Pain management is always fascinating subject for any practitioner. There is no 100% pain management in the world; this is the belief in all leading pain management consultants.

Pain or shula is nicely described in the text of ayurveda.

शङ्कुस्फोटनवत्तस्य यस्मात्तिव्राश्च वेदना: I

शूलासक्तस्य लक्ष्यन्ते तस्मात शूलमिहोच्यते II

(सुश्रुत संहिता, उत्तर तन्त्र, अध्याय ४२, श्लोक १९)

Needling feeling and condition is known as Shula / Vedana / pain.

Pain management is always fascinating subject for any practitioner. There is no 100% pain management in the world; this is the belief in all leading pain management consultants.

Pain or shula is nicely described in the text of ayurveda.

Shankusfotanvattasyayasmattivraschvedanaha

Shula saktasyalakshyantetasmatshulamuchyate.

(Sushrut Samhita, Uttar tantra, Chapter 42, Shloka 19)

 

शङ्कुस्फोटनवत्तस्य यस्मात्तिव्राश्च वेदना: I

शूलासक्तस्य लक्ष्यन्ते तस्मात शूलमिहोच्यते II

(सुश्रुत संहिता, उत्तर तन्त्र, अध्याय ४२, श्लोक १९)

Needling feeling and condition is known as Shula / Vedana / pain.

Mythologycal aspects of Shula:

Once Lord Shiva was meditating and he was disturbed by Lord Kama. Lord Shiva became angry and throw his ‘Trishula’ (a weapon with htree ends y) on him. Lord Kama ran to Lord Vishnu and asked him to prevent from this Trishula. Lord Vishnu with his spiritiual power blocked Trishula, thus Trishula falls on the earth, which resulted into birth of ‘Shula’ or Vedana

It is borne by Trishula, so it is known as Shula. A pain like nail pierecing in the body is Shula.

Type of Pain:

1. Vatashula – (pain due to Vatadosha) Heart pain, chest pain, intestinal colic, lumbago or lower back pain, sacral pain, pain in bladder and uterine region

2. Pitta Shula - (pain due to Pitta dosha)

3. Kaphashula - (pain due to Kaphadosha)

4. Tridoshaj Shula (pain due to all three dosha)

5. Aamajshula (pain due to Aama)

6. Dvidoshajshula - (pain due to combination of any 2 dosha)

Other types :

1. Parinam Shula (pain during digestion of food) for example; pain due to duodenal ulcer, tympanitis etc.

2. Annadravashula (pain after digestion of food) for example pain due to chronic gastritis, gastric ulcer, heartburn etc.

Shula causing factors:

वातमूत्रपुरिषाणांनिग्रहादतिभोजनात् |

अजीर्णाध्यशनायासविरुद्धान्नोपसेवनात् ||

पानीयपानात्क्षुत्कालेविरुढानांचसेवनात् |

पिष्टान्नशुष्कमांसानमुपयोगात्तथैवच ||

एवंविधानांद्रव्याणामन्येषाम्चोपसेवनात् |

दोषाःप्रकुपिता: कोष्ठेशूलंसज्जनयन्तिहि ||

(सुश्रुतसंहिताउत्तरतन्त्र४२/१८ )

A voluntary retention of flatus, stool or urine (veg dharan), over-eating, indigestion, eating before the digestion of previous food, over-exertion, use of incompatible diet, drinking water when hungry, dry food or cakes of dry meat, etc can derange and aggravate the dosha. Disturbed dosha (mainly Vata) produces pain (Sula) in the main cavity of the trunk (Koshtha).

- (SushrutSamihta, Uttartantra 42/18)

Vedana relation with Vatadosha:

Narteaniladruk – No pain is possible without Vatadosha

Na Vatenvinashulam - Without Vata, pain can not be there

Sangnavahanamnadinampratanodwejanodbhavaha

Sarveapishulastenahuhushulanamanilahprabhuhu.

( MadhavNidana, Chepter 26, Shloka 1)

Anywhere in the body, one can feel pain due to local disturbances in sensory nerves system. In any kind of pain there is major factor is vatadosha.

Shirahshul – as very common complain

Out of various kinds of painful conditions, diseases etc; headache is the most common complain in the society. It is very difficult to find out a person having no experience of headache in his / her entire life time. Theoretical knowledge – types of headache, causes and symptoms of various kinds of headache are described thoroughly in the classical texts.

