Sushruta’s 7 Types of Treatments Sapta Upakrama

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Sapta Upakramas are the treatments used in ancient days for surgical interventions and procedures especially for treatment of acute /chronic wounds, their complications and to prevent their relapse. Their utility can be extended in skillful ways to treat other systemic diseases also with changes in treatment designing.

Sapta Upakramas are 7 kinds of treatments which are explained in Sushruta Samhita, ‘Amapakvaishaniyam Adhyayam’ Sutra sthana 17th chapter, Verses 54. Sapta = seven, Upakrama = treatments.
Master Sushruta has just mentioned the names of these 7 kinds of treatment without explaining them in detail. The verse which highlights the names of these 7 specialized treatments is the last verse of this chapter. So we get a question, what might be the clinical or surgical utility of the procedures which are not detailed in the texts?
Read – Shashti Upakrama Meaning, Classification, Clinical Significance

Magnification of 7 Upakramas – Master Sushruta has just given a synopsis of these treatments in Sutra Sthana, a section of treatises wherein things need to be said in nutshell. He also had a magnified version of these 7 treatments and called it as ‘Shashti Upakrama’ i.e. ’60 kinds of treatments’. So precisely, Sushruta has hidden ‘60 precious treatment procedures’ within the core of 7 treatments only to present them in a magnified way in the later context. Sushruta has explained these 60 kinds of specialized treatments in the first chapter of Chikitsa Sthana section which mainly deals with treatment aspects of many diseases.
Read – Charaka Vrana Chikitsa – 25th Chapter – Wounds, Ulcers

Sapta Upakrama

Master Sushruta has explained the chronology in which these 7 treatments should be administered. They are –

  1. Vimlapana
  2. Avasechana
  3. Upanaha
  4. Patana Kriya
  5. Shodhana
  6. Ropana
  7. Vaikrutapaha

Sanskrit Verses

Shashti Upakrama in Sapta Upakrama

Different kinds of treatments mentioned in shashti upakrama have been included under sapta upakrama. Interestingly the 60 treatments explained in chikitsa sthana are also mentioned in a chronology. The inclusions of fragments of 60 treatments under each treatment of sapta upakrama themselves define each of the 7 treatments and what, how and when these treatments shall be conducted. In either case the chronology shall be maintained. All treatments and included sub treatments are not needed in all cases of wound treatment. They are selective and conditional and apply to the stage of wound we are dealing with.
Read – 4 Types Of Swedana As Per Sushruta And Vagbhata

1. Vimlapana

Vimlapana means to soften or causing to wither / languish. From the list of 60 treatments the below mentioned 6 treatments are included under Vimlapana. They are used to make the wound soft.

Sl NoName of the Upakrama (treatment)Meaning
1Apatarpana fasting
2Alepaapplication of medicinal pastes
3Parishekashowering of medicinal fluids
4Abhyangaoil massage
5Swedafomentation or sudation
6Vimlapanagentle pressing / cleansing measures

2. Avasechana

Avasechana means to expel the doshas. From the list of 60 treatments the below mentioned 4 treatments are included under Avasechana.

Sl NoName of the Upakrama (treatment)Meaning
2Snehainducing oiliness
3Vamanatherapeutic emesis
4Virechanatherapeutic purgation

3. Upanaha

Upanaha means applying a poultice. It is a kind of sudation therapy. From the list of 60 treatments the below mentioned 2 treatments are included under Upanaha.

Sl NoName of the Upakrama (treatment)Meaning
2Pachanahelping the pus to form properly so as to drain it out

4. Patana Kriya

Patana means tearing, slipping, dividing or making incision. Kriya is the method in which this is conducted. From the list of 60 treatments the below mentioned 9 treatments are included under Patana Kriya.

Sl NoName of the Upakrama (treatment)Meaning
15Daranasplitting / tearing

Read – Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma

5 & 6. Shodhana and Ropana

Shodhana means cleansing. Ropana means healing. From the list of 60 treatments the below mentioned 13 treatments are included under Shodhana and Ropana.

Sl NoName of the Upakrama (treatment)Meaning
1SandhanaUnification, union of fractures
3Shonita sthapanaChecking the bleeding, enabling proper circulation
4NirvapanaApplication and showering of cold potency medicines
5UtkaarikaApplication of warm semi-solid vata alleviating medicinal pastes to treat wound inflammation and necrosis of wounds
6KashayaAdministering herbal decoctions
7VartiApplication / inserting suppositories
8KalkaHerbal Paste Application
9SarpiUse of medicated ghee
10TailaUse of medicated oils
11RasakriyaAdministration of semi-solid medicinal extracts
12AvachurnanaSprinkling of herbal powders
13Vrana DhupanaFumigation of wounds

Read – Injury, Wound care Ayurvedic Remedies, Medicines

7. Vaikrutapaha

Vaikrutapaha means removing the deformities or undesired changes which have occurred as complications or sequels of wounds. From the list of 60 treatments the below mentioned 26 treatments are included under Vaikrutapaha.

Sl NoName of the Upakrama (treatment)Meaning
1UtsadanaElevation of wounds – treatment of wounds with some herbs to improve granulation tissue so as to raise the floor of the wound
2AvasadanaDepression of wounds  – removal of unhealthy, unnecessary, hyper-granulation tissue from floor of the wound which might delay healing of wounds
3Mrudu KarmaSoftening the edges of the wounds
4Daruna 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, daruna karma is done)
5Kshara Karma Application of alkalis
6Agni KarmaFire cauterization
7Krshna KarmaInducing black color (hypo-pigmentation area made normal like surrounding tissue)
8Pandu KarmaInducing white color (hyper-pigmentation area made normal like surrounding tissue)
9PratisaaranaTablets 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
10Roma SanjananaTreatments and medicines (measures) enabling growth of hairs
11Loma ApaharanaTreatments and medicines (measures) enabling removal of unnecessary hairs
12Vasti KarmaMedicinal Enemas
13Uttara Vasti KarmaEnemas given through urinary and genital passages
15Patra DaanaCovering the wounds with leaves
17BrmhanaBulk promoting and strengthening treatments
18VishagnaAnti-toxins, treatments and medicines which nullify or neutralize the effect of poisons and toxins
19Shiro virechanaNasal instillation of medicines
20NasyaNasal instillation of medication / Errhines
21Kavala dharanaRinsing of mouth with medicinal liquids
23Madhu sarpiAdministration of honey and ghee
25AaharaDietetic regimen
26Rakshaa 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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