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Parshva Shula Causes, Signs, Pathogenesis, Remedy, Fashionable View

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Parsva / Parshva = aspect, flank, ribs – sides of thorax or ribcage (chest) / sides of stomach (stomach) on this context. Shula = ache, colic
Synonyms: Parshvashoola, Parshvashoola, Parshvashula, Parsvashula,

Although Parshva means each ‘sides of chest wall and stomach’ the situation is commonly thought of as ‘urah parshva shula’ i.e. ache within the sides of the chest area. However Grasp Sushruta has magnified the model of parsva shoola and has additionally included ache in each areas i.e. sides of the chest and stomach in his rationalization of pathogenesis and signs of the illness.

However in the identical context Grasp Sushruta has additionally defined Kukshi shula which implies ache within the stomach. Right here the ache can’t be manifested in solely the central area of the stomach however in reality would cowl the edges of the stomach additionally. If ache within the sides of the chest and in addition stomach is manifested in parsva shula then what was the necessity of explaining kukshi shula instantly after parshwa shoola?
Learn – Shoola Sorts, Signs, Remedy, Medicines, Treatments

Causes of parshva shoola

Meals and actions which trigger vitiation of kapha are the first causes of parsva shula.


  • Because of the consumption in extra of incompatible meals and getting uncovered to the actions and seasons which trigger vitiation of kapha, the kapha will get aggravated.
  • This aggravated kapha strikes in direction of the edges of the physique i.e. sides of the chest (and stomach) and will get lodged therein.
  • This kapha blocks the pathways of vata thus obstructing its free actions.
  • This vata blocked by vitiated kapha causes distension of chest (and stomach) in fast time and in addition causes sounds within the chest (gurgling sounds within the stomach).
  • It additionally causes pricking ache within the flanks i.e. sides of each chest and stomach.
  • This illness attributable to vitiated kapha and vata is known as parsva shula.
    Learn – Kapha Dosha – Basic introduction

Signs of Parsva Shula

Adhmana – distension of chest / stomach
Gudagudayanam – irregular sounds within the chest / gurgling sounds within the stomach
Suchibhiriva nistodam – ache as if pricked by pins and needles within the flanks i.e. sides of the chest and stomach
Krichra uchchvasa – problem in respiration
Annam na vanchati – lack of want to eat meals
Na nidram upaiti – lack of sleep / insomnia

Why ought to we think about parsva shula as ‘ache within the sides of the chest’ alone?

  • It’s a standard notion and perception in Ayurveda scientific apply that parsva shula is ‘ache within the sides of the chest’ and never ‘ache within the sides of the stomach’. It’s because –
  • Kukshi shula which has been defined instantly after parsva shula encompasses ache in not solely the stomach but additionally the ache in its sides
  • Parsva Shula talked about as one of many signs of Rajayakshma illness, its signs and therapy (by Grasp Charaka) clearly defines and explains ‘ache within the sides of the chest wall’
  • The stomach signs and sleeplessness talked about among the many signs of parsva shula could also be manifested as an impact of the ache within the sides of the chest over the stomach
  • It’s smart to grasp the phrases adhmana, gudagudayanam, suchibhiriva nistodam (that are normally used with stomach illnesses) as relevant to the chest and never for the stomach.
    Learn – Parinama Shoola : Definition, Sorts, Remedy, Medicines

Sanskrit Verses

Remedy of Parsva Shula


Grasp Charaka charts out widespread therapy rules and formulations for six situations related to rajayakshma i.e. rhinitis, headache, cough, hoarseness of voice, dyspnea and ache within the sides of the chest cavity.

Contemplating these rules the under talked about therapies might be thought of to fight parsva shula.

The under talked about could also be skillfully administered –
Sudation – poultice, steaming, tubular, showering and so on types of sweating therapies
Therapeutic massage with natural oils
Anointments over the pinnacle
Showering of medicinal liquids
Tub bathtub / immersion
Meals ready with barley
Learn – Annadrava Shoola: Definition, Remedy, Treatments

Shodhana / Panchakarma measures

When the doshas are collected in extra and are able to get expelled, cleaning therapies ought to be administered within the type of therapeutic emesis and therapeutic purgation.

