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A BRIEF REVIEW ON SHASTI UPAKRAMA

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 International Journal of Applied Ayurved Research ISSN: 2347- 6362
A BRIEF REVIEW ON SHASTI UPAKRAMA

Varma Alok1
Lecturer Dept of Shalya Tantra BKAMCH, Daudhar, Moga, Punjab.India.
ABSTRACT
In Ayurvedic text the Sushruta samhita , written by legendary surgeon of ancient age
Acharya Sushruta is the foundation of Ayurvedic medicine as well as surgery. He has given
special attention on describing basics of surgery. There is a general impression that Sushruta
samhita is the only an ancient Indian Ayurvedic text book of surgery. Sushruta samhita
contains 184 chapters , divided into fives sthana ,having description of 1120 illness, 700
medicinal plants, detailed and elaborated knowledge of accurate anatomy, 64 preparation
from mineral and 57 preparation based on animal sources. It still retains landmark position in
the field of surgical text.Acharya Sushruta is worldwide known for his historical work on
plastic surgery, he has also made similar numerouscontributions on various aspects of
medicine, such as fracture and dislocation, urinary stone, various type of skin disease as
kustha, panchkarma procedure, toxicology, pediatrics, eye diseases, psychiatry, obstetrics
and gynaecology etc. A very limited conceptual work has been performed on the selected
chapters of Sushruta samhita. Therefore a review conceptual study has been carried out on
the Shastiupakrama of vrana of sushruta samhita. Outcome of the study shows that Sushruta
samhita is written in the aphorism form and technique describe in it regarding treatment of
vrana in its various stages are the basic of whole surgery. The all 60 upakrama can be
simplified and included in 7 upakrama of sopha.It is need of hour to explore the hidden truth
by decoding the versions of the text.
KEY WORD:Sushruta samhita, shastiupakram ,Shaptopakrama,Vrana
INTRODUCTION: Ayurveda is the most manner. As we know in any kind of
ancient medical science of our civilization. surgery there is a common thing that is
1
Ayurveda considered as fifth veda alog wound. Either we made it or it already
with the Rigveda, Samveda, Yajurveda and present in the patient. So to understand
Atharve veda.The vedas are considered to surgery it is very important to understand
be the first record of the ancient the wound first.Sushruta samhita was
knowledge and civilization. Among these written in the holi city of Kashi sometimes
four vedas maximum description of around 1000BC3. Sushruta was primarily a
Ayurveda is found in Atharvaveda2. Later surgeon and recognized as the Father of
on Ayurveda developed as a seprate system surgery4 in the world. The management of
of medical science and upgraded as upveda wound is describing in Sushruta samhita
of Atharva veda. Ayurveda initially have in very detail manner. He advises sixty
main two stream i.e. medicine and surgery. upakrama (method) of treating wound is
Agnivesh tantra is the prime literature of lot of different conditions known as
medicine and Sushruta samhita is the main shashtiupakram5 in Chikitsa sthanam. In
pillar of Ayurvedic surgery. In Sushruta present study a attempt is made to
samhita various surgical procedure are understand various upakrama in nowadays
described in very simple and scientific surgical aspects.

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 Varma Alok etal: A Brief Review on Shasti Upakrama

