Shashti Upakrama (Sixty Procedures) in the management of Vrana (Wound) - A Review

Background: Sushrutha Samhita, compiled by Acharya Sushrutha, lays down the principles of Ayurveda in general and the branch of Surgery or Shalyatantra in particular. As a warfare surgeon he provides a detailed description of the conditions the surgeons faced in their practice like wounds, fractures, dislocations, torn or damaged ears, nose, limb etc which either had to be amputated or reconstructed; haemorrhage, pains, intestinal obstruction, ascites etc. Management of wounds and ulcers was a challenge to Sushrutha and other physicians of those times and continues to be so even in today’s medically advanced era. Aim: To compile and evaluate the Shashti Upakrama mentioned for the management of Vrana in Sushrutha Samhita and to understand their utility in accordance to the present day wound management concepts. Materials & Methods: The 60 Upakrama mentioned in Sushrutha Samhita were analysed and scientifically discussed to check for their relevance for the management of Vrana in accordance to today’s needs. Observations: The challenges faced by him in his practice made him to lay down an elaborate method of managing the Vrana (Wound). Shashti Upakrama (Sixty procedures) deals with the management of Vrana Shopha (Inflammation), Vrana and the cosmetic repair of the formed scar. The management principles adopted for the wound management in the present modern science and the Shashti Upakrama mentioned by Sushrutha are similar and Sushrutha moreover lays great emphasis on the cosmetic repair of the formed scar and also mentions treatment modalities to prevent wound dehiscence and its recurrence. Conclusion: Shashti Upakrama is not only a scientific method for the management of a wound/ulcer from the stage of abscess to the stage of a well formed, cosmetically acceptable scar but is a more advantageous methodology.