Shirahshul - Headache causes can be broadly categorized as, mechanical factors, chemical factors, neurogenic factors, psychogenic factors

• Irregular diet-sleeping pattern , I.e. ratrijagaran, day time sleep,excess intake of fast food, excessive fasting, hypoglycemia, seasonal changes-rutu sandhi, post viral infection, alcohol, smoking,  excess intake of coffee, excessively watching TV ,poor ventilation and less oxygenated environment, vegavadharan-suppression of natural urges etc…..

• Headache can be due to any disease like CVD,HTN, hypotension, atherosclerosis, aneurysm, endocrinal disease , allergic disease, chronic sinusitis, infection like T.B meningitis,otitis media, trauma, encephalitis, Brain tumor, Cerebral infraction, Vision problem, Stress, bad teeth, trigeminal neuralgia, sinusitis etc.

 

Management:

In the clinical practice to manage headache, three factors are very important to implicate. Aahara, Vihara and Aushadh.

Not preferable diet &activities (Aahara and Vihara)

One must avoid:

Suppression of natural urges

Excessive eating, fasting

Indigestion

Incompatible diet

Excessive - exercise, traveling, sexual activities

excessive cold food, drink

late night working

excessive intake of dry quality food

hot, spicy foods, fermented foods, superfined wheat flour products, too much sour taste or citrus fruits, dairy products and meat

caffeine, tea, and alcohol

Avoid direct exposure to the sun, or wind, and cold climate

Tension, anxiety, anger and worry

Preferable diet and activities:

Diet according to individual body constitution and season

Proper sleep

Daily exercise

Sun-wind protective cloths and accessories

Management of headache

(Author’s favorite ‘Sixer for Headache’):

1. Aushadha (medicines)

Durva, apamargkshar, Lajjalu, Tagara, ashwagandha, Brahmi, shatavri, guduchi, Jatamansi, Shatpushpa, ela and GodantiBhasma are choice of herbs in the management of headache..ShirahshuladivajraRas, Pathyadikadha etc are very known formulas available in the market .

Mostly used combination in our practice :godantibhasma and giloysatva - each 1 gram with water in acute condition. Usually it works in 30-40 min. But if needed can be repeated after every hour till shirahshul subsides.

2. Special Diet:

As vata and pitta are major dosha imbalance found in the symptom / disease headache, there is a need of specific diet recommendation. Food with Sweet taste, heavy and oily gunas are recommended. Ghee and sharkara are our favorite foods.

Mostly used combination in our practice:Wheat halwa:

Little warm, freshly prepared Halwa, made from wheat flour, sarkara and 50 grams cow’s ghee should be consumed daily morning – nearly sunrise time for 10 days.

3. Nasal drops – nasya (nasal administration of medicine)

"Nasa hi shirsodwaram"   Nasya gives very good results in headache.Navan nasya, Marsh-pratimarshnasya and Avpidnasya are prescribed in the books according to dosha imbalance.

Mostly used combination in our practice :Cow’s ghritnasya2-2- drops in each nostril in the morning and before bed time is most common suggestion.Gud-sunthiavapidnasya is major tool for our success in the management of headache.

4. Shirodhara

Coconut water shirodhara or plain jaldhara are known for good results in headache.

Mostly used combination in our practice :kshirdhara - with herbs like chandan, amlaki, yastimadhu, brahmi, rose water etc.. for at least 7-8 sittings with duration of 30 to 40 mins..

5. Local abhyang

नित्य स्नेहआदृ शिरसः शिरशूलं न जायते...Now a days we avoided hair oil it is also reason for headache.

Mostly used combination in our practice :daily head massage or oiling in hair with coconut oil, brahmi oil or chandanbalalakshadi oil.

6. Local paste application (lepam)

Mostly used combination in our practice :A paste prepared from salt, sunthi (ginger) powder and wheat flour - on forehead subsides headache with vata and kaphadosha imbalance

Using combination of above said “mostly used combination in our practice”, we have achieved more then 91% success in the management of acute or chronic shirahshul conditions.

*The article is based on experiences of Dr Prerak Shah in Clinical Practice 

Download Article