AIM AND OBJECTIVE: sushruta was to subside mainly Vedna and

1. To evaluate, elaborate and discuss Daha locally.
the various surgical concepts of Abhyang is the next upakaram ,
Shashtiupakrama of Sushruta Samhita. look more important when we see with the
2. To understand the basic principle angle that by local Abhyanga pathology
of wound management. can be broken down, to prevent
MATERIAL AND MATHOD:The all progression of disease. As we know
reference of Shashti upakrama are according to Ayurvedic principle disease
collected and compiled from sushruta mostly starts due to srotorodha, play
smahita and other Ayuvedic classics and important role in producing sophaa. So
various modern textbooks of surgery. The with the help of Abhyanga Srotorodha
various upakrama are discussed with might be relieved and opening srotasa at
their method and importance of there in the site of sophaa.
enhancing wound healing. Swedana is the next upakrama that
OBSERVATION: As Acharya Sushruta help both locally and systemically. As with
mentioned Shashtiupakrama in chapter the help of swedana ,Aama pachan affects
one of Chikitsa sthanam of his Samhita in systemically and reduces kupita vata and
reference to management of Vrana. He kaphadoshaat the site of vrana sopha. In
describe almost all the basic principle of cotest to vrana sopha Abhyanga may be
surgery in form of saptoupakrama of very useful for dilution of Dosha to break
sopha6, he shows very close and practical srotosangha, responsible for Samprapti.
approach towards the patient of vrana Vimlapana is the next upakrama
sophaa. He started shashti upakrama with advocated by sushruta is with the help of
the Aptarpana,that means Langhana. finger tip, thumb, or with green stick softly
Langhana is used probably to brake the rubbing at the site of sophaa that may
pathology in very initial stage, as we know work by dispersing the accumulated
according to Ayurvedic text most of the Doshas in the corresponding srotas so that
nija vyadhi starts with the development of srotosangha may be release and pathology
Aama, later on that after association with may break. If we discuss within light of
Doshas produces vyadhi.In case of sophaa modern medical science, that before
when Aam7 associates with Dosha and developing a cutaneous abscess8,mostly
brings them in vidagdhavastha , that cause the focus lays in side any sweat gland, hair
pakva sopha leading to puya formation follicle root or close sebaceous gland, so
that require active and aggressive with the help of vimlapana may be there is
management. So with the first upakrama opening of mouth of that particular gland
shushruta wants to break pathology very or focus so that progression of disease is
early to limit progression of disease. checked.
Next upakrama Alepa and Upanahupakrama is a form of
Parisheka are mainly use for the saman of swedna,which is used for the purpose to
local kupita Doshas and reduces sign and subside or aggravate the process of Sopha
symptoms when used with different Paka. As if Doshas involved in sophaa are
specific yoga stated in sutrasthana vidaghdha then after upanah ,sophaa will
mishrak adhyay. Here approach of go under pakvastha and if Doshas are
avidagha then due to effects of upanah
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,the Doshas after vilayana circulate in to swedana so that make easy to sodhana of