Ghrtapana – One ought to take massive portions of ghee after meals for few days to get relieved from ache in flanks. The under talked about ghee are helpful –
Dashamuladhya Ghrta
Bala Ghrta
Rasna Ghrta
Jivantyadi Ghrta
Duralabha Ghrta

Use of Shatphala Ghrta (Sushruta)
Shatphala Ghrta talked about within the context of ‘therapy of Plihodara – enlargement of spleen and liver’. Must be used blended with powder of purified asafetida.

Use of Ghrta (Sushruta)
Pure ghee ought to be given for oral consumption blended with powder of pure asafetida.
Learn – Oleation – Snehakarma Dose, Advantages, Facet Results, Administration

Leha – medicated confections
Kharjuradi Leha – Confection ready with the under talked about components is beneficial –
Pippali – Lengthy pepper
Pathya – Terminalia chebula
Karkatasringi – Pistacia integerrima
Duralabha – Fagonia cretica

Shuntyadi Leha – confection ready with under talked about components ought to be used –Ginger
Chitraka – Plumbago zeylanica
Parched grain
Pippali – Lengthy pepper
Amalaki – Emblica officinalis

Talisadhya Churnam
Sitopaladi Churnam
Pushkaramuladi Churnam (Sushruta)

Powder ready with equal amount of the under talked about components ought to be taken –
Pushkaramula – root of Inula racemosa
Purified asafetida
Sauchal salt
Vid salt
Rock salt
Haritaki – Terminalia chebula

The powder ought to be taken together with decoction of barley.

Advantages – This formulation cures ache within the sides of the chest, ache within the coronary heart and ache within the urinary bladder.

Use of Eranda Taila (Sushruta)
Castor oil (oil of Ricinus communis) ought to be administered blended with any one of many under talked about autos making an allowance for the structure, illness and time interval or stage of illness –
Madhya – wine
Mastu – supernatant layer of curds
Meat soup

When the particular person feels hungry he ought to be served with meals together with milk or meat soup of animals and birds residing in desert-like areas.
Learn – Castor Oil Advantages, Analysis, Facet Results, How To Use, Dose

Use of Bijapura (Sushruta)
Seeds of Bijapura fruit – Citrus medica or its freshly extracted juice ought to be boiled and processed with milk. This milk ought to be consumed.

Dietetic inclusions

Meat soup of quail, gray francolin, partridge, cock, ready with ghee added with lemon juice, pepper powder and rock salt ought to be served contemporary and scorching.
Meals ready with rice, barley or wheat ought to be served with soup of radish or horse gram.
For people who find themselves used to consuming wine, a supernatant layer of the wine by the identify Varuni ought to be given to drink.
Water processed with Laghu Panchamula group of herbs ought to be given for consuming.

Exterior measures

Functions – These pastes could also be utilized over the half / painful a part of the chest –

1. Baladi Pradeha – Paste of the under talked about ought to be utilized blended with ghee –
Bala – Sida cordifolia
Rasna – Pluchea lanceolata
Sesame seeds
Blue number of lotus / water lily

2. Guggulvadi Pradeha – Paste of the under talked about ought to be utilized blended with ghee –Guggulu – Commiphora mukul
Devadaru – Cedrus deodara
Nagakesara – Mesua ferrea

3. Shatapushpadi Lepa – Paste of the under talked about ought to be utilized blended with ghee –
Shatapushpa – Anethum sowa
Kushta – Saussurea lappa
Tagara – Valeriana wallichii

For therapeutic massage – the under talked about medicaments could also be used –
Chandanadi Taila
Shatadhauta Ghrta

Showering of liquids – one of many under talked about shall be used –
Recent milk of cow
Decoction of Licorice
Freshly collected rain water
Water boiled and ready with Chandanadi group of herbs

Different helpful formulations
Balajeerakadi Kashayam
Dashamula Kaduthrayam Kashayam
Nayopayam Kashayam
Punarnavadi Kashayam
Rasonadi Kashayam
Vidaryadi Kashayam

Fashionable correlation

The under talked about situations would possibly trigger ache within the flanks, primarily within the sides of the thoracic cavity / chest cavity and therefore could also be included in correlated examine with parsva shula. They’re –
Intercostal neuralgia

