Multicentric Validation of Questionnaire on Twak, Raktha and Mamsa Sara...

[Full title: Multicentric Validation of Questionnaire on Twak, Raktha and Mamsa Sara Pareeksha]

[Find the meaning and references behind the names: Bala, Hassan, Sara, Long, Ayu, Mahesh, Sreekumar, Mana, April, Shakti]

REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 82 Multicentric Validation of Questionnaire on Twak, Raktha and Mamsa Sara Pareeksha Parvathy Sreekumar 1 , Ajantha 2 , Mahesh Hirual 3 1 Post Graduate Scholar, Dept. of Roga Nidana Evam Vikruti Vijnana, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India. 2 Professor, Dept. of Roga Nidana Evam Vikruti Vijnana, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India. 3 Associate Professor, Dept. of Roga Nidana Evam Vikruti Vijnana, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India. I NTRODUCTION Ayurveda is a holistic science of life deals with healthy lifestyle, health upgrade and sustenance, disease prevention, diagnosis and treatment. Scientific evaluation of Ayurveda has been recognized since long time. Scientific value of Diagnostic approach according to Ayurveda centered on two-fold approach- Roga Pareeksha and Rogi Pareeksha . Rogi Pareeksha pertained with health status both physical and Address for correspondence: Dr. Parvathy Sreekumar Post Graduate Scholar, Dept. of Roga Nidana Evam Vikruti Vijnana, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India. E-mail: drparvathy.ayu@gmail.com Submission Date: 17/02/2022 Accepted Date: 24/03/2022 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA psychosomatic state of the patient. In-depth examination of the patient is inevitable as medicines selection done by prior assessment of Roga and Rogi Bala Ten-fold examination of Rogi comprises of Prakriti, Vikriti, Sara, Samhanana, Pramana, Satmya, Satva, Ahara Shakti, Vyayama Shakti and Vaya. [1] The term Sara signifies the purest form of Dhatus . The delineation of Sara implies the normal functioning of Dhatwagni, Bhootagni and Jataragni resulting in the proper production of Dhatus in the Sapthadhatu sequence. Ashta Saras are explained that comprises of seven Dhatu Sara and Satwa Sara. [2] It is one among the important techniques of clinical examination employed to assess the status of different Dhatus. Sara ascribed as “ Vishudhatharo Dhatu ”, essence of Dhatu that provides stability to the body [3] Derangement of Dhatu Sarata leads to Dhatuvaishamya , fallouts in disease manifestation [4] Sara Pareeksha is done to ascertain the Bala Mana Visheshajnana and Ayu Pramana. [5] The relevance in assessing the Bala of a person has been cited in Kalpasthana in the context of Samshodhana A B S T R A C T Ayurveda is a holistic science of life deals with healthy lifestyle, health upgrade and sustenance, disease prevention, diagnosis and treatment. It follows an individual focused treatment strategy. Sara Pareeksha is one of the parameters for the assessment of strength of an individual. This work is intended for revalidating of concept of Sara Pareeksha to the contemporary era aimed at its reachable equality in perception without losing its meaning. Very few works are done on Sara Pareeksha and no known works consummate on the questionnaire designing, detailed assessment of Twak, Raktha and Mamsa Sara . Need of standardization of basic principles like Sara concept should be supported with solid evidence using contemporary parameters Scientific and statistical validation of questionnaire on assessment of Sara Pareeksha , showed relevance in effective and efficient examination of Sara Pareeksha. Key words: Questionnaire Designing, Validation, Twak Sara Pareeksha, Raktha Sara Pareeksha, Mamsa Sara Pareeksha, Dhatu, Ayurveda.

[Find the meaning and references behind the names: Prasanna, Main, Sid, Rasa, Shad, Good]