whole body.Upanah breaks the Samprapti sharira,by these means the severity of
of sopha and sopha subsided completely. inflamation reduces markedly. Vamana is
Pachana is the next upakrama describe by indicated when kaphaja lakshana are more
Acharyasushruta, when upanah unable to prominent and virechana is indiacted when
show result locally and sopha neither pitta dosha is prominent.By these sodhana
subsided nor become pakva, now Acharya karma diseases limits at the stage and not
taken a general or systemic approach for progress further.These reduces sign and
the pachan of aam Doshas by symptoms locally as well as systemically.
administering pachana drug by oral route. Next upakrama from Daran to
If involved Doshas are avidagdh then with shivana all these are describe as shalya
the use of pachana drug the local focus is karma used in different types of Nija and
broken and Doshas left free into blood Agantuja vrana to remove puya from
stream. pakva sopha. The Puya(pus) included dead
Next upakrama Vishravan7 is a pathogen and cellular debris.Pus11 consists
kind of rakta mokshana with the use of of a thin, protein-rich fluid, known
Sringa , Alabu , jalauka and siravedha.The as liquor puris, and dead leukocytes from
vitiated (Kupita) dosas are removed from the body's immune response (mostly
the site of sopha with the rakta mokshana. neutrophils). During
Here different method of rakta mokshana infection, macrophages release cytokines
is used according to prominence of which trigger neutrophils to seek the site
involved dosa9 and level of dosas in of infection by chemo taxis. There, the
body10, as if dosas are present neutrophils engulf and destroy the bacteria
superficially/ skin then method of rakta and the bacteria resist the immune
vishravana should be jalaukavcharana. If response by releasing toxins
dosas are little deep then alabu ,shringa called leukocidins. As the neutrophils die
and Prachan should be mathod of choice. off from toxins and old age, they
If dosas are spread throughout body and are destroyed by macrophages, forming the
deep seated, then method of bloodletting viscous pus.Puya nirharan is used to clear
should be Siravedha. This may work as the pathogens in modern prospects and
illuminating the dosas outside the body Dosas in Ayurvedic prospects. Beside
and diminishes the local sign and shastra karma some other method are also
symptoms. Leech therapy is specially used for puya nirharan. Some drugs are
indicated in toxic inflammation may be advised for local application for this
internal or external. purpose12. By their chemical action pakva
Next Snehan,Vamana and sopha ruptured itself without using any
Virechana all these upakrma are very shastra. Acharya sushruta advised some
important part of panchkarma therapy. drugs as Yavakhara,Samudrafen and
Basically this is again a conservative saindhav lavana for the lekhana karma by
approach of Acharyas, by these method the their chemical debridment. Next four
dosas are expelled through body via upakram Eshana, Aharana, Vedhana And
urdhva and adho marga. Because prior to Vidravana are performed by Shastra.
panchkarma dosas circulated in body are Shivana and shandhana karma are used to
brings in to mahasrotas by Snehan and
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approximate the edges of non infected Utkarika is the next upakram, in