Parsva shula is attributable to kapha and vata. If this situation is in comparison with pleurisy –
Kapha predominant parsva shula might be thought of as ‘pleurisy with effusion whereby there will likely be enlargement of chest cavity (ayama).
Vata predominant parsva shula might be thought of as ‘dry pleurisy’ whereby there will likely be constriction of chest cavity (sankocha)

Relying on the positioning of lesion the ache might be on one aspect or either side of the chest cavity. Extreme ache within the aspect of the chest cavity is the predominant symptom of dry pleurisy. On this situation the ache would enhance when the affected person breathes or coughs. The motion of the chest is diminished on the aspect. On the identical time the motion of the stomach will enhance throughout respiration. The particular person will even discover it tough to breathe simply. There can also be an accompanying fever. Fever won’t be seen in situations of pleurodynia and intercostal neuralgia. These situations additionally will match into the differential analysis of parsva shula.

Pleurisy Causes, Signs, Prevention And Remedy

Pleura are the skinny tissues that line lungs and chest wall. Placing it the opposite method, the liner or outer protecting of the lungs are known as pleura. Pleurae are plural and embrace coverings of each lungs. Every lung is roofed by 2 pleura separated by an area full of a lubricant fluid. The internal layer near the floor of the lung is known as visceral pleura and the outer layer is known as parietal pleura. The pleurae rub in opposition to one another whereas respiration. This normally doesn’t generate any friction for the reason that tissue is satiny and there may be adequate lubrication. However when there may be an infection in these tissues, they change into irritated and swollen. This causes vital ache in area of lungs. This situation is known as pleurisy or pleuritis. It causes sharp chest ache ‘pleuritic ache’ that worsens throughout respiration.

It isn’t a typical situation any extra. It’s efficiently handled with antibiotics over the previous few years. Antibiotics have additionally helped in stopping bacterial infections which trigger pleurisy. Current day pleurisy is because of viral infections. Alternatively pleurisy associated deaths are uncommon.
Learn – Dyspnoea – Issue in respiration: Causes, Pathophysiology, Analysis

Signs of Pleurisy

Primary symptom – Sharp and stabbing ache within the chest, within the area of lungs once you breathe is the chief symptom of pleurisy.

Relieving components – The ache could ease once you apply strain on essentially the most painful space of the chest or once you maintain your breath.

Aggravating components – Ache will worsen once you breathe, cough, sneeze or transfer about. Ache would possibly worsen with motion of the higher physique. The ache may radiate to the again or shoulders.

Related signs
Ache on one aspect of the chest, again and in shoulders
Shortness of breath-
Shallow respiration (protection mechanism to keep away from feeling the ache)
Muscle aches
Joint ache
Lack of urge for food
Fluid buildup across the lungs (pleural effusion)
Learn – Atelectasis Causes, Signs, Remedy, Ayurveda Idea

Pleurisy will likely be accompanied by a number of of the under talked about situations – Pleural Effusion / fluid across the lungs – In some circumstances of the illness, fluid will construct up within the area between the pleurae and impart strain on the lungs. The lungs won’t work correctly. This effusion could initially act like a cushion and can make the chest ache disappear as a result of the layers of pleura don’t rub in opposition to one another in order to trigger the ache.

Atelectasis / collapse of lung – When a considerable amount of fluid is current within the pleural area it could create strain. It will compress the lung to an excellent extent that partial or full collapse of the lung happens and that is known as atelectasis. It will result in problem in respiration. The affected person may also develop a cough.

Empyema – The additional fluid which has change into contaminated across the lungs can typically get contaminated. This ends in accumulation of pus. That is known as empyema. This situation is commonly accompanied by fever, chills and dry cough.
Learn – Emphysema – Causes, Signs, Remedy, Prognosis, Ayurvedic Understanding


The commonest reason behind pleurisy is viral infections. Viruses trigger infections within the lungs. This results in pleurisy.
Different causes –
Bacterial an infection / Bacterial pneumonia
Fungal / parasitic infections
Wounds within the chest / blunt trauma (to the chest wall)
Fractures of ribs / rib trauma
Chest / lung tumors
Pulmonary emboli
Immune / Autoimmune problems (SLE, RA and so on)
Problems of coronary heart surgical procedure
Lung most cancers
Sickle cell anemia
Lymphoma / mesothelioma
Sure drugs


