Chapter CLXXXVI - The Nidanam of Sula neuralgic pain etc

Now hear me, O Sushruta, discourse on the Nidanam of Shula (Colic, etc., and neuralgic pain). Over-fatiguing physical labour, excessive riding, or pedestrian journey, sexual excesses, late hours, drinking of extremely cold water, ingestion of extremely parchifying articles of fare, such as peas, Mudgapulse, etc., eating before a previous meal is digested, hurt or injury, eating of bitter or astringent articles in exclusion of those of any other taste, as well as of incompatible food-stuff, suppression of any natural urgings of the body, grief, fasting, and excessive laughter or talk are the factors, which tend to enrage the bodily Vayu, which, in its turn, produces colicky (neuralgic pain) in the chest, sides, back, sacrum and pelvis. Eight different forms of Shula are recognised in practice according as the different morbific principles of the deranged Vayu, Pittam, etc., either severally or jointly bring on an attack, although a dominant action of the deranged Vayu should be regarded as lying at the root of each case of neuralgic (Shula) pain or colic.

The Vataja type of Shula is spontaneously aggravated after the completion of the process of digestion, at nightfall (evening), in cloudy days and in winter and the rainy season. The pain subsides and comes on at close intervals in this type of the disease, the emission of stool and flatus is suppressed, and the patient complains of a pricking or breaking pain in his limbs, which is relieved by fomentation, massage, oily applications, and the use of hot food.

Ingestion of excessively hot, irritating, alkaline or indigestible articles of fare (that undergo an acid reaction in the stomach after digestion), use of fermented liquors or of extremely acid food, anger, exposure to heat or to the sun, sexual excesses, and over-fatiguing physical labour are the factors, which tend to derange the Pittam, which, in its turn, brings on a peculiar kind of Shula (colic) about the umbilicus, which is usually known as Pittaja Shula. Thirst, delusion (feeling of intoxication) with a burning sensation in the body, perspiration, epilepsy, vertigo, and a scorching heat in the body are the further characteristics of this type of Shula, which is spontaneously aggravated at noon, at mid-night, during the process of digestion and in autumn, and is ameliorated in winter and by cold measures and applications.

Use of the cooked flesh of aquatic animals, or of those that frequent swamps or live in marshy places, drinking of milk, milk-curd or the expressed juice of sugarcane in inordinate quantities, and factors that tend to aggravate the Kaphah should be regarded as the exciting causes of a kind of Shula in the stomach (Kaphja Shula) of which nausea, cough, lassitude of the body, salivation with a distaste for food, numbness of the stomach and heaviness of the head form the specific features. This disease is intensely aggravated at morning, and in spting and winter, and immately after a meal. In the type due to the concerted action of the deranged Vayu, Pittam and Kaphah, a colic is experienced in the chest, back, sacrum, sides, abdomen and the pelvis and death may result within a very short space of time. The type of Shula, which is due to the incarceration of mucous in the intestines (Amaja), tympanites with a rumbling sound in the abdomen, nausea, vomiting, heaviness of the limbs, suppression of stool and urine and salivation and a feeling of being packed in a wet sheet together with other specific symptoms of the Kaphaja type speedily manifest themselves.

In the type of Shula, due to the incarceration of mucous in the intestines, nausea, vomiting with a rumbling sound in the intestimes, suppression of stool and anus, salivation with a feeling as if the body is packed jn a wet sheet, and other specific features of the Kaphaja type of this disease are also present. In the types of Shula respectively due to the combined actions of the deranged Vayu and Kaphah, Pittam and Kaphah, and Vayu and Pittam the pain is confined to regions of the urinary bladder (Pelvis according to certain authorities) heart, sides and the back, to the inguinal, umbilical and cardiac regions, and to those of sacrum, pelvis heart sides, back and umbilicus respectively, an intense fever and an intolerable burning sensation in the body being the further characteristics of each of them. Cases of Shula (neuralgia) brought about through the several actions of the deranged Vayu, Pittam and Kaphah readily prove amenable to medicine, those due to the combined action of any two of the said Doshas are comparatively more difficult to cure, while those which are due to their concerted action (Sannipatika) baffle all medicinal remedies.

The deranged bodily Vayu, aggravated by its own exciting factors, produces a kind of Pre-digestionary colic, which is called Parinama Shula (Gastralgia). This disease is so named from the fact that the colic is brought on after the ingested food is considerably digested in the stomach and close before the completion of the process of digestion. The nature of an attack, which is usually experienced at the advanced stage, and before the completion, of the process of digestion, may be determined with regard to the predominance of the deranged Vayu, Pittam, or Kaphah, acting as its exciting cause. In the Vataja form of Parinama Shula tympanites with a rumbling sound in the belly, suppression of the stool and urine, malaise and rigour are the symptoms that are usually developed. The pain in this type is relieved by the use of hot, emulsive food. Ingestion of pungent, acid, or saline articles of fare may be set down as the exciting cause of a case of Pittaja type of this disease, which is characterised by thirst, malaise, and perspiration with a burning sensation in the body. It shows signs of marked amelioration under cold applications and cooling measures in general. Nausea, vomiting, and epileptic fits are exhibited in the Kaphaja type of this disease. The pain continues long and becomes persistent and is relieved by the use of bitter, pungent articles of fare. The presence of specific features of any two of the deranged Vayu, Pittam, etc., in a particular case of Parinama Shula, indicates its origin through the agency of those two morbific principles of the body, while that of the specific features of all the there Doshas points to its Sannipatika origin, a case of the latter type being always regarded as incurable, in as much as it produces emaciation of the body and entirely impairs the digestive faculty of the patient. The type of colic which comes on simultaneously with the commencement of the digestion of the ingested food, or after the completion of the digestive process, or just after ihe ingested food is carried down into the stomach and before it is fully converted into chyme, and which does not show any sign of amelioration even with a strict regimen of diet and conduct, is called Anna-Drava-Shula (lit colic of undigested chyme or chyle). Ejection of the contents of the stomach and the consequent assimilation of the deranged bile give relief in this type of Gastralgia.