wounds by using shastra. which vataghna dravya are used in the
Peedan is the next upakrama used form of warm semisolid (paste like)
mainly for the vrana sophaa appear in soft formulation. May it subside the symptoms
,vital organs define as marma Pradesh in developed due to Vata prakopa.This is
our body. Because shastra karma in indicated in inflamed or/& necrosed
contraindicated in marma Pradesh. Some wound.
medicines are used in form of pralepa for From kashaya upto Dhoopa1 all the
purpose of peedana13. Pralepa should be upakrama are used for Sodhana and
done in the manner so that the mouth of ropana of vrana. The medicines used in
sopha left open, and let it dry. After some upakrama decide the function of
time dried pralepa provide a pressure on upakrama . If drug taken having sodhana
cavity by contraction that results into properties then it clean the wound and if
drainage of us collected inside the cavity. drugs having ropan properties then it
Peedana karma is a kind of vidravana enhances the healing of the wound. For
without using shastra. example brihati,kantkari ,hartaal and
Sonita sthapana is the next manahshila sadhita tail and ghrita are for
upakrama describe just after shastra sodhan15 karma and kanguka, triphla,
karma as we know every where, when rodhram, kasheesh, shravanhya, dhav, &
shastra is use there is bleeding. So after ashvakrna tvak are used for ropan16 karma
drainage of puya, some amount of rakta is From Dhoopan upto last upakrama
also discharge at the site of shalya karma Rakhsavidhan all may be considered into
that may be acceptable. But to avoid the last saptaupakrama of sopha i.e.
excessive loss of blood Acharya dictated Vaikritapaham17. As we know in our body
sonitha sthapana. As blood being most when any nija vyadhi tends to develop
important dhatu said by Acharya shushrut then there must be some disturbences in
himself “Dehasya rudhiram mooolam the samyavastha of Dosas. So to resolve
rudhiiyam dharyat,tasya yatnen this vaikritavasth of dosas i.e. vikrti
sanrakhsyam raktam jivit sthitah”14. So vaikritapaham should be employed.
when there is bleeding we should stop This process of vaikritapaham is devided
immediately to avoid excessive loss. into Local and systemic. Among the
Raktasthapan is achieved by four method Shashtiupakrama from utsadana to
advised by Acharya sushruta are lomapaharan acts localy as utsadana
Sandhan,Skandan Pachan and Dahana. ,means the wound having depressed or
From here Acharya concentrate on deep floor due to less developed
sodhana and ropana of vranasopha. granulation tissue are treated with some
Nirvapana is the next upakram in drugs which improve granulation tissue so
which lepa and sheka of sheetal dravya are that floor is raised in some extent. Next
applied. It may help in sandhan karma and upakrama avshadna is used to remove
subside the local symptoms. Daha, paak unhealthy, unnecessary hyper granulation
due to Kupita pitta and kapha and rakta. tissue from floor of the wound which
So these upakram may help in sandhana produces delayed healing. Mridukaran is
karma. the next upakrama in which wound
margins and edges are make soft. Because
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hard fibrosed edges may hamper wound Haritaki with Ajaksheera that make skin
healing and produces chronicity. In simillar to surrounding skin.
mridukaran specially vataghna dravya are Pratisarana is the next upakrama
used. in which some rough powder of Mulethi,
Daruna karma is the next Kutkutandtvak, Nirmali and Muktashakti
upakrama just opposite to mridukaran as mix along with gomutra tablets are
some wound having less tensile strength so prepared. These tablets are now rubbed on
that wound margin easily separate causing the surface of healed wound to make it
early dehiscence and wound healing rough which was very shiny after wound
delayed. So to avoid long time wound healing. So the healed area becomes
healing daruna karma should be done. enough rough as healthy skin.
Next upakrama kshara karma is Romasanjanan is the next
used especially in chronic non healing upakrama in which ashes of elephant teeth
wound for chemical debridement18 so that is used for increasing growth of hairs. It
fresh healthy granulation tissues appears may be used at the site where hairs are lost
and improve healing. due to any kind of injury, that may re
Next upakrama Agnikarma is a appear by romasanjanan.
very important and describe separately as a Next upakrama Lomapaharana
upyantra in sutra sthanam. It is very used to remove excess hairs present at the
important therapy for treatment of many site of injury. For this purpose, shankha
diseases, but in concern to wound churna&harital in 2:1 ratio .mix with amla
management, it is especially employed dravya and apply as lepa.
when there is any kind of blood or liquid Vastiis the next upakrama used
discharge from wound19. The different especially for vataja wound which having
type of shalaka are used for Agnikarma. sever pain & present in lover portion of
Agnikarma stop bleeding immediately as body. Vatshamaka drugs are used for vasti
well as do a kind of sterilization due to that may act on vata dosah. In the
heat. As Acharya stated dahana20 is the continuation Uttarvati upakram used for
method of rakta sandhan. So it important the urogenital tract desease i.e. different
in discharging wound. mutraghata, mutradosh, sukradosh ,
Krishna karma is the next upakrama that Artava dosha and wounds caused by
is very important method of vaikritapaham Ashmari.
stated in saptaupakrama of sopha. Where Bandhan is the next upakram used for the
ever there is a hyper pigmentation occurs open wounds .Acharya provide it’s
after wound healing. We must try to make complete detail in sutrasthanam. This
that area similar to surrounding skin protects wound being infected and fibrosed
surface that look cosmetically better. For and keeps it mridu so that heal quickly.
this purpose some drug like Bhallataka is Patradanam is the next upakrama
used for this purpose, so that vikriti is a kind of bandhan. Some chronic wound
developed due to disease may be resolved. with fix and less fleshy areas are covered
Pandu karma is the next upakrama by some plants leaves poured with
similar to previous upakrama where hypo different Doshashamak drugs.
pigmented area is treated with drug like Krimighna is the next upakrama
used specially for infected wounds. The
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 Varma Alok etal: A Brief Review on Shasti Upakrama

