Shashti Upakrama Meaning, Classification, Clinical Significance

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 NoSaptopakrama (7 therapies)Treatments of Shashti Upakramas (60 therapies) included under 7 main therapiesTotal Number of treatments included under 7 main therapies
1VimlapanaApararpana to Vimlapana06
2AvasechanaVisravana to Virechana04
3UpanahaUpanaha and Pachana02
4PatanaChedana to Sevana09
5ShodhanaSandhana to Vrana Dhupana13
7VaikrutapahaUtsadhana to Raksha Vidhana26
 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 NoName of the Upakrama (treatment)MeaningInclusion in Sapta Upakrama
1Apatarpana starvation / fastingVimplapana
2Alepaapplication of medicinal pastes
3Parishekashowering of medicinal fluids
4Abhyangaoil massage
5Swedafomentation or sudation
6Vimlapanagentle pressing / cleansing measures
8Snehainducing oiliness
9Vamanatherapeutic emesis
10Virechanatherapeutic purgation
12Paachanahelping the pus to form properly so as to drain it out
15Daaranasplitting / tearing
22SandhanaUnification, union of fracturesShodhana & Ropana
24Shonita sthapanaChecking the bleeding, enabling proper circulation
25NirvapanaApplication and showering of cold potency medicines
26UtkaarikaApplication of warm semi-solid vata alleviating medicinal pastes to treat wound inflammation and necrosis of wounds
27KashayaAdministering herbal decoctions
28VartiApplication / inserting suppositories
29KalkaHerbal Paste Application
30SarpiUse of medicated ghee
31TailaUse of medicated oils
32RasakriyaAdministration of semi-solid medicinal extracts
33AvachurnanaSprinkling of herbal powders
34Vrana DhupanaFumigation of wounds
35UtsaadanaElevation of wounds – treatment of wounds with some herbs to improve granulation tissue so as to raise the floor of the woundVaikrutapaha
36AvasaadanaDepression of wounds  – removal of unhealthy, unnecessary, hyper-granulation tissue from floor of the wound which might delay healing of wounds
37Mrudu KarmaSoftening the edges of the wounds
38Daaruna KarmaHardening 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)
39Kshara Karma Application of alkalis
40Agni KarmaFire cauterization
41Krshna KarmaInducing black color (hypo-pigmentation area made normal like surrounding tissue)
42Pandu KarmaInducing white color (hyper-pigmentation area made normal like surrounding tissue)
43PratisaaranaTablets 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
44Roma SanjananaTreatments and medicines (measures) enabling growth of hairs
45Loma ApaharanaTreatments and medicines (measures) enabling removal of unnecessary hairs
46Vasti KarmaMedicinal Enemas
47Uttara Vasti KarmaEnemas given through urinary and genital passages
49Patra DaanaCovering the wounds with leaves
51BrmhanaBulk promoting and strengthening treatments
52VishagnaAnti-toxins, treatments and medicines which nullify or neutralize the effect of poisons and toxins
53Shiro virechanaNasal instillation of medicines
54NasyaNasal instillation of medication / Errhines
55Kavala dharanaRinsing of mouth with medicinal liquids
57Madhu sarpiAdministration of honey and ghee
59AaharaDietetic regimen
60Rakshaa vidhanaSterilization (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)

Click to Consult Dr Raghuram Y.S. MD (Ayu)

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