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 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)