main aim is to decrease load of pathogens Aahar is the most important part of
from wound site. This is done by washing management of any disease with the
with kwath (Decoction) applying Lepa medicine. So patient having a large wound
prepared by krimighna drugs and should avoided guru and vidahi aahar. So
Kharodaka .The extraction of krimi from laghu aahar should be given in small
wound site. amount but frequently
Brinhad karma is the next Raksha vidhana is considered as
upakrama employed in the person that last upakrama of wound management. In
became ksheerna(emaciated) due to long this along with patient’sshalya karmagar
time illness. So keeping mind the status of and shastra should be fumigated with
Jatharagni patient should be treated with gugulu and mantrocharna is advised that
brinhad drugs and karma. may kill the small pathogenic organisms.
Vishaghna is the next upakrama The Yama and Niyama should be advised
used for the treatment of wound made by to patient that may help him for
the toxic effect of any substances .Acharya management.
Sushruta described in detail in the These 60 upakrama are described in
kalpasthanam. Sushrutasamhita in chikista sthanamfor
Sirovirechana is the next the successful management of wound.
upakrama mainly used for the wounds One, or more than upakrama may used at
with kaphaj lakshan and present in the any time of treatment state.
head, neck and throat areas. DISCUSSION:In the present work there
Nasya is the next upakrama is detailed study on Shashti upakrama has
,employed in the wound of kantha and been done. The Shashti upakrama are
above region which are affected by Vata described in chikitsa sthanam chapter one
Doshas. in detail. Acharya Sushruta describes the
Kanvala is the next upakrama basic of surgery in the form of
used specially for thewounds of oral management of wound. As we know in
cavity, on gums and teeth. According to any kind of surgery either there is wound
involvement of Doshas Usna and sheetal already or we made it. So being a good
kanvala is advised. surgeon we have to know that how we deal
Dhoom is the next upakrama used with the different stages of wound.
mainly for the Kaphavataja vyadhi and Acharya sushruta advised 60 upakrama
vrana with sopha and peeda above jatru for the management of wound.
(jatrordha) Pradesh. Among these upakrama one or
Madhusarpiis the next upakrama in which more than one upakrama may be
madhu and sarpi is used for sandhana employed according to condition of
karma of vrana especially in new and wide wound, disease, condition of patient,
vrana. Here madhu and sarpi collectively availability of drugs and all that. All these
acting for sandhan karma. 60 upakrama can be classified into the
Yantra are used for the purpose of seven upakrama of sopha .Saptopkrama
extracting shalya and used for debridmentt of sopha are stated in chapter 17 of
of vrana.Acharya sushruta consider these sutrasthanam named Aampakvaeshniyam
instruments for wound management as a adhyaay. These upakrama are Vimlapana,
upakrama. Avasechana, Upnaha,Patana kriya,
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sodhana, Ropnam and last vaikritapaham. occurs during/after wound healing process.
These regimen of saptopakrama is These all upakrama broadly can be
described for both aam and pakva sopha categorizes into two types as systemic
means it included Nija and Agantuja both vaikritapaham and local vaikritapaham.
type of vrana. During disease condition Doshas becomes
As in nija vrana dosha are unbalance and may dhatus becomes
involved from initial and in agantuja kheerna and any kind of unwanted
vrana involment of dosh occure lateron. In material accumulates in body so by the use
refrence to sopha saptopakrama are of vasti, uttarvasti
advocated from initial to last,Vimlapana in krimighna,sirovirechana,bandh,kanval,nas
aam sopha and vaikritapaham for the ya,dhoom,madhusarpi,yantra, ahar and
wound made during surgery after Rakhsavidhana the doshas may be in
pakvavastha. In saptopakrama from samyavastha.
vimlapana to upnaha our approach is The upakrama of local
conservative and for this purpose from vaikritapaham plays an important role in
alep to vaman initial eleven upakramaare the process of wound healing. These
used for the same purpose. So initial 11 included utsadna, avshadna, Mridu karma,
upakrama may be included into initial 3 daruna karma, kshara karama , Krishna
upakrama of saptopakrama of sopha. Next karma ,Pandu karma
saptopakrama Patana included all the Pratisarana,Lomapharana and
shastra karma as chedana, lekhana, Lomasnjan. These above upakrama work
bhedana, darana, eshana, Aaharana, as local vaikritapaham. Utsadan karma
Vedhana, Vishravana and sheevan karma. used to elevate the floor of wound by
Among these all shastra karma which one improving granulation tissue with the use
should be employed is depends upon the of stated drugs in chapter and Avsadana is
condition of disease, patient’s condition, used to depress the over elevated surface
availability and choice of surgeon. of wound by removing excess granulation
After Patana next two upakrama tissue which may produces hindrance in
Shodhana and ropana included next 14 healing process.Mridu karam is used to
Shashti upakrama from sandhna to soften the wounds margin that reduces
vranadhupan. These two upkrama are speed of healing.Krishna karma used often
basically drug based so Acharya described after healing to reduce the hypo
the different drugs that act as shodhana pigmentation produce on scar. Pandu
and ropana purpose.As he described karma is also used in contrast to reduce the
khashaya upakrma so for the sodhana discoloration on scar. Lomapaharan and
purpose shodhan dravya are used as Lomsanjanan are also use according to
kashaya and for ropana purpose decoction vikrity produces on scar surface. This is the
of ropana dravya is used. Among all most important upakrama amongs
Saptopakram vaikritapaham is the most saptopakrama and having lot of procedure
importanat and wast and included rest all under this.
the Shashti upakrama. As we CONCLUSION:The study can be
vaikritapaham means the upakrama which concluded that Acharya Sushruta describe
is used for the purpose to reverse or Shashti upakrama in the management of
decrease severity of the changes that wound in detail. That can be employed
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 Varma Alok etal: A Brief Review on Shasti Upakrama

