Estimation of Dhatusaara in Different Age Groups An Analytical Cross-Sectional Study

INTRODUCTION Ayurveda is one of the oldest sciences (6000 BCE) of the world which discuss about the concept of dhatu along with the core concepts of tridosha, panchmahabhootha, prakriti etc. It tells that the  physical constitution of any living creature is formed by dhatus. There are seven dhatus, namely rasa, rakta, mamsa, medas, asthi, majja, shukra performing specific functions.

Acharya Charak stated, “bala mana vishesh gyaanartham updishyate,” which means that dhatu sara assesses an individual’s level of strength. The purest form of dhatus, sara, must be in its ideal state (Prakrit avastha) and not influenced by any dosha in order to exhibit these traits. When dhatvagni and bhutagni are in their optimum state, the formation of sama dhatus takes place and when these dhatus are in their excellent state, it is called sara of that particular dhatu.

Dhatusara is the essence of dhatus (visudhataro dhatu) which signifies the ultimate quality of dhatu and excellent functional aspect. Dhatusara has been mentioned for the assessment of strength (Bala) and life span of patient. Individuals on the basis of dhatusara have been classified  into various categories depending upon the predominance of a particular dhatu in the body, except  the Satva saara which is based on the predominance of satva (psychic factor). In the body, eight saara have been described in texts of Ayurveda.

According to Acharya Charak, age is broadly divided into three stages viz. Baalya Avastha, Madhyam Avastha & Jeerna avastha.

Baalya avastha is determined up to the age of 16 years when dhatu are immature(बालमपरिपक्वधातुम), sexual characters are not manifested the body is delicate, unenduring with incomplete strength and predominance of Kapha. From 16-30 years all dhatu are in developing state(विवर्धमानधातुगुण).

Madhyam avastha*(30-60 years)* is characterized by strength, energy, virility, valor, acquisition, retention, recollection, speech, understanding and qualities of all dhatu having developed properly(सर्वधातुगुण); with proper physical and mental strength, without degeneration in qualities of dhatu, with predominance of Pitta and is up to 60 years.

Jeerna avastha*(60-100 years),* during this period dhatu, sense organs, strength, energy, virility, prowess, acquisition, retention, recollection, speech and understanding generally or gradually degenerate (भ्रश्यमानधातुगुण), this phase is predominated by Vayu. During this stage the measure of life span is one hundred years.

Keeping the above facts in mind, present study entitled “EstimationofDhatusaaraInDifferent Age Groups–*An *AnalyticalCross-Sectional**Study”has been designed to assess the dhatusaara of the healthy individuals in different age groups.

Lacunaeinexisting****knowledgeThere are several studies regarding Dhatus and Dhatu Sarata separately. There is no available literature which tells direct relationship of Dhatu Sarata with Vaya.

 Previous Study done

1. Jagruti Chaple . Ayurvedic aspect of Dhatu Sarata and its Application Int J Ayu Pharm Chem 2018 Vol. 9 Issue 2[e ISSN 2350-0204]

2. Pragya Sharma, Mahesh Vyas, Bhojani Meera K et al. Signifcance of Sara Pariksha in Ayurveda: A Critical review. Research and Reviews:A Journal of Ayurvedic science,Yoga and Naturopathy;5(3):1-6p.

3. Review Article Clinical Significance and Research-oriented Approach of Dhatu Sarata (Tissue Excellence)- by Dr.Ridhima Gupta, Dr. Manjry Anshumala Barla, Dr. Rakesh Roushan-Dept of Kriya Sharir- Journal of Advanced Research in Ayurveda, Yoga, Unani, Sidhha & Homeopathy (ISSN: 2394-6547)

4. Review Article STUDY OF DHATU SARATA AND ITS SIGNIFICANCE IN CAREER ASSISTANCE- by Dr. Prachi Upesh Likhar and Dr. Upesh Madhukar Likhar-Dept of Kriya Sharir- World Journal of Pharmaceutical Research(ISSN 2277– 7105).

5. Review Article A CRITICAL REVIEW ON CONCEPT OF SARA IN AYURVEDA- by Dr.Vinita Dhruw,Dr. Gitanjali Sasmal and Dr.Vinay Bhardwaj-Dept of Kriya Sharir- World Journal of Pharmaceutical Research(ISSN 2277– 7105).

