E-ISSN:2456-3110

Review Article

Meda Sara Pareeksha

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

Validation of questionnaire on Meda Sara Pareeksha - A Multicentric Study

Sindhu Br1*, Hirulal M2
DOI:10.21760/jaims.9.4.9

1* Sindhu Br, Post Graduate Scholar, Dept of Roga Nidana Evam Vikruti Vijnana, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Mahesh Hirulal, Associate Professor, Dept of Roga Nidana Evam Vikruti Vijnana, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Ayurveda is one of the most renowned traditional systems of medicine that has survived and flourished from ages till date. There are many avenues still to be explored by the researchers, practitioners and experts in the field who carry the responsibility of keeping the traditional systems of medicine alive and contributing to their growth in the future. It follows an individual focused treatment strategy. Sara is described as ‘Vishudhataro Dhatu’[1] meaning best quality of the Dhatu and is one among Dashavidha Pareeksha.[2] 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 Meda 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.

Keywords: Questionnaire, Validation, Meda Sara Pareeksha, Dhatu, Ayurveda

Corresponding Author How to Cite this Article To Browse
Sindhu Br, Post Graduate Scholar, Dept of Roga Nidana Evam Vikruti Vijnana, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Sindhu Br, Hirulal M, Validation of questionnaire on Meda Sara Pareeksha - A Multicentric Study. J Ayu Int Med Sci. 2024;9(4):64-68.
Available From
https://jaims.in/jaims/article/view/3127

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-15 2024-02-25 2024-03-06 2024-06-16 2024-03-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 19.22

© 2024by Sindhu Br, Hirulal Mand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2024;9(4)64
Sindhu BR et al. Validation of questionnaire on Meda Sara Pareeksha - A Multicentric Study

Introduction

Scientific value of diagnostic approach according to Ayurveda centered on two-fold method - Roga Pareeksha and Rogi Pareeksha. Rogi Pareeksha pertained with health status both physical and 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.[3] The term Sara signifies the purest form of Dhatus. Ashta Saras are explained that comprises of seven Dhatu Sara and Satwa Sara. It is one among the important techniques of clinical examination employed to assess the status of different Dhatus. Sara ascribed as essence of Dhatu that provides stability to the body. 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 Chikitsa.[6] Samshamana 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”. Rakta Saraperson is known to possess unctuous (Snigdha) and coppery nails (Tamra Nakha), eyes (Nayana), palate (Talu), tongue (Jivha), lips (Oshtha), palms and soles (Pani padatala).[11] 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.[12]

Meda Dhatu is the fourth structural element in the order of Sapta Dhatu. Meda Sara is characterized by the abundance of unctuousness in complexion, voice, eyes, hair of the head and other parts of the body, nail, teeth, lips, urine and faeces. Such

Individual are endowed with wealth, power, happiness, enjoyment, charity, simplicity and delicate habits. Medasara person is known to pass unctuous urine and sweat, has a mellow voice, a bulky body and are incapable of doing physical labour.

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 Siddhi”[13] 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.

Aim and Objectives

To frame, assess and validate questionnaire on Meda Sara Pareeksha.

Methodology

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


J Ayu Int Med Sci 2024;9(4)65
Sindhu BR et al. Validation of questionnaire on Meda Sara Pareeksha - A Multicentric Study

measures and yield valid and reliable individual disparities that self-report scales generate. Questionnaire developing based on the classical reference of assessment of Charaka Sushrutoktha Meda Sara Purusha Lakshanas, followed by validation through research methods. Basically, validation of Questionnaire involves two steps: 1. Preparation of Questionnaire 2. Expert Validity - obtaining 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 that to in Meda Sara and its importance in diagnosis and treatment, this questionnaire framed following Charaka, Sushrutoktha Meda Sara Lakshana

Table 1: The qualities of Meda Sara in Ayurvedic classical literature[14,15]

SaraCharakaSushruta
Meda SaraComplexion, voice, eyes, hairs, nails, teeth, lips, urine and fecesUnctuousUnctuous urine, sweat, voice, mighty body and lack of exercise tolerance
Psychological featuresWealth, prosperity, happiness, enjoyment, charity, simplicity and delicacy in dealing

Charakoktha Meda Sara Lakshans are Snigdhata of Varna, Svara, Netra, Kesha, Loma, Nakha, Danta, Oushta, Mutra, Pureesha, Vitta, Aishwarya, Sukha, Upabhoga, Pradhanani, Arjava, Sukumara Upacarata. Other than Charakoktha Meda Sara Lakshana, Sushruta Acharya has mentioned Snigdha Sweda, Bruhat Shareera, Ayaasa Asashinu. Total 9 domians - Varna Snigdhata, Svara Snigdhata, Netra Snigdhata, Kesha Loma Snigdhata, Nakha Danta Oushta Snigdhata, Mutra Pureesha Sveda Snigdhata, Brihat Shareera, Ayaasa Asahishnu, Psychological characteristics of Meda Sara of 33 questions were framed & scores are attributed. Here the term Snigdhata is understood with Paryaya and its Guna Karma.

  • Paryaya - Cikkanam, Masrinam according to Amarakosha[16]
  • Snigdha Guna Karma - Kledana according to Ashtanga Hrudiya,[17] Maardava according to Acharya Sushruta[18]

Hence term Snigdha is apprehended as Cikkana, Masruna, Mardava, Kledana and these meanings of Snigdhata are applied according to the context in framing the questionnaire for Snigdhata of Varna, Svara, Netra, Kesha, Loma, Nakha, Danta, Aushta Mutra, Pureesha & Sveda. Assessment of these Sara Purusha Lakshanas including both objective and subjective parameters and scores were 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:

1. Focus Group Discussion / In-Depth Interviews with subject experts.

2. Giving questionnaire with options-panel of experts are identified, a content validation form created that defines the construction of questionnaire.

