vata Prakopa, wherein aggravated Vata Dosha envelops nearby Pitta and Kapha Doshas within the gastrointestinal tract, leading to colicky pain during food digestion.

Kapha subsequently undergoes breakdown within its own domain, engaging with Pitta and Vata, thereby instigating colicky pain during the processing of ingested food. This recognizable form of discomfort, commonly referred to as Shoola or colic, is well-documented.^[1,2]Top of FormBottom of Form

Concept of Parinama Shoola

The term "Parinama Shoola" is inherently descriptive, indicating abdominal colic experienced during the digestion process, typically occurring 3-4 hours post-meal as food progresses through the intestines. Parinama Shoola is classified as an "Avarana Janya, Tridoshaja Vyadhi."

Symptoms involving the combination of two or three doshas manifest when there's an elevation of two or three respective doshas. The Tridoshaja type, characterized by emaciation, weakened strength, and digestive issues, is regarded as extremely challenging to treat. ^[3]

Pathogenesis of Parinama Shoola

The progression of Parinama Shoola involves dry foods (such as barley, dry vegetables, and lean meats), irregular eating habits, and fasting exacerbating Vata, subsequently followed by Pitta and Kapha. Proper and comprehensive blockage, known as Samavritya, occurs, wherein aggravated Vata diminishes Pitta and Kapha.

Prognosis of Parinama Shoola^[3]

For Parinama Shoola of Tridoshaja nature, where all three Doshas are involved, it is considered incurable. Similarly, Parinama Shoola linked with complications becomes incurable when there is a decline or deterioration in Bala, Mamsa, and Agni.

Annadrava Soolam^[3]

जीणें जीर्यत्यजीर्णे वा यच्छूलमुपजायते ।।२१।।
पथ्यापथ्यप्रयोगेण भोजनाभोजनेन च ।
न शमं याति नियमात्सोऽन्नद्रव उदाहृतः ।।२२।।
(अन्नद्रवाख्यशूलेषु न तावत्स्वास्थ्यमश्नुते ।
वान्तमात्रो जरत्पित्तं शूलमाशु व्यपोहति ।।१।।

Another form of colic, termed Annadrava, presents with intense and persistent pain that persists regardless of digestion, food intake, comfort measures, or their absence. In this type, relief from pain is only achieved after the expulsion of accumulated pitta through vomiting.

Exploring the causes of Parinama Shoola and Annadrava Shoola in Ayurveda: Incorporating Peptic Ulcer Insights

Ayurveda attributes the causative factors of Parinama Shoola and Annadrava Shoola to Samana Vata, Pachaka Pitta, and Kledaka Kapha. Additionally, external influences include Slesmaja Krimi (H. pylori), a spiral-shaped, microscopic bacterium manifesting symptom such as abdominal pain, bloating, nausea, and burning stomach pain, closely resembling the Ayurvedic concept of Slesmaja Krimi as described by Acharya Charaka. Charaka, in Vimana Sthana, elucidated that Slesmaja Krimi, imperceptible to the naked eye, resides in the Amaasaya.^[4]

It results from local defects caused by inflammation compromising the mucosal integrity of the stomach or duodenal wall, typically developing chronically. Acid pepsin production, cellular renewal, mucous secretion, blood flow, mucosal barrier, prostaglandins, epidermal development, and Helicobacter pylori all play a role in its etiology. Additionally, it can be interpreted as an imbalance between the production of acid and the protective system of the stomach mucosa, including prostaglandin and bicarbonate. The lining of the stomach and duodenum, the top portion of the small intestine, become inflamed with ulcers.

The parietal cell, also known as the oxyntic cell, resides in the isthmus, neck, or oxyntic gland at its apical end. In its resting state or when unstimulated, it exhibits prominent cytoplasmic tubulovesicles and intracellular canaliculi with short microvilli. Upon stimulation, H, K-ATPase is expressed in the tubule's membrane, leading to the presence of long microvilli along with apical canaliculi. Acid secretion, a membrane-based process, transforms into a complex network of apical intracellular processes at the apical canalicular surface, requiring substantial energy. The oxyntic gland houses the acid-secreting parietal cell, which secretes intrinsic factor (IF) and contains receptors for gastrin, histamine, and acetylcholine, among other acid production stimulants. Various ligands and their associated receptors activate different signalling pathways, explaining why combinations like histamine and gastrin or acetylcholine can enhance acid production. In PUD, histamine, gastrin, and acetylcholine, which stimulate acid secretion, are associated with the aggressive element Vata. The major stomach secretory products potentially causing mucosal damage are HCl and pepsinogen. Basal acid production is primarily influenced by cholinergic input from the vagus nerve and histaminergic input from nearby stomach sources.

Discussion

Peptic ulcer disease, though not a recent discovery, has been long recognized in Ayurveda, correlating with concepts such as Parinama Shoola and Annadrava Shoola. According to Madhav Acharya Nidana, Annadravashoola presents unique discomfort patterns during and after food digestion, attributed to aggravated Vata dosha encircling Pitta and Kapha Doshas, causing colic discomfort.