Article by Dr Raghuram Y.S. MD (Ay)
Parinama means transformation. The Shoola or colic or pain abdomen which occurs due to transformation (digestion) of the food is called Parinama Shoola.
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The Shoola (colic or pain abdomen) which occurs due to transformation (digestion) of the food is called Parinama Shoola. (Parinaama = transformation, digestion)
स्व निदानैः प्रकुपितो वायुः सन्निहतः तदा।
कफ पित्ते समावृत्य शूलकारी भवेत् बली॥
बलासः प्रच्युतः स्थानात् पित्तेन सह मूर्च्छितः।
वायुम् आदाय कुरुते शूलं जीर्यते भोजने॥
कुक्षौ जठर पार्श्वेषु नाभ्यां वस्तौ स्तनान्तरे।
पृष्ठ मूल प्रदेषेषु सर्वेषु एतेषु वा पुनः॥
भुक्त मात्रे अथवा वन्ते जीर्णे च अन्ने प्रशाम्यति।
षष्टिक व्रीहि शालीनां ओदनेन च वर्धते॥
तत् परिणामजं शूलं दुर्विज्ञेयं महा गदम्।
आहार रस वहानां स्रोतसां दुष्टि हेतुकम्॥
केचित् अन्नद्रवं प्राहुः अन्ये तत् पक्ति दोषजम्।
पक्ति शूलं वदन्ति एके केचित् अन्न विदाहजम्॥
भुक्ते जीर्यति यत् शूलं तत् एव परिणामजम्।
तस्य लक्षणं एतद् हि समासेन प्रकीर्त्यते॥(यो.र.शूल निदानम्.१-६)
On consuming or getting exposed to the causative factors which aggravate Vata, the Vata gets vitiated out of proportions. This vitiated Vayu gets mixed (association) with morbid pitta and kapha and later gets consequently blocked by these 2 doshas. This vitiated Vata mixed and blocked by pitta and kapha causes severe shoola. This is called Parinama Shula.
Alternative explanation of Parinama Shula pathogenesis – ‘The shleshma or kapha in the stomach gets dislodged from its place. This displaced pitta later gets admixed with pitta. The vitiated Vayu further displaces pitta and kapha and causes severe pain during the digestion of food. This is called Parinama Shoola.
Symptoms of Parinama Shoola –
Bhukta matre – after intake of the food
Vanta matre – afer vomiting
Jeerne cha anne – after complete digestion of food
Shashtika shali – food cooked with rice grown in 60 days
Vrihi dhanya – barley etc
Shali odana – cooked rice
In some other context, the manifestation of Parinama Shoola is thus explained – ‘The shleshma or kapha (in the stomach) on getting dislodged from its place will get admixed with pitta. The vitiated Vayu further displaces them and causes severe pain during the digestion of food. This is called Parinama Shoola.
The mechanism can be thus explained with respect to modern context –
Excess pitta or acidic secretions damage the mucous layers (balasa) of the duodenum. The mucous layer sheds (stage of erosion of the intestinal wall predisposing for the formation of sores or ulcers) from its place and gets admixed with pitta or acids. Since the mucous layer forms a buffer and protective sheath of the intestines (and also all the viscera), falling of shleshma or shedding of its mucous membrane leads to the formation of ulcers or sores in the walls of the intestines. This is the stage of ulcer formation. The Vayu gets aggravated (irritation of nerve fibres at the region of sores) and causes severe pain. When the acidic food (semi digested food admixed with digestive juices and acids coming from the stomach) enters the duodenum (first part of the small intestine wherein the remaining digestion takes place to completion) for further digestion, it corrodes and irritates the sores causing severe pain during the process of digestion. The pain remains until the acidic food is pushed off from the duodenum or until the afflicted person consumes food so as to dilute the acids in the stomach, thus preventing their entry into the duodenum.
The above said symptamatology of Parinama Shula describes the disease as a severely painful and dreadful disease of unpredictable nature. It presents with pain during digestion of food in the duodenum. This happens due to the contact of sores or ulcers in the duodenum with acidic food coming from the stomach. The pain subsides on taking food because, the presence of food buffer and dilutes the acids in the stomach as a result decreases the quantity of acids flowing into the stomach.
The sites of manifestation of pain as explained above describes its nature of spread and radiation as understood by Ayurveda (referred and radiated pain). It also reflects the knowledge of Ayurveda doctors (of ancient period) about the anatomical relation of different organs.
The explanation of aggravating and relieving factors explain, the depth of knowledge the ancient stalwarts of Ayurveda had regarding every aspect of the disease.
Dosha Specific symptoms of Parinama Shula:
Vataja Parinama Shula (Parinama Shula caused by vitiated Vayu):
Paittika Parinama Shula (Parinama shula caused by vitiated pitta) –
Shlaishmika Parinama Shula (Parinama shoola caused by vitiated kapha) –
Dwidoshaja Parinama Shoola (Parinama Shula caused due to vitiation of doshas in duals) –
Sannipataja parinama shoola (parinama shoola caused due to vitiation of all the 3 doshas) –
Symptoms of vitiation of all the 3 doshas will be present in sannipataja or tridoshaja parinama shula.
Prognosis of Parinama Shula (incurable parinama shoolam) –
Below said types of Parinama shoolas are said to be incurable:
Tridoshaja type of Parinama shula – when all the three Doshas are involved
Parinama shula in which there is diminution / deterioration of bala (strength), mamsa (muscles) and agni (digestion capacity or metabolism)
Parinama shoola associated with upadravas (complications)
Complications of Parinama shula:
Tridoshaja type of Parinama shula and parinama Shula associated with deterioration of strength, muscle bulk and digestion capacity is also incurable.
Treatment for Parinama Shoola:
लंघनं प्रथमं कुर्यात् वमनं च विरेचनम्।
वस्ति कर्म परं च अत्र पक्ति शूल उपशान्तये॥(यो.र.शूल चिकित्सा.१)
Below mentioned are the treatment principles of Parinama Shoola –
Treatment principles of individual Parinama Shoola