Introduction

Features of different Sara according to samhitas-

Rasa/twak Sara- Individuals having the excellence of Tvak are characterized by unctuous, smooth, soft, clear, fine, less numerous, deep rooted and tender hair and lustrous skin. Such individuals are endowed with happiness, good fortunes, power, enjoyment, intellect, knowledge, health, excitement and longevity3.

Rakta Sara- Individuals having the excellence of Rakta are characterized by unctuousness, red colour, beautiful dazzling appearance of the ears, eyes, face, tongue, nose, lips, sole of the hands and feet, nails, forehead and genital organs. Such individuals are endowed with happiness, great genius, enthusiasm, tenderness, moderate strength and inability to face difficulties. Their body remains hot4.

Mansa Sara- Individuals having the excellence of the Mansa Dhatu 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. Such individuals are endowed with forgiveness, patience, no greediness, wealth, knowledge, happiness, simplicity, health, strength and longevity5.

Meda Sara- Individuals having the excellence of Meda-Dhatu are 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 individuals are endowed with wealth, power, happiness, enjoyment, charity, simplicity and delicate habits6.

Asthi Sara- Individuals having the excellence of Asthi-Dhatu or bone tissue are characterized by robust heels, ankles, knees, fore-arms, collar-bones, chin, head, joints, bones, nails and teeth. Such individuals are very enthusiastic and active, and are endowed with strong and firm bodies as well as longevity7.

Majja Sara- Individuals having the excellence of majja or marrow are characterized by softness of organs, strength, unctuous complexion and voice and robust long and rounded joints. Such individuals are endowed with longevity, strength, learning, wealth, knowledge, progeny and Honors8.

Shukra Sara- Individuals having the excellence of Shukra Dhatu 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. Such individuals are loved by women; they are strong and endowed with happiness, power, health, wealth, honor and children9.

Sattva Sara- Individuals having the excellence of mental faculties are characterized by good memory, devotion, gratefulness, wisdom, purity, excessive enthusiasm, skill, courage, brave in fighting, absence of sorrow, proper gait, and depth of wisdom and sincerity in actions and virtuous acts10.

Material And Methods:

MATERIAL: It includes two parts as follows –

A. Literary Study Material

B. Observational Study Material

1. 1. 1. 1. Literary Study Material

Literary review has been done from Ayurveda text books, bruhatrayi, modern textbooks, internet media, etc.

The data collected in presented in following headings from literature material.

1. Preview – Previous dissertations related to Sarata, AsthiSarata
2. Ayurveda literature study includes following highlighting points

• Concept of Sarata and AsthiSarata from brihatrayee
• Concept of Asthi dhatu, praman prakriti from brihatrayee.

1. Modern literature review for following major points

• Modern literature related anthropometry.
• Modern literature review of bone and associated body parts.
• Modern literature review of post menopause and Calcium.

Observational Study Material

1. 1. Written informed consent was taken prior to observation.
   2. The AsthiSarata of an individual is evaluated with the help of M.U.H.S. preform attached as annexure.
   3. The observational study was conducted with the help of anthropometric measurements.
   4. The anthropometry and swanguli praman was taken as mentioned in annexure 3.
   5. The blood calcium levels were tested in pathology laboratory.

SAMPLE SIZE:

Considering confidence interval at 95%, prevalence rate 66.67%11 and rate of osteoporosis in post-menopausal females is 18% and absolute precession is 15% considering data insufficiency 15% sample size according to formula

?? = Z2P(1−P)/ E2

Z2PQ/E2=25.19=26

For the convenience of study, 29 volunteers will be taken of Asthi sara and 29 volunteer of Asthi Asara.

N =58

For the sake of study 58 participants will be taken.

• Type of Study Design– A comparative observational study
• Sampling Technique– Purposive sampling was conducted

Volunteers were selected according to inclusion and exclusion criteria to get desire number of sample.