Parvathy Sreekumar et al. Validation of Questionnaire on Twak, Raktha and Mamsa Sara Pareeksha ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 83 Chikitsa. [6] Shamana Chikitsa also hinged upon the Rogi Bala [7] as well as Aushadha Sevanakala. [8] Rasa the foremost formed Dhatu among Sapta-Dhatus, Acharya Dalhana clarifies that in terms of Twaksara [9] The word Twak corresponds to Rasa residing in the Twak. [10] Hence Twaksara person possess a good quality of Rasa Dhatu in predominance. Twak Sara Purushas can be defined as “individuals having predominance of essence of a good quality and quantity of Rasa Dhatu, characterized with a healthy and good looking skin”. Rasa Dhatu is the Sara of Shad Rasayuktha Ahara known as Poshya Dhatu . On Pachana of these Poshya Dhatus in presence of Agni derived from Pitta transforms to Raktha Dhatu that is action of Ranjaka Pita on Rasa. [11] Sara of Ahara after being subjected to Paka by Ranjaka Pita attains reddish color forms Raktha Dhatu [12] Mamsa Dhatu is the third structural element in the sequence of Saptadhatu formation, considered as one of the important criteria for defining compactness of body and immunity of an individual [13] Innate strength of the individual cannot be assessed by the bulk of the body, can only be judged by the Sara Pareeksha . Physician should not be misjudged to decide a person is strong or weak from his bulky or small body structure or appearance. Lean and slender may seems to be strong enough, just comparable to “ Pipeelika Bharaharanavath Sid dhi” [14] ; implies that small ants capable of carrying much more weight than its own. Vikriti (pathological changes) in Sara to be assessed as it varies according to the stages of Samprapti of Vyadhi, food and lifestyle the individual. Ayurveda requires evidence based research in the area especially in diagnostic principles so that Ayurvedic diagnosis can be made more pinpointed leading to more effective treatment strategies as it is a science based on logical explanation on Pareeksha aspects. O BJECTIVE To frame and validate questionnaire on Charakoktha Twak, Raktha and Mamsa Sara Pareeksha. M ETHODOLOGY Two Steps in Questionnaire Study 1 Method of Designing Questionnaire 2 Method of Validation of Questionnaire Steps of Designing Questionnaire ▪ Write a study protocol ▪ Draw a plan of analysis ▪ Draw a list of the information needed ▪ Design different part of questionnaire ▪ Order of questions ▪ Rating scale ▪ Complete the questionnaire Questionnaires are the most commonly used tool in survey research. However, the results of a particular survey are worthless if the questionnaire is written inadequately. Questionnaires should produce valid and reliable demographic variable measures and yield valid and reliable individual disparities that self-report scales generate. Questionnaire developing based on the classical reference of assessment of Charakoktha Twak, Raktha and Mamsa Sara Purusha Lakshanas, followed by validation through research methods. Basically, validation of Questionnaire involves three steps: 1. Preparation of Questionnaire 2. Expert Validityobtaining suggestions and recommendations of subject experts for Content validity, to check the content of Questionnaire, this is done by experts or authority persons. 1. Preparation of Questionnaire Considering the lack of tools for the assessment of Sara and its importance in diagnosis and treatment, this questionnaire framed based on Twak, Raktha and Mamsa Sara Purusha lakshanas isolated from Charaka Samhita . Questionnaire framed with a total of 151 items under the domains Twak, Raktha and Mamsa Sara Pareeksha . Twak Sarata assessment done with 2 main domains – Twak (skin) and Loma (bodily hairs), 9 sub domains under each domain that are Snigdha, Slakshna, Mrudu, Prasanna, Sookshma, Alpa, Gambheera, Sukumara and Saprabha . Total 37 questions under those 23 questions framed for Twak (skin) and 14 questions framed for Loma (bodily hairs).

[Find the meaning and references behind the names: Anand, Mere, Karna, Amrita, Guru, Patel, Vishnu]

Parvathy Sreekumar et al. Validation of Questionnaire on Twak, Raktha and Mamsa Sara Pareeksha ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 84 For Raktha Sarata assessment overall 55 questions outlined under 4 parameters to be evaluated - Snigdhata, Raktavarna, Shrimad and Bhrajishnu at Karna (ear pinna) , Akshi (eyes) , Mukha (face) , Jihwa (tongue) , Nasa (nose) , Osta (lips) , Panithala (palm) , Padathala (sole) , Nakha (nail) , Lalata (forehead) and Mehana (perineum) . 59 questions framed for the assessment of Mamsa Sara under Sthira, Guru, Shubha and Mamsopachita that are being examined at Shanka (temporal region), Lalata (forehead), Krukatika (back of neck), Akshi (periorbital region), Ghanda (zygomatic region), Hanu (mandibular region), Greeva (neck), Skanda (shoulder), Udara (abdominal region), Kaksha (axilla), Vaksha (thorasic region), Panisandhi (joints of upper limb) and Padasandhi (joints of lower limb). Assessment of these Sara Purusha Lakshanas including both objective and subjective parameters and scores will be attributed accordingly. Respective methodology followed are enlisted in the questionnaire attached. Method of Validation of Questionnaire 2. Expert Validation Expert validation for construct and content validity that includes: a) Focus Group Discussion / In-Depth Interviews with subject experts. b) Giving questionnaire with options-panel of experts are identified, a content validation form created that defines the construction of questionnaire. c) To examine and explore opinions regarding the items about both the positive and negative aspects of Questionnaire intended to measure and give expert opinions. R ESULT AND DISCUSSION The questionnaire was designed based on Charakoktha Twak, Raktha and Mamsa Sara Purusha Lakshanas. All the assessment parameters were segregated individually, translated into English in form of subjective and objective analysis. Total 17 experts were identified Govt. Ayurveda College, Bisapur, Chattisgarh; five from Amrita School of Ayurveda, Kollam, Kerala; Vishnu Ayurveda College, Palakkad, Kerala; Mandsaur Institute of Ayurveda Education and Research, Mandsaur, Madhya Pradesh; Karnataka Ayurveda Medical College, Mangalore, Karnataka; K V G Ayurveda College, Sulia, Karnataka; Hillside Ayurveda Medical College and Hospital, Saldoddi, Banglore, Karnataka; SDACH – Chandigarh; SDMCAH, Hassan, Karnataka and Parul University, Vadodara, Gujarat; Global Institute of Ayurveda, Rajkot, Gujarat; and two from G J Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidhyanagar, Anand, Gujarat. They were sent the questionnaire for informed opinion from experts with a track opinion provided with judgement and information regarding assessment. Among the total majority suggestion were on Snigdhata evaluation including the necessity adding of more grading system, nature of moisturizers used. Also, suggestion for assessment of parameter like Sookshma Twak, Rakthavarnata, Guru, Mamsopachita were accepted and changes done in accordance with the requirement and available standard scales. All the 17 experts acclaimed that all questions incorporated were needed. Initially comprised of 139 questions, after incorporating the expert opinions 12 questions were added. CONCLUSION The inherent power of an individual cannot be assessed by mere muscle bulk, fat distribution and BMI. The actual strength of an individual can only be ascertained with Sara Pareeksha. Assessment of Sara is very crucial in the practice of Ayurveda as it act as a window to understand the status of Dhatu in an individual. Also, for assessing the Bala of individual and paramount importance in selection of Chikitsa . Thus, Evaluation of Dhatu Sarata can be expedient in Samprapthi Vighattana. Scientific and statistical validation of questionnaire on assessment of Sara Pareeksha showed relevance in effective and efficient examination of Sara Pareeksha . REFERENCES 1 Kushwaha HC (Editors). Rogbhishakjitiya Vimana, Charaka Samhita. Varanasi: Chaukambha Orientalia. 2005;693 p.