The doctor will diagnose the situation after thorough examination of the affected person, case recording and conducting the required exams. Initially the situation and reason behind irritation shall be decided. The under talked about exams could be advisable in order to make a exact analysis –
Blood Checks – will assist to find out infections and reason behind an infection. They will even assist in revealing problems associated to the immune system if any.
Chest X-rays – will assist to verify if there may be irritation within the lungs. It additionally assist to search out if lungs are utterly inflating or not and in addition decide if there may be air or fluid in between the lungs and ribs.
Decubitus X-ray – is an X-ray taken whereas mendacity on aspect. It will verify if there may be any fluid buildup across the lungs.
CT scan – will give an in depth image of the within of chest and a better take a look at the irritated tissue. These are cross sectional pictures of chest which assist the physician discover out abnormalities within the chest. The detailed pictures out there from the scan will present the situation of the pleura and in addition if there are different causes of ache together with blood clot within the lung.
Ultrasound – will assist in discovering out irritation or fluid buildup associated to pleurisy (effusion).
Biopsy – assist in figuring out the reason for pleurisy.
ECG / EKG – Used to rule out sure coronary heart issues as causal for chest ache.

Procedures used to take away fluid and tissue from pleural area for testing them –Thoracentesis – the fluid across the lungs will likely be eliminated and analyzed for the presence of infections. Elimination of the fluid will even assist you breathe higher.
Thoracoscopy / pleuroscopy – helps in trying into the pleural area, to find the irritated space and to gather tissue samples for evaluation. It can even be suggested if TB or most cancers is suspected to be causal to your pleurisy.

When to see a physician?

You want to see a physician if there may be unexplained chest ache which is extreme and when it occurs once you breathe.

Way of life modifications, House treatments

These measures assist in relieving signs although they could not treatment the illness –

Taking drugs frequently
Get good relaxation – the affected person must discover a correct place to sleep and relaxation. The place ought to be such that it ought to offer you least discomfort.
No smoking – Smoking is dangerous for lungs and would possibly worsen the irritation in pleurisy.

Remedy of Pleurisy

Remedy is principally depending on the underlying trigger. Instance – antibiotics will likely be prescribed if bacterial pneumonia is the trigger. Pleurisy could resolve by itself if virus is the trigger.
Good relaxation is required for complete therapeutic.
One ought to lie on the aspect having extreme ache. The strain exerted on the painful aspect by sleeping on that aspect would make the ache go away.

Different therapy
Antibiotics which might assist in coping with the an infection
Aspirin, ibuprofen, NSAIDs – to fight ache associated pleurisy
Ache and cough remedy
Medicines to interrupt up any blood clots
Medicines to take away pus and mucus
Bronchodilators / inhaler gadgets
Fluid drain – If there may be extreme fluid accumulation in and across the lungs i.e. pleural effusions the docs could recommendation you to get hospitalized for fluid drain.


This illness can have extreme long run implications. Early analysis and therapy are the important thing methods for complete treatment. In search of medical assist and therapy and strictly following the course of therapy as suggested by the docs will yield optimistic outcomes. Identification of underlying causes will assist in good and efficient restoration.


A examine carried out on 254 sufferers to find out the age at which tuberculous pleurisy / tuberculous pleural effusions happen it was discovered that about 62.2% of sufferers had been youthful than 35 years of age. (A)

A comparative examine was performed on diagnostic instruments in tuberculous pleurisy and thoracoscopy was discovered to be essentially the most correct but most costly device for establishing the analysis of tuberculous pleurisy. (B)

Ayurveda Understanding

Pleurisy might be carefully correlated and studied with a situation named and defined as ‘parsva shula’ by Grasp Sushruta.
Pleurisy also needs to be handled on the traces of –
Shwasa Chikitsa – when there may be shortness of breath and shallow respiration
Kasa Chikitsa – when cough predominates the image of pleurisy
Jwara Chikitsa – when fever, physique pains, headache, chills, joint pains and lack of urge for food are current
Udakavaha sroto dushti / Shotha Chikitsa – in presence of pleural effusion

Click on to Seek the advice of Dr Raghuram Y.S. MD (Ayu)


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