• Eligibility Criteria –

a. Inclusion Criteria

Postmenopausal females with age group 45 to 55

b. Exclusion criteria

1. Females with history of chronic illness.

2. Females age above 60 years.

3. Females who are taking Hormonal therapy.

4. Females taking calcium supplement.

PLAN OF WORK

1. Conceptual Study

• Previous work done
• Conceptual study of Sarata and AsthiSarata from Brihatrayee.

1. Observational study with help of anthropometry.
2. Checking the blood calcium levels of all postmenopausal females.

Methodology:

1. Volunteers were screened as per inclusion and exclusion criteria to get desired number of volunteers. Written and informed consent of all volunteers was taken. Asthi dhatu Sarata was assessed with the help of standard MUHS dhatu Sarata proforma. Swanguli praman was calculated using vernier Caliper and dimension of the head was calculated. Conversion of observed measurements from centimetre to Anguli praman was done.Blood calcium levels were done at pathology lab.Observational data was collected.Statistical analysis was done on collected observational data. Proper conclusion was drawn and interpreted.

Assessment of AsthiSarata using MUHS Proforma:

1. The characteristics in the proforma can be classified in physical, mental and physico-mental.
2. The physical characteristics like Sthool parshni, Sthool gulf, Sthool janu, Sthool Aratni, Sthool jatru, Sthool chibuk, Sthool shir/ Mahashira, Sthool parva, Sthool Asthi, Sthool nakha, Sthool dant, Maha skandh, sara prakriti are purely physical characteristics. They are examined by darshan, sparsh and prashna pariksha. On darshan Pareeksha the the robustness of bony part is observed, In sparsh Pareeksha the differentiation of robust bony part is done from a muscle, tendons and ligaments. Pramana of pratyanaga is measured. In prashana Pareeksha details about the physiological strength of a particular part were asked.
3. Mahotsaha, kriyawant, saubhagya, aayushmant are mental chracteristics, they were examined by prashna Pareeksha with questions like

1. Did you take initiatives in work and maintain high level energy and vitality till the end?
2. Can you work effortlessly and with enthusiasm for long time?
3. After a hectic schedule, can you do your further daily routine?
4. Did you feel lucky, that you have been fortunate & have good fortunes in life.

1. Sthira prakriti, Kleshsahatva are physico-mental characteristics, they were examined by darshan and prashna Pareeksha. Some questions for prashna Pareeksha are as follow -

1. Are you able to do heavy work?
2. Are you able to face stressful situation with calm mind?
3. Did you make involuntary/ voluntary movements of legs/ hands?

1. After examinations of all the characteristics, total percentage is calculated. According to the value of percentage grades of sara, i.e. Uttam, Madhyam, Asar as decided. A volunteer with score between 60 – 100 is considered uttam sara, score between 50 – 59 is considered Madhyam sara, score below 49 is considered Asara.96
2. Praman prakritia of individual Pratyanga is described in the samhita.

Observation - All volunteers were examined using M.U.H.S. Asthisrata Parikshan proforma and anthropometric measurements assessment of prakriti bhava. The data was collected.

Data has been presented under following headings.

• Demographic data
• Observed data
• Statistically analyzed data

Statistical Analysis - Descriptive statistics was used to describe the data. Mean and standard deviation was used for numeric variables.

Frequency and percentage were used for qualitative variables. An Independent sample t test was used to compare two qualitative groups. Chi-squared test was used to see an association between two qualitative variables.

Demographic data

• Age
• Gender
• Assessment criteria for 'Asthisarta' have been followed
• Observed data was arranged according to grades of Asthisarta and anthropometric measurements.

Statistical analyzed data –

• Presentation of data has been done under following headings.

A. Tabulation

B. Graphical presentation.

• The frequency distribution analysis of demographic data was done & presented in tabular as well as graphical form.
• The frequency distributions analysis of individuals according to grades of AsthiSarata and anthropometric measurements were done & presented in tabular as well as graphical form.

