Shoola Types, Symptoms, Treatment, Medicines, Remedies

Article by Dr Raghuram Y.S. MD (Ay)
Sudden pain occurring in the abdomen is called Shula. The person suffering from Shula feels as if pierced or torn apart by a sharp weapon of the like of a trident. 

Definition of Shula

शूल रोपणवत् पीडा यस्य आकस्मात् प्रजायते।
त्रिशूल संभवं च एनं शूलं आहुः पुराविदः॥(यो.र.शूल निदानम्.३)
शङ्ख स्फोटनवत् तस्य यस्मात् तीव्रा च वेदना।
शूलासक्तस्य भवति तस्मात् शूलम् इह उच्यते॥(यो.र.शूल निदानम्.४)
Shankha sphotanavat tasya yasmaat teevraa cha vedanaa
Shoolaasaktasya bhavati tasmaat shoolam iha uchyate (Ref – Yoga Ratnakara Shula Nidaanam 4)

Pain in the abdomen resembling ‘Shankha Sphotana’ i.e. ‘blasting pain in the temples’ is called Shoola

Types of Shoola

Shula is of 8 types. They are:

1. Vatika Shoola – caused by vitiated Vata
2. Pittaja or Paittika Shula – caused by vitiated Pitta
3. Shlaishmika or Kaphaja Shoola – caused by vitiated Kapha
4. Sannipataja Shula – caused by all 3 vitiated doshas
5. Vata-Pittaja Shula – caused by vitiation of Vata and Pitta
6. Vata-Kaphaja Shula – caused by vitiation of Vata and Kapha
7. Pitta-Kaphaja Shoola – caused by vitiation of Pitta and Kapha
8. Amaja Shula – caused by Ama or improperly formed (immature) essence of nutrition / digestion (intermediate products of digestion)

Parinama Shoola and Annadrava Shoola are special types of shula and its variants. They have not been included under the 8 types of shool because of the unique way of their presentation. Both these type of shoolas closely resemble with peptic ulcers and have a strong relationship with the food intake.

Parinama Shula – closely resembles duodenal ulcers
Annadrava Shula – closely resembles gastric ulcers

Treatment of Shoola

General principles of treating shoola include skilful administration of the below said (depending on dosha involvement and nature of the disease):

• Vamana – therapeutic emesis
• Langhana – fasting (therapies and measures producing lightness in the body)
• Swedana – steaming or hot fomentation
• Pachana – digestants, medicines which digest the immature essence of nutrition / digestion in circulation (ama), which is the root of many metabolic diseases
• Phalavarti – suppositories
• Kshara – alkalis
• Churna – herbal powders
• Kshara gutika – tablets made up of alkalis

In Vata predominance

• Snehana – external and internal administration of medicated oils and ghee
• Payasa – sweetened preparation with milk, rice, cardamom, raisins, cashew etc
• Krushara – semisolid preparation of rice with green grams, ginger, ghee etc
• Snigdha Pishita – meat preparation enriched with ghee and or oil

External measures:
Tila Sweda – Sesame fomentation – Sesame should be grinded in Kanji (sour fermented herbal liquid or rice wash water kept until it gets sour and formented) and made into paste. This paste is tied in a bolus using sterile cloth. This bolus should be made hot on a pan. This bolus is rubbed all over the abdomen especially in the painful area.

Bilwadi sweda – Powder of bark of Bilwa (Aegle marmelos), powder of root bark of erandamula (root of castor plant) and tila (sesame) should all be grinded in Kanji, tied in a bolus, made hot and rubbed gently over the abdomen

Madana lepa – Madana phala (fruit of Randia dumetorum) should be grinded in Kanji and made into paste. This paste is applied around the navel region.

Hingwadi kalka – hingu (asafoetida), tila taila (sesame oil) and saindhava lavana (rock salt) made into paste with urine of cow should be applied around the navel region

Sarshapadi lepa – Sarshapa (mustard) and shigru twak (bark of drumstick) tree made into paste by grinding them in buttermilk should be applied all over the abdomen

Useful formulations:

• Kulattadi Yusha – Soup prepared using Saindhava Lavana (rock salt), shunti (ginger), pippali (long pepper), maricha (black pepper), dadima (pomegranate) and kulattha (horse gram) mixed with ghee
• Balaadi kwatha – decoction of equal portions of bala (Sida cordifolia), Punarnava (Boerhavia diffusa), eranda mula (roots of castor plant), brihati (Solanum indicum), kantakari (Solanum xanthocarpum) and Gokshura (Tribulus terrestris) mixed with Hingu (asafoetida) and saindhava lavana (rock salt)
• Nagaradi Kwatha – decoction of shunti (ginger) and eranda mula (roots of castor plant) mixed with purified hingu (asafoetida) and Suvarchala lavana (Souchal salt)
• Indrayava kwatha – decoction of indrayava (seeds of Holarrhena andidysenterica) mixed with purified hingu (asafoetida) and suvarchala lavana (souchal salt)
• Dashamula kwatha (decoction of 10 roots) mixed with eranda taila (edible castor oil)
• Dashamoola kwatha (decoction of 10 roots) mixed with purified hingu (asafoetida) and suvarchala lavana (souchal salt)
• Karanjadi churna – Powder of equal quantities of Karanja (Pongamia pinnata), suvarchala lavana (souchal salt), shunti (ginger) and shuddha hingu (purified asafoetida) mixed in hot water