3. To examine and explore opinions regarding the items about both the positive and negative aspects of Questionnaire intended to measure and give expert opinions.

Result and Discussion

The questionnaire was designed based on Charaka Sushrutoktha Meda Sara Purusha Lakshanas. All the assessment parameters were segregated individually, translated into English in form of subjective and objective analysis. Total 12 experts were identified two from Alva’s Ayurveda Medical College Moodbidri; two from JSS Ayurveda Medical College, Mysuru; two from SDMCA, Udupi; SDMCA, Banglore; Kahaer’s Sri BM Kankanawadi Ayurveda College, Shahapur, Belgavi; Guru Gorakshnath Institute of Medical Sciences (Ayurveda College), Arogya Dham, Balapar Road, Sonbarsa, Gorakhpur, Uttar Pradesh; SGES’S Dr. N.A. Magadum Ayurvedic Medical College, Hospital and PG Research Centre, Ankali. Tq. Chikodi. Dist. Belgaum; two from Parul University, Vadodara, 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


J Ayu Int Med Sci 2024;9(4)66
Sindhu BR et al. Validation of questionnaire on Meda Sara Pareeksha - A Multicentric Study

grading system and Quantifying mild, moderate, severe unctousness. Also, suggestion for assessment of parameter like Snigdhata of Swara and Varna, Bruhat Shareera were accepted and changes done in accordance with the requirement and available standard scales. All the 12 experts acclaimed that all questions incorporated were needed. Initially comprised of 27 questions, after incorporating the expert opinions 6 questions were added.

Conclusion

The actual strength of an individual can only be ascertained with Sara Pareeksha. The inherent power of an individual cannot be assessed by mere muscle bulk, fat distribution and BMI. 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 beneficial 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. Acharya YT, editor. Caraka samhitha with Ayurveda deepika commentary by Cakrapanidatta on Caraka Samhita of Agnivesha, Vimanasthana; Rogabishakjitheeyam: Chapter 8, Verse 94. Reprint edition 2016. Varanasi: Chaukhamba Surbharati Prakashan, 2016; p.276

2. Acharya YT, editor. Caraka Samhitha with Ayurveda deepika commentary by Cakrapanidatta on Caraka Samhita of Agnivesha, Vimanasthana; Rogabishakjitheeyam: Chapter 8, Verse 102-115tika. Reprint edition 2016. Varanasi: Chaukhamba Surbharati Prakashan, 2016; p.278

3. Kushwaha HC (Editors). Rogbhishakjitiya Vimana, Charaka Samhita. Varanasi: Chaukambha Orientalia. 2005;693p.

4. Byadgi PS. Parameshwarappa’s Ayurvediya Vikruti Vijnana & Roga Vijnana. Chaukambha Publications, New Delhi. Vol 1, 2013:449p.

5. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji

Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;277p.

6. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;673p.

7. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;646p.

8. Charaka Samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor), New Delhi; Chaukambha Publications. Reprinted 2014;646p.

9. Paradakara H S Sastri. Ashtangahrdaya by Vagbhata. Varanasi; Chowkamba Surbharati Prakashan. reprint ed, 2005;10p.

10. Acharya J T, Acharya N R. Sushruta Samhita of Sushruta, Nibandha Sangraha Vyakhya of Dalhana. Varanasi: Chaukhamba Orientalia. 7th edition, 2002;152p.

11. Sushruta, Sushruta Samhita, Sutra Sthana, Aturopkramaniya Adhyaya. In:35/16.Vaidya Jadavji Trikamji Acharya., editor. Varanasi: Choukhambha Krishanadas Academy; 2004. p. 152.

12. 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.

13. Charaka samhita, elaborated by Charaka and Dridabala, with Ayurveda Deepika. Commentary by Chakrapani Datta, Jadavji Thrikamji Acharya (Editor). New Delhi; Chaukambha Publications. Vimanasthana, 8th Chapter, 115 verse, Reprinted 2014;287p.

14. Acharya YT, editor. Caraka Samhitha with Ayurveda deepika commentary by Cakrapanidatta on Caraka Samhita of Agnivesha, Vimanasthana; Rogabishakjitheeyam: Chapter 8, Verse 106. Reprint edition 2016. Varanasi: Chaukhamba Surbharati Prakashan, 2016; p.278.


J Ayu Int Med Sci 2024;9(4)67
Sindhu BR et al. Validation of questionnaire on Meda Sara Pareeksha - A Multicentric Study

15. Acharya J T, editor. Sushruta Samhita with the nibandhasangraha commentary by Acharya Dalhan, Sutrasthana; Athurupakramaniyam: Chapter 35, Verse 16. Reprint edition 2017. Varanasi: Chaukambha Sanskrit Sansthan, 2017; p.152.

16. https://niimh.nic.in/ebooks/e-Nighantu/amarakosha /?mod=read&h=snigdha Amarakosha: chapter 4, verse 46.

17. Paradakara HSS, editor. Astangahrdaya with sarvangasundara commentary of Arunadatta, Sutrasthana; Ayushkamiya: Chapter 1, Verse 18. Reprint edition 2018. Varanasi: Chaukambha Sanskrit Sansthan, 2018 ;p.12

18. Acharya J T, editor. Sushruta Samhita with the nibandhasangraha commentary by Acharya Dalhan, Sutrasthana; Annapaanavidhiadhyayay: Chapter 46, Verse 516. Reprint edition 2017. Varanasi: Chaukambha Sanskrit Sansthan, 2017; p.252.


J Ayu Int Med Sci 2024;9(4)68