 Research****questionWhether there is a variability in dhatusaara of individuals in different age groups?

  HypothesisThere is an effect of vaya (age) on dhatusaara of the individuals.

Aim· ESTIMATION OF DHATUSARA IN DIFFERENT  AGE GROUPS.

Objectives Â· To estimate the dhatusara of the individual in three different age groups (preferably bala vaya, Madhya vaya and vridha vaya) over the entire duration of research.

ReviewofliteratureSara provides information about the condition of different dhatus in Sharira and also gives an idea of status of Satva (mind) of an individual. Sara is defined as the excellency of Dhatu.Among the fundamental constituent of body, the Dhatus are very important, which performs the functions of Dharana (Structural framework) and Poshana (Nutritional pool)

Assessment for a Dhatu and its structural and functional state by virtue of its quality and functions can be done by Sara Pareeksha. By the described of Chakrapaani it is clear that characteristics of Sara is an index to measure the Bala of individual Dhatu.[4]

Derivation - The term “Sara” is derived from the root Sr. Sthire with Suffix Ghan meaning essential, most excellent, stable, true, strong, genuine, and vigorous. Three meanings are taken from the word sara force, steady and ultimate.

According to Chakrapani’s Sara concept is related to the Dhatu concept. Each individual consists of seven Dhatus (elementary tissue) in homeostasis state. The body, which is consists of seven Dhatu in several quantum, differs from one another at the extents of Dhatu Sarata. Based on that Sara mainly classified as Pravara, Avara and Madhyama. Among all those eight, Sattva Sara denotes longer life and prosperity than the Twaka Sara. Sushruta Samhita also emphasized that a physician can treat a patient more effectively, if he assesses the life expectancy of patient on the basis of the criteria of measurement of each body part and Sara Pariksha.

l Charaka Samhita- Twak Sara, Rakta Sara, Mamsa Sara, Meda Sara, Asthi Sara, Majja Sara, Shukra Sara, Sattva Sara.

l Sushruta Samhita- Twak Sara, Rakta Sara, Mamsa Sara, Meda Sara, Asthi Sara, Majja Sara, Shukra Sara, Sattva Sara.

l Astanga Samgraha- Twak Sara, Rakta Sara, Mamsa Sara, Meda Sara, Asthi Sara, Majja Sara, Shukra Sara, Sattva Sara.

l Astanga Hridaya- Twak Sara, Rakta Sara, Mamsa Sara, Meda Sara, Asthi Sara, Majja Sara, Shukra Sara, Sattva Sara.

l Kashyapa Samhita- Twak Sara, Rakta Sara, Mamsa Sara, Meda Sara, Asthi Sara, Majja Sara, Shukra Sara, Ojas Sara, Sattva Sara.

SarvaSara/Pravara Sara Purusha-These persons having all eight sara will have great physical and mental strength, more happiness, able to face difficulties, self confidence in all enterprises, virtuous act, having firm and balanced body with balanced movements which is very careful and proper. There will be smooth and of high pitch, good to listen booming voice, slowness of aging and pathogenic process. Mostly having similar and numerous offspring and they will be having a longevity of life in family.

Madhyama Sara Purusa- Moderate amount of assorted Sara possess qualities with respectively Sara in moderate degree and which shows characteristic of Sarva Sara moderately.

Asara/Avara Sara Purusa- Features of Asara are not mentioned in compendia, hence we have to know features of Asara purusha logically or using Yukti Pramana. These persons, having slightest of various Sara, opposite qualities of respective Saras in minimum degree or least characteristics of Sarva Sara. They can’t withstand prolonged physiological activity. That’s why Sarva Sara individual has relatively higher resistance as compared to another Sara in an individual. The person having all the Sara, but predominating in one will possess more resistance against the various diseases which can arise because of its absence.

Hence, all the subtypes of eight Sara must be examined as Sarva, Madhyama and Avara Sara by routine assessment in clinical examinations.