In Pitta predominance

Vamana (therapeutic emesis) – with decoction of Patola patra (leaves of pointed gourd) and ikshu rasa (sugarcane juice)
Virechana – should be administered after Vamana

Useful formulations:

• Shatavaryadi kwatha – decoction of Shatavari (Asperagus racemosus), Yashtimadhu (Glycyrrhiza glabra), Bala (Sida cordifolia), Kusha (Desmostachya bipinnata), Gokshura (Tribulus terrestris), made cold, mixed with old jaggery and honeyBrihatyadi Kwatha – decoction of brihati (Solanum indicum), Gokshura (Tribulus terrestris), erandamula (roots of castor plant), Kusha (Desmostachya bipinnata), Ikshu mula (roots of sugarcane), sugandha bala (Valerian wallichii)

  Triphala-Aragwadhadi Kwatha – decoction of Haritaki (Terminalia chebula), bibhitaki (Terminalia bellirica), Amalaki (Emblica officinalis) and Aragwadha (Cassia fistula) mixed with honey and sugarShatavari rasa – Juice of Asparagus racemosus or its decoction mixed with honey should be given early in the morning
  Amalaki swarasa – juice of Amla mixed with sugar should be given early in the morning on empty
  stomach
  Gudadi yoga – payasa or sweetened preparation with guda (old jaggery), shali (rice), yava (barley) and ksheera (milk)
  Ksheera-sarpi – milk mixed with ghee
  Jangala mamsa rasa – meat soup of animals living in desert areas

  

In Kapha predominance

The below said are highly beneficial in Kaphaja Shoola –

• Shaali dhanya – rice
• Jangala mamsa – meat of the animals living in the desert regions
• Arishta – neem
• Katukam rasam – pungent foods
• Madhya – medicinal fermented liquids or alcoholic preparations
• Jeerna godhuma – old wheat

Other useful formulations –

• Patoladi Kwatha – Decoction prepared using Patola patra (leaf of pointed gourd), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Amalaki (Emblica officinalis) and Guduchi (Tinospora cordifoila) should be taken mixed with honey.
• Drakshadi Kwatha – Decoction of Draksha (raisins) and Vasa (Adhatoda vasica)
• Pathyadi Kwatha – decoction of Pathya (Terminalia chebula), indrayava (seed of Holarrhena antidysenterica) and Pushkaramula (Inula racemosa) added with powders of purified asafoetida, long pepper and Aconitum heterophyllum (Ativisha)
• Matulunga rasa (juice of citron fruit) added with Yava kshara (alkali of whole plant of barley) and honey
• Shigru kwatha (decoction of bark of drumstick) mixed with Yava kshara and honey
• Loha bhasma (ash of iron) mixed with Triphala churna (powder of 3 fruits), honey and ghee

Pathya Apathya

As per Chakradatta,
For Vata aggravation, oils and fats along with horse gram soup, mixed with rock salt, Trikatu, asafoetida, black salt and pomegranate is beneficial.
For Pitta aggravation, jaggery,barley, rice, milk, ghee are suitable
For Kapha aggravation, rock salt, table salt, black salt, ginger, long pepper, asafoetida, hot wáter are suitable.

Pathya-Apathya (wholesome and unwholesome things) in Shula
The below said are said to be wholesome and beneficial (pathya) in shula:

• Patola – pointed gourd
• Karavellaka – bitter gourd
• Kshara – alkalis
• Shigru – drumstick
• Samudra lavana – Sea salt
• Lashuna – garlic
• Ushna jala – hot water
• Jambhira rasam – juice of Citrus medica
• Kushta – Saussurea lappa
• Eranda taila – castor oil
• Gomutra – urine of cow
• Vastukam – Chenopodium album
• Samvatsaroshita shali – rice stored from 1 year
• Laghu padartha – foods which are easy and light to digest

The below said are the unwholesome things in shula:

• Ruksha – dry foods
• Tikta – bitter foods in excess
• Kashaya – astringent foods in excess
• Katu – pungent foods in excess
• Amla – sour foods in excess
• Madhya – alcohol
• Vaidalam – dicots
• Tila – sesame
• Sheeta – cold foods and exposure in excess
• Guru – heavy to digest foods
• Viruddha bhojana – mutually incompatible foods
• Vyaayama – excessive physical exercise
• Maithuna – excessive indulgence in sex
• Vegavarodha – forcibly controlling the natural urges
• Shoka – grief, sorrow
• Krodha – anger
• Ratri jagarana – awakening till late night

