Types: Shulas are of eight types: They are four due to three doshas that are:
- Vaataj Shula
- Pittaj Shula
- Kaphaj Shula
- Tridoshaj due to combination of all the doshas
- Amaj shula is due to ama dosha
There are three more varieties of shulas due to different dual combinations of doshas:
- Vaat-kaphaj Shula
- Pitt-kaphaj Shula
- Vaat-pittaj shula.
However, in all these above mentioned varieties of shula, vaayu has a predominant role.
Aetio-pathogenesis of Vaataj Shula: In this type, vaat is severely vitiated by:
- Excessive physical exercise.
- Riding on animals, vehicles etc.
- Excessive sexual intercourse
- Keeping awake at nights
- Drinking too much of cold water
- Eating plenty of pulses like moong daal or arhar daal or by eating extremely dry non-fatty food
- Eating before the previous meal has been digested
- Consumption of astringent or bitter food, over-germinated cereals, incompatible food or dry non-fatty meat and vegetables.
- Suppression of the urges to defaecate, ejaculate, urine or to pass flatus.
- Grief, fasting and excessive laughter or talking too much.
All the above mentioned factors produce colicky pain in five regions, viz. the precordial region, flanks, back, sacral and the vesical region.
Clinical features of vaataj Shula:
- It is characterized by periods of exacerbations and remissions again and again and is associated with retention of faeces and flatus and pricking and tearing types of pain.
- The colicky pain becomes acutely exacerbated after the food has been digested, at twilights, during the cloudy weather and when it is cold.
- On the other hand, it is relieved by sudation, massage with oil etc. as well as by the intake of fatty and hot food.
Aetiopathogenesis of Pittaj Shula: In pittaj shula, pitta gets aggravated very soon by the excessive intake of alkaline substances, extremely pungent, hot and heart-burn producing food, oils, legumes, oil cakes or kulath soups, too acid or too sour food, various wines intake, anger, excessive sitting in front of fire or physical exercise, too much of exposure in the hot sun and over-indulgence in sexual intercourse causing ill digestion of food. Clinical Features:
- It produces colicky pain accompanied with thirst, fainting, a burning sensation and pain in the umbilical region. This colic is also associated with perspiration, vertigo and a sucking sensation.
- It gets exacerbated at noon and midnight, at the time of digestion of food and during the autumn season.
- On the other hand, it is relieved during the cold season, by the use of cold objects as well as by eating sweet and cold food.
Aetiopathogenesis of Kaphaj Shula: Consumption of too much of meat of swampy and aquatic animals, excessive intake of sugarcane juices, sesamum puddings and pancakes as well as other kapha producing aetiological factors cause vitiation of kapha and give rise to colicky pain.
Clinical Features: It is associated with nausea, cough, malaise, anorexia, excessive salivation, sensation of the stomach region being covered with wet clothes and a feeling of heaviness in the abdomen and the head. This colicky pain always gets aggravated after meals, at sunrise, during winters and early spring season.
Sannipaataj Shula: This type of colic is caused by the simultaneous vitiation of all the three doshas producing a mixture of all the above mentioned clinical features. The clinicians consider it to be a very troublesome condition; hence it should be discarded from treatment as it considered as assadhya rog.
Amaj Shula: Distension with the gurgling intestinal sounds, nausea, vomiting, sensation of heaviness and of being covered with wet clothes, constipation, excessive salivation and other features of kaphaj shula are the characteristic signs and symptoms of aamaj shula.
- The site of pain of kapha-vaataj shula is in the region of urinary bladder, precordium, flanks and back.
- The site of kapha-pittaj shula is in the epigastric, cardiac and the mid-umbilical regions
- The vaat-pittaj shula is characterized by a burning sensation and fever and is very severe.
Prognosis of the Doshaj Shulas: The colic due to a single dosha is curable; that due to a dual combination of doshas is difficult to cure; whereas the severe colic due to vitiation of all the doshas and also one associated with complications is incurable.
Parinaam Shula (Duodenal Ulcer): When vaayu, vitiated on account of its specific aetiological factors, gets localized, and getting enveloped by kapha and pitta becomes more powerful, it produces colicky pain. This colic occurs during the period of digestion and is called parinaamaj shula.
Further Classification of Parinaamaj Shula: It is recognized as vaataj when it is associated with flatulence, tympanitis, constipation, oliguria, restlessness and spasms. The pain gets relieved usually on taking fatty and warm substances. It is said to be pittaj when the colic is accompanied with thirst, a burning sensation, uneasiness and perspiration; it gets aggravated by taking pungent, sour and salty food and is relieved by taking substances having cold properties. It is diagnosed to be kaphaj when the colic is associated with vomiting, nausea, confusion and pain is mild but remains persistent for a long time; it gets relieved on taking pungent and bitter substances. Mixed clinical features are seen when this is due to the vitiation of any of the two doshas.
Tridoshaj Parinaam Shula (Ulcer Cancer): The colic due to the vitiation of all the three doshas is associated with cachexia, excessive weakness and is markedly diminished digestive capacity. It is considered to be incurable.
Annadrava Shula (Gastric Ulcer): It is known to be a condition when the pain occurs either after the food has been digested, during its digestion or even before it has been digested; it neither subsides by the use of salutary or unsalutary substances nor by taking food or by remaining without food. In a patient of annadrava shula, the pain is not relieved as long as digestive juice is not expelled out by vomiting; it is then followed by a quick relief.