Acharya Charak has emphasized that sometimes, the physicians may take a wrong decision only by seeing the body of the patient like strong due to being corpulent, weak because of leanness, and very weak because of having small body. However, rationally, it’s observed that, the strength of any persons can’t be estimated by looking at the external structure of the body. It’s completely untrue to believe that an individual is of a huge body, then he will be strong and if he is poor, then he will be weak. They are like ants that have small body and appearance emaciated but can carry heavy load. Big and corpulent persons may have less strength than the lean and short body, like elephant having big and strong body possessing less strength that the lean and short bodies lion.

l Individuals having the excellence of rasaare characterized by Unctuous, smooth, soft, clear, fine, less numerous, deep rooted, and tender hair and lustrous skin.

l Individuals having the excellence of rakta are characterized by unctuous and coppery red nails, eyes, palate, tongue, nose, lips, sole of the hands and feet, nails, forehead, and genital organs.

l Individuals having the excellence of mamsa are characterized by Stability, heaviness, beautiful appearance and plumpness of temples, forehead, nape, eyes, cheeks, jaws, neck, shoulder, abdomen, axillae, chest, and joints of upper and lower limbs being covered with flesh.

l Individuals having the excellence of medaare characterized by Abundance of unctuousness in complexion, voice, eyes, hair of the head and other parts of the body, nail, teeth, lips, urine, and feces.

l Individuals having the excellence of asthi are characterized by Robust heels, ankles, knees, fore- arms, collarbones, chin, head, joints, bones, nails, and teeth.

l Individuals having the excellence of majja are characterized by Softness of organs, strength, unctuous complexion, and voice and robust long and rounded joints.

l Individuals having the excellence of sukra are characterized by Gentleness, gentle look, having eyes as if filled with milk, cheerfulness, having teeth which are unctuous, round, strong, even and beautiful, clean and unctuous complexion and voice, dazzling appearance and large buttocks.

l The sattva sara persons are endowed with memory, devotion , are grateful , knowledgeable, cleanliness , enthusiastic, skillful, courageous, fighting in battle with valor, free from anxiety, having well-organized activities and highly intellectual abilities engaged in virtuous act.

Different Factors affecting Dhatu Sarata Dhatu Sarata in different Vaya (Age Group) :

Children (balya awastha) generally have less dhatu sara since their dhatus are in the developing stage (Aparipakwa, Asampoorena Dhatutwam). Due to ksheena dhatus, vriddha exhibit less dhatu sarata whereas, madhyam ayu purusha (middle age) possesses the best sara due to uttam bala.

MaterialsandmethodsStudypopulation: Apparently 150 healthy study participants irrespective of gender will be included in the study (50 for each group).

Calculation of sample size is done in accordance with an observational study of healthy subjects. Daniel’s formula calculation gave a sample size of 384 which is maximum sample size for an observational study. As our study is having a limited time period and elaborative performa for dhatusara estimation, it is not possible to enroll 384 subjects. Hence, sample size of 100 was proposed in IRC which was later on increased to 150 by IRC.

 Study plan: Dhatusaara will be determined by the dhatusaara assessment module of ayusoft developed by CDAC.

Study****period: 1 year

 Study****design: Analytical cross-sectional study (observational study)

 Statistical****method: Descriptive Statistics will be applied.

Mean and Standard Deviation of all three groups will be reported considering the data is normal. If data is appeared to be skewed then Kolmogorov–Smirnov test will be applied to test the normality. If data is confirmed skewed then Median and Ranger will be reported.

 **Study****location:**Subjects from CBPACS, Khera Dabar and nearby areas.

 Inclusion****criterial Apparently healthy individuals of the age groups irrespective of gender:

 o Baalya Avastha : 18-30 years

o Madhyam Avastha : 30-60 years

o Jeerna Avastha : >60 years

  Exclusion****criterial Person suffering from any acute or chronic illness.

l Pregnant woman.

l Any congenital or acquired anomaly,

l Person having any kind of co-morbidity like T2DM, HTN, THYROID DYSFUNCTION, CVD etc.

 Expected Outcome The result will be a data backed presentation of qualitative and quantitative changes in Sara of dhatus with progression of age. 1. Result is expected to show“Variability of Dhatusara” of an individual with progression of age. It is expected that sara of dhatus will decrease progressively as mentioned in Ayurvedic texts. Thereby it will further help in establishment of the principle of dhatu/dhatusara in Rachana Sharir.

2. Result is also expected to show the “proportion of variability” of dhatusara with age. This will be further addition in the knowledge of dhatusara.