Apathya – Yogaratnakara

Black gram etc. grains, alcohol, sexual intercourse, intake of cold substances, exposure to sunlight, being awake at night, anger, grief, sour substancs like fermented gruel etc.,

Ayurvedic medicines

Best Ayurvedic medicines for Peptic Ulcers and shoola: 

Bhasma (calx) etc:
Shankha Bhasma
Shukti bhasma
Mukta shukti bhasma
Shambuka bhasma
Kapardika bhasma
Abhraka bhasma
Mandura bhasma
Giloy satva
Pravala pishti etc

Avaleha / Rasayana (confections):
Kushmanda Rasayana
Chyavanprash
Vilwadi leham
Gudardrakam etc

Ghrita (medicated ghee):
Sukumara ghritam
Indukantam ghritam
Triktakam ghritam
Shatavari ghritam etc

Proprietary Medicines

• Tab Acidon (Dhanwantari)
• Tab Alsarex (Charak)
• Tab Amlonil (Manil)
• Tab Gasex (Himalaya)
• Tab Ayurzyme (BAN)
• Tab Gupizyme (Gufic)
• Tab Amlaparimala (Pavaman)
• Tab Amlapittantak Yog (Baidyanath)
• Tab Calci-7 (Unjha)
• Tab Sooktyn (Alarsin)
• Cap Pepcer (Ayulabs)
• Cap Zulcer (Gufic)
• Cap Gaso-Cap (Kumar)
• Cap Gid (Capro)
• Cap GID Plus (Capro)
• Cap Plantacid (Solumiks)
• Cap Oracid (Fizikem)
• Syrup Madiphala Rasayana (Kesari)
• Syrup Ojus (Charak)
• Syrup / Tab Pep-Up (Vasu)
• Syrup Ayucid (Ayush)
• Syrup Jeeraka Rasayana (Nanjangud)
• Suspension / Tab Himcocid (Himalaya)
• Suspension Pepcer (Ayulabs)
• Syrup Zulcer (Gufic)
• Syrup Alopazyme (Alopa)
• Drops / Syrup / Tab Dilapsin (Solumiks)
• Powder Acidex (Everest)
• Granules Kerakhand (Everest)
• Powder Kusuma Amrita Churna (Kumar)
• Linctus Rakshodara (Pentacare)
• Linctus Kandamla Rasayana (Nanjangud)

Vati / Gulika (tablets):
Chitrakadi Vati
Shanka vati
Mahashanka vati
Kamadugha ras
Shula gajakesari ras
Chandrakala ras
Leelavilasa ras
Amlapittantak loha
Punarnavadi mandura
Dhatri loha etc

Churnas (herbal powders for internal consumption):
Hingwashtaka Churna
Yashtimadhu churna
Higuvachadi churna
Avipattikara churna
Yava kshara churna
Narikela lavana churna

Single herbs

Single herbs useful in Peptic ulcers

• Yashtimadhu – Glycyrrhiza glabra (Indian licorice)
• Amrita – Tinospora cordifolia
• Patola – Pointed gourd
• Shatavari – Asparagus racemosus
• Amalaki – Indian gooseberry
• Punarnava – Boerhavia diffusa
• Ashwagandha – Withania somnifera
• Loha – iron
• Kshara – alkali
• Mandura – waste product of iron
• Shanka – conch
• Shukti – shells
• Yava – Barley
• Narikela – coconut

Effective decoctions for Pains and Colic from Sahasrayogam

1. Soolahara Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 44, 57

a. Nirgundyadi Kashayam

b. Palasha Twak Kashayam

c. Erandadi Kashayam

d. Erandadi Kashayam 2

2. Shleshmajwarahara Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 4

3. Satavaryadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 19

4. Bilwambudadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 47

5. Dhanyabalakadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 48

6. Vidalin Veradi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 67

Other Yogas From Sahasra Yoga Text Book
Deepaneeya Peya
Indukantha Ghrita
Dasanga Ghrita
Sasa Vasadi Ghrita
Trikatukadi Choorna (Choorna Raja)
Kayampurandaradi Choorna
Hingu Twagadi Choorna
Karpooradi Choorna
Modakadi Choorna
Soolari Choorna
Soolahara Choorna
Swayam Bhasma
Mahavriksha Lavana
Tambula Bhasma
Vaiswanara Choorna
Dasamoolarishata
Kumaryasava
Satavari Guda
Madhusnuhi Rasayana
Pulimkuzhambu
Gudardraka
Kukkuta Rasayana
Suryaprabha Gutika
Setubhanda Matra
Paccha Endiyadi Gutika
Soolakuthara Rasa
Ananda Rasa
Kanakasundara Rasa
Anthrakuthara Rasa
Mulayiladi Kashaya
Viralveradi Kashaya

Click to Consult Dr Raghuram Y.S. MD (Ayu)