according to the different stages of wound 6. Sushruta Samhita, edited with

.The concrete of study is thatShashti Ayurveda Tatva Sandipika by Kaviraja
upakrama are expansion of saptopakrama AmbikaDutta Shastri Chaukhambha
of vranasopha. It is easy to learn and apply Sanskrit Sansthan, Sutra sthanam
the principle of saptopakramain the chapter 17 /22,23, p74.
management of surgical wounds.Where as 7. Sushruat Samhita, edited with
Shashti upakrama provide us lot of option Ayurveda tatva Sandipika by Kaviraja
for the management of wound in different Ambika dutta Shastri, Chaukhambha
stages. Among all these upakrama those Sanskrit Sansthan, sutra sthanam
which comes under vaikritapaham are chapter 17/6 p-71
having more importance in present 8. http://www.uptodate.com/contents/skin
scenario. In modern surgery there is no any -abscesses-furuncles-and-
definitive method to managing the scar carbuncles/abstract/1
that develops after surgery. With the use of 9. Sushruta Samhita, edited with
krisna Karma and pandu we thoroughly Ayurveda Tatva Sandipika by Kaviraja
manage the deformity develop after AmbikaDutta Shastri Chaukhambha
surgery with the use prepration advocated Sanskrit Sansthan, Sutra sthanam
in samhita. Beside this Kshar karma, chapter 13 /4, p43.
utsadana and avsadana are also having lot 10. Astangahrdayam,edited with vidyotini
of important in management of chronic hindi commentary by Kaviraja
ulcers. There is need of time to do more Atrideva Gupta, Vaidya yadunandan
retrograde study on different procedure of Upadhyaya, Chaukhambha Sanskrit
Shashtiupakrama in clinical area of Sansthan, Sutra sthanam chapter
Ayurveda 26/52-54,p147
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1. Kashyap samhita commented by pandit M. Brock Biology of Microorganisms
Hemraja sharma Viman Sthan 11th ed. Pearson Prentice Hall. USA.
Chaukhambha Sanskrit Sansthan p62 2006: 734
2. Sushruta Samhita, Nibandh Sangrah 12. Sushruta Samhita, edited with
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dalhana, jadavji T,editor Varanasi, AmbikaDutta Shastri Chaukhambha
Chaukhambha Sanskrit Sansthan p2 Sanskrit Sansthan, sutra sthanam
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Chaukhambha Sanskrit Sansthan .p1 AmbikaDutta Shastri Chaukhambha
4. http://wiki.answers.com/q/who_is_the_ Sanskrit Sansthan, sutra sthanam
father of surgery. chapter 36/11, p138
5. Sushruta Samhita,edited with 14. Sushruta Samhita, edited with
Ayurveda Tatva Sandipika by Kaviraja Ayurveda Tatva Sandipika by Kaviraja
AmbikaDutta Shastri Chaukhambha AmbikaDutta Shastri Chaukhambha
Sanskrit Sansthan, Chikitsa sthanam Sanskrit Sansthan, sutra sthanam
chapter 1 /8, p4 chapter 14/44, p56

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 Varma Alok etal: A Brief Review on Shasti Upakrama

15. Sushruta Samhita, edited with

Ayurveda Tatva Sandipika by Kaviraja Corresponding Author:
AmbikaDutta Shastri Chaukhambha Dr.Alok Varma
Lecturer Dept of Shalya Tantra
Sanskrit Sansthan, sutra sthanam
BKAMCH , Daudhar, Moga, Punjab.
chapter 36/19, p138 India.
16. Sushruta Samhita, edited with
Ayurveda Tatva Sandipika by Kaviraja
Source of support: Nil
AmbikaDutta Shastri Chaukhambha
Sanskrit Sansthan, sutra sthanam Conflict of interest: None
chapter 36/28, p139 Declared
17. Sushruta Samhita, edited with
Ayurveda Tatva Sandipika by Kaviraja
AmbikaDutta Shastri Chaukhambha
Sanskrit Sansthan, sutra sthanam
chapter 17/23, p74
18. A manual of Kshara sootra karma by
Prof. R.C Arya.chapter 8 p-118
19. Sushruta Samhita, edited with
Ayurveda Tatva Sandipika by Kaviraja
AmbikaDutta Shastri Chaukhambha
Sanskrit Sansthan, sutra sthanam
chapter 12/10, p39
20. Sushruta Samhita, edited with
Ayurveda Tatva Sandipika by Kaviraja
AmbikaDutta Shastri Chaukhambha
Sanskrit Sansthan, sutra sthanam
chapter 14/39, p55

9 www.ijaar.in IJAAR VOLUME 1 ISSUE 5 MAY-JUN 2014

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