By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Master Sushruta is the grand master of surgery. In Sushruta Samhita we come across 60 specialized treatments grouped under a heading called ‘Shashti Upakrama’. Shashti means 60 number, Upakrama means treatments.
Read – Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma
Clinical utility of Shashti Upakrama
Sasti Upakramam is a group of 60 sub-therapies/treatments. They are explained in the context of treatment of Vranas in Chikitsa Sthana Section of Sushruta Samhita (Chapter 1). This would probably be one among the most ancient descriptions of ‘comprehensive management of wounds, ulcers, inflammation and wound-scars’. Though this explanation has been given in the context of wound management, these treatments are extremely helpful in managing the associated inflammation and the scars formed after the wounds have been healed. All treatments are not used for the same purpose; they are used for different purposes at different stages and presentations of the wounds. They are explained in the same chronology in which they need to be administered ‘stage-wise’.
Therefore the 60 procedures explained by Master Sushruta help in dealing with –
- Management of Vrana Shopha – i.e. inflammation around the wounds / ulcers / abscess
- Management of Vrana – wounds and ulcers
- Management of Vrana Vastu – cosmetic repair of the formed scar
The modern day wound management too looks influenced by Sushruta’s shashti upakrams, but Sushruta’s version looks more comprehensive. Many measures explained by Ayurveda are purely limited to the field and expertise of Ayurveda and are not practiced in modern medicine or any other contemporary medical systems.
Sushruta’s explanation emphasis on the cosmetic repair of the wound scars, modalities to prevent recurrence and dehiscence of wounds which shows the advancement of surgical practices in the ancient day.
Therefore Sashti Upakram includes treating the wounds right from the stage of abscesses to the stage of scars. These comprise of more advantageous methods of wound management in comparison to the same interventions done by other medical systems involving many scientifically advanced modern approaches.
Read – Nadivrana – Sinus: Types, Symptoms, Ayurvedic Treatment
Shashti Upakramas as part of Sapta Upakarmas – These 60 treatments can grossly included in Sapta Upakarmas i.e. 7 treatments of shopha (swelling associated with wounds). Below mentioned are the 7 therapies in which the 60 treatments are included.
| Sl No | Saptopakrama (7 therapies) | Treatments of Shashti Upakramas (60 therapies) included under 7 main therapies | Total Number of treatments included under 7 main therapies |
| 1 | Vimlapana | Apararpana to Vimlapana | 06 |
| 2 | Avasechana | Visravana to Virechana | 04 |
| 3 | Upanaha | Upanaha and Pachana | 02 |
| 4 | Patana | Chedana to Sevana | 09 |
| 5 | Shodhana | Sandhana to Vrana Dhupana | 13 |
| 6 | Ropana | ||
| 7 | Vaikrutapaha | Utsadhana to Raksha Vidhana | 26 |
| Total = 60 treatments |
Read – Injury, Wound care Ayurvedic Remedies, Medicines
Shashti Vidha Chikitsa – 60 types of treatment
The Shashti upakrama i.e. 60 types of treatment strategies used in surgical practice explained by Master Sushruta are as below mentioned –
| Sl No | Name of the Upakrama (treatment) | Meaning | Inclusion in Sapta Upakrama |
| 1 | Apatarpana | starvation / fasting | Vimplapana |
| 2 | Alepa | application of medicinal pastes | |
| 3 | Parisheka | showering of medicinal fluids | |
| 4 | Abhyanga | oil massage | |
| 5 | Sweda | fomentation or sudation | |
| 6 | Vimlapana | gentle pressing / cleansing measures | |
| 7 | Visraavana | drainage | Avasechana |