[Find the meaning and references behind the names: Sharma, Deepika, Bhagwan, Nil, Med, Prakashan]

Parvathy Sreekumar et al. Validation of Questionnaire on Twak, Raktha and Mamsa Sara Pareeksha ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 85 2 Agnivesha. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;278 p. 3 Kushwaha HC (Editors). Rogbhishakjitiya Vimana, Charaka Samhita. Varanasi: Chaukambha Orientalia. 2005;693 p. 4 Byadgi PS. Parameshwarappa’s Ayurvediya Vikruti Vijnana & Roga Vijnana. Chaukambha Publications, New Delhi. Vol 1, 2013:449 p. 5 Agnivesha. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;277 p. 6 Agnivesha. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;673 p. 7 Agnivesha. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;646 p. 8 Agnivesha. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;646 p. 9 Paradakara H S Sastri. Ashtangahrdaya by Vagbhata. Varanasi; Chowkamba Surbharati Prakashan. reprint ed, 2005;10 p. 10 Acharya J T, Acharya N R. Sushruta Samhita of Sushruta, Nibandha Sangraha Vyakhya of Dalhana. Varanasi: Chaukhamba Orientalia. 7 th edition, 2002;152 p. 11 Acharya JT. Susrutha Samhita with Nibandhasangraha commentary of Dalhana, Nyayachandrika Panjika of Gayadasa Acharya on Susruta Samhita of Susruta. Varanasi: Chaukambha Orientalia. 9 th edition, 2007;60 p. 12 Acharya JT. Susrutha Samhita with Nibandhasangraha commentary of Dalhana, Nyayachandrika Panjika of Gayadasa Acharya on Susruta Samhita of Susruta. Varanasi: Chaukambha Orientalia. 9 th edition, 2007;59 p. 13 R.K Sharma and Bhagwan Dash. Charaka Samhita, English translation and critical exposition based on Chakrapani Datta’s Ayurveda Deepika. Chaukambha Sankrit Series Office, Varanasi. Reprint – 2020, Vol 1, Sutra Sthana, 21, Shloka 18; page no 377. 14 Agnivesh. Charaka samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor). New Delhi; Chaukambha Publications. Vimanasthana, 8 th Chapter, 115 verse, Reprinted 2014;287 p. ******************************* How to cite this article: Parvathy Sreekumar, Ajantha, Mahesh Hirual. Multicentric Validation of Questionnaire on Twak, Raktha and Mamsa Sara Pareeksha. J Ayurveda Integr Med Sci 2022;3:82-85. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Guru, Dhatu, Bala, Rasa, Ahara, Agni, Ayurveda, Satva, Pramana, Prakriti, Paka, Mamsa, Vaya, Sara, Kalpasthana, Vikriti, Samprapti, Ranjakapitta, Satmya, Rasadhatu, Mamsadhatu, Snigdhata, Samshodhana, Chikitsa, Vyadhin, Samhanana, Aharashakti, Vyayamashakti, Purushalakshana, Twak, Subjective analysis, Shamanacikitsa, Roga Pareeksha, Rogi Pareeksha, Sara Pareeksha, Expert validation, BMI, Dhatu Sarata, Dhatwagni, Raktha Dhatu, Content validity, Samshodhana Chikitsa, Twak Sara, Jataragni, Dhatuvaishamya, Objective analysis, Validation, Questionnaire, Bhootagni, Focus group discussion, Poshya Dhatu, Validation of questionnaire, In-depth Interview, Sapthadhatu.