Shula ( Peptic Ulcer)

Ayurveda has a unique concept on diet and digestion. Disharmony at any level of Annavasrotas (Gastro-Intestine tract) will lead to disease. The stomach wall is composed of four layers. The inner lining (mucosa) consists of millions of microscopic glands which secrete gastric juices. Owing to faulty food habits and stressful life, peptic ulcer/ soola has become a very common health problem.

Shula Peptic Ulcer

Peptic ulcer is a chronic disease affecting up to 10% of the world’s population. The formation of peptic ulcers depends on the presence of gastric juice pH and the decrease in mucosal defenses. Non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori (H. pylori) infection are the two major factors disrupting the mucosal resistance to injury. Whereas in Ayurveda Ulceration of the stomach lining, which is the classic description of a peptic ulcer, is clearly due to excessive amounts of heat or prakupita pitta in the body. The mucosal resistance can also occur due to the ‘Virudha-ahara’ (A unique concept of Ayurvedic diet) and it plays a significant role in the etio-pathogenesis of most of GIT disorders.

Pain is the main symptom of a stomach ulcer, either around the stomach or slightly higher up:

• In Annadravasoola (Gastric Ulcer) – The pain in Annadravasoola is continuous and severe and mostly on the epigastric area. The pain is more before a meal or after the digestion, which gets relieved on taking food or after vomiting.
• In Parinamsoola (Duodenal ulcer) – The pain in the Parinamasoola is in the upper quadrants of the stomach which is predominant during the digestion of food. The pain relieves with the digestion of food.

Other major symptoms includes:

The main risk factors for both gastric and duodenal ulcers are:

• H. pylori infection.
• NSAID users have four times the risk of complications of peptic ulcer, and two times in aspirin users.
• The hypersecretory acidic environment of GIT together with dietary factors or stress worsens the conditions.
• Regular over use of Broad-spectrum Antibiotics which will damage the intestinal flora can also lead to the condition.

• Virudha Ahara(Incompatible Diet) – There are Certain foods when in combination will interrupt the metabolism of tissue which later inhibits the process of formation of healthy mucosal tissues.
• Dushita Ahara – Excessive intake of Amla (fermented items like curd, pickles etc).
• Vidahi and Abhisyandi foods like alcohol.
• H.Pylori infections.
• NSAIDs – NSAIDs block your body from making a chemical that helps protect the inner walls of your stomach and small intestine from stomach acid.

Dietetic errors like:

• Abhojana (starvation).
• Athibhojana (excessive and binge eating).
• Adhyasana (intake of food prior to digestion of meal).
• Emotional disturbances like Chinta(Thoughts), Krodha(Anger), Bhaya(Fear), Shoka(Grief) etc. A Danish study showed that psychological stress could increase the incidence of peptic ulcer.

Etio-pathogenesis

The causative factors lead to Mandagni(Reduced digestive fire), which leads to the fermentation of Pitta. This fermented pitta burns the food in the stomach and converts it into improperly digested, excessively charred acidic chime. Sometimes this fermented Pitta itself is thrown out which will start corrosion of the mucous lining the GIT.

Treatment is to be planned according to the causative factor. Even though there is considerable Pitta vitiation, the treatment should be planned after proper investigations to rule out the H Pylori infection, the intensity of ulcer and also to rule out further complications like perforation or leakage.

According to the old hypothesis, acid secretion was thought to be the sole cause of ulcer formation and reduction in acid secretion was thought to be the major approach towards therapy. However, in the light of recent evidence this concept has changed. Now treatment of ulcer mainly targets the potentiation of the defensive system along with lowering of acid secretion.

Ayurvedic treatment protocol is not merely symptomatic. A holistic way is better adopted in chikitsa. In Peptic ulcer management, Neutralization of Pitta and anulomana of Vata along with some krimi chikitsa are basic modalities adopted.

The treatment of ulcer is not merely acid control, following other factors like Reduction in the intensity of pain, Improving digestive process and Promoting healing and repair of ulcerated mucosa has also been given due consideration while treatment.

In Initial stages the treatment should aim at reducing the heat and pitta in the body. The vitiated pitta is to be expelled out by proper sodhana (Detoxification) with proper medicated Ghee. This Ghee will help in improving the immunity and promotes the healing of the Ulcer. Sodhana (Detox) is important during the course. Virechana is the best detox therapy that can be introduced as the medicine of choice can be pitta reducing like Avipathy Choorna.

After this Sodhana, Samana (pacification) treatment is to be introduced. It includes herbal medicines and several external therapies. Herbal medicines which will reduce the acid secretion; (The Pitta) and which increases the production of mucosa is given which promotes healing. Special therapies for Ulcers include:

Complications

If not treated timely or if unwholesome diet, regimen and habits continued, it may lead to:

Do’s (Pathya)

Follow the meal times. Eat three small meals and avoid periods of hunger or overeating.

Food items

• Vegetables like white pumpkin, bitter gourd, matured ash gourd,leafy vegetables except Methi Wheat, old rice, barley, green gram, sugar candy, cucumber, Fruits like gooseberry, dry grapes, black grapes, pomegranate etc are good.
• Take an adequate amount of fluids like medicated water with ushir (wala) or coriander seeds, or laja (puffed rice).
• Avoid fatty rich, spicy and hot and sour foods and beverages, citrus products, chocolate and confectionary items.
• Avoid foods containing excess amounts of garlic, salt, oil, chillies,etc. very often.

Don’ts (Apathya)

At Saranya, we believe in the old school application of Ayurveda wisdom with a modern approach rooted in evidence based practise. The medicines and therapies are fixed only after individual consultation through listening, understanding the need and analyzing the root cause. We incorporate different diagnostic methodologies in identifying the root cause of pain and plan unique customized treatment strategies to eliminate the causes.

We believe in restoring the quality of life by relieving the hardships and pain of those who suffer from Soola.