| 8 | Sneha | inducing oiliness | |
| 9 | Vamana | therapeutic emesis | |
| 10 | Virechana | therapeutic purgation | |
| 11 | Upanaha | poultices | Upanaha |
| 12 | Paachana | helping the pus to form properly so as to drain it out | |
| 13 | Chedana | excision | Patana |
| 14 | Bhedana | incision | |
| 15 | Daarana | splitting / tearing | |
| 16 | Lekhana | Scraping | |
| 17 | Eshana | Probing | |
| 18 | Aaharana | Extraction | |
| 19 | Vyadhana | Puncturing | |
| 20 | Vidravana | Liquefaction | |
| 21 | Seevana | Suturing | |
| 22 | Sandhana | Unification, union of fractures | Shodhana & Ropana |
| 23 | Peedana | Compression | |
| 24 | Shonita sthapana | Checking the bleeding, enabling proper circulation | |
| 25 | Nirvapana | Application and showering of cold potency medicines | |
| 26 | Utkaarika | Application of warm semi-solid vata alleviating medicinal pastes to treat wound inflammation and necrosis of wounds | |
| 27 | Kashaya | Administering herbal decoctions | |
| 28 | Varti | Application / inserting suppositories | |
| 29 | Kalka | Herbal Paste Application | |
| 30 | Sarpi | Use of medicated ghee | |
| 31 | Taila | Use of medicated oils | |
| 32 | Rasakriya | Administration of semi-solid medicinal extracts | |
| 33 | Avachurnana | Sprinkling of herbal powders | |
| 34 | Vrana Dhupana | Fumigation of wounds | |
| 35 | Utsaadana | Elevation of wounds – treatment of wounds with some herbs to improve granulation tissue so as to raise the floor of the wound | Vaikrutapaha |
| 36 | Avasaadana | Depression of wounds – removal of unhealthy, unnecessary, hyper-granulation tissue from floor of the wound which might delay healing of wounds | |
| 37 | Mrudu Karma | Softening the edges of the wounds | |
| 38 | Daaruna Karma | Hardening the margins of the wounds (some wounds have less tensile strength so that the wound margin easily separate causing early dehiscence and wound healing delayed. To avoid long time wound healing, daaruna karma is done) | |
| 39 | Kshara Karma | Application of alkalis | |
| 40 | Agni Karma | Fire cauterization | |
| 41 | Krshna Karma | Inducing black color (hypo-pigmentation area made normal like surrounding tissue) | |
| 42 | Pandu Karma | Inducing white color (hyper-pigmentation area made normal like surrounding tissue) | |
| 43 | Pratisaarana | Tablets made up of rough powder of medicinal herbs is rubbed on soft shiny skin (after wound healing) so as to make the skin surface rough, just like the normal skin | |
| 44 | Roma Sanjanana | Treatments and medicines (measures) enabling growth of hairs | |
| 45 | Loma Apaharana | Treatments and medicines (measures) enabling removal of unnecessary hairs | |
| 46 | Vasti Karma | Medicinal Enemas | |
| 47 | Uttara Vasti Karma | Enemas given through urinary and genital passages | |
| 48 | Bandha | Bandages | |
| 49 | Patra Daana | Covering the wounds with leaves | |
| 50 | Krimighna | Disinfectants | |
| 51 | Brmhana | Bulk promoting and strengthening treatments | |
| 52 | Vishagna | Anti-toxins, treatments and medicines which nullify or neutralize the effect of poisons and toxins | |
| 53 | Shiro virechana | Nasal instillation of medicines | |
| 54 | Nasya | Nasal instillation of medication / Errhines | |
| 55 | Kavala dharana | Rinsing of mouth with medicinal liquids | |
| 56 | Dhooma | Fumigation | |
| 57 | Madhu sarpi | Administration of honey and ghee | |
| 58 | Yantra | Instrumentation | |
| 59 | Aahara | Dietetic regimen | |
| 60 | Rakshaa vidhana | Sterilization (the surgical ward, instruments etc should be sterilized by fumigating with Guggulu (Commiphora mukul) etc herbs and Mantra uccharana (uttering or reciting holy hymns) to kill the small pathogenic organisms) |