Observations

Table no. 1 – Height (in cm) wise distribution

The above table reveals that -

In Asthi Sara – Group A – majority of the patients i.e. 19 (65.52 %) were having height in between 150 to 160 cm, 7 (24.14 %) patients were having height in between 160 to 170 cm, 2 (6.90 %) patients were having height in between 170 to 180 cm, 1 (3.45 %) patient was having height in between 140 to 150 cm.

Where in Asthi Asara – Group B – majority of the patients i.e. 21 (72.41 %) were having height in between 150 to 160 cm, 6 (20.69 %) patients were having height in between 140 to 150 cm and 2 (6.90 %) patients were having height in between 160 to 170 cm.

Graph no. 1

Table no. 2 – Weight (in kg) wise distribution

The above table reveals that -

In Asthi Sara – Group A – majority of the patients i.e. 19 (65.52 %) were having weight in between 50 to 60 kg, 9 (31.03 %) patients were having weight in between 60 to 70 kg and 1 (3.45 %) patient was having weight in between 70 to 80 kg.

Where in Asthi Asara – Group B – majority of the patients i.e. 15 (51.72 %) were having weight in between 60 to 70 kg, 12 (41.38 %) patients were having weight in between 50 to 60 kg and 2 (6.90 %) patients were having weight in between 40 to 50 cm.

Graph no. 2

Table no. 3 – BMI (in kg / m2) wise distribution

The above table reveals that -

In Asthi Sara – Group A – majority of the patients i.e. 23 (79.31 %) were having BMI in between 18.01 to 25 kg / m2 and 6 (20.69 %) patients were having BMi in between 25.01 to 30 kg / m2

Where in Asthi Asara – Group B –majority of the patients i.e. 16 (55.17 %) were having BMI in between 18.01 to 25 kg / m2 and 13 (44.83 %) patients were having BMi in between 25.01 to 30kg/m2.

Graph no. 3

Table no. 4 – Shir – Ayam wise distribution

The above table reveals that -

In Asthi Sara – Group A – majority of the patients i.e. 24 (82.76 %) were having Shir Ayam greater than 6 anguli and 5 (17.24 %) patients were having Shir Ayam less than or equal to 6 anguli.

Where in Asthi Asara – Group B – maximum number of the patients i.e. 21 (72.41 %) were having Shir Ayam less than or equal to 6 anguli and 8 (27.59 %) patients were having Shir Ayam greater than 6 anguli.

Graph no. 4

Table no. 5 – Shir – Parinah wise distribution

The above table reveals that -

In Asthi Sara – Group A – maximum number of the patients i.e. 16 (55.17 %) were having Shir Parinah less than or equal to 32 anguli

and 13 (44.83 %) patients were having Shir Parinah greater than 32 anguli.

Where in Asthi Asara – Group B – maximum number of the patients i.e. 28 (96.55 %) were having Shir Parinah less than or equal to 32 anguli and 1 (3.45 %) patient was having Shir Parinah greater than 32 anguli.

Graph no. 5

Table no. 6 – Janu – Ayam wise distribution

The above table reveals that -

In Asthi Sara – Group A – majority of the patients i.e. 20 (68.97 %) were having Janu Ayam greater than 4 anguli and 9 (31.03 %) patients were having Janu Ayam less than or equal to 4 anguli.

Where in Asthi Asara – Group B – majority of the patients i.e. 23 (79.31 %) were having Janu Ayam greater than 4 anguli and 6 (20.69 %) patients were having Janu Ayam less than or equal to 4 anguli.

Graph no. 6

Table no. 7 – Janu – Parinah wise distribution

The above table reveals that -

In Asthi Sara – Group A – maximum number of the patients i.e. 23 (79.31 %) were having Janu Parinah greater than 16 anguli and 6 (20.69 %) patients were having Janu Parinah less than or equal to 16 anguli.

Where in Asthi Asara – Group B – maximum number of the patients i.e. 23 (79.31 %) were having Janu Parinah less than or equal to 16 anguli and 6 (20.69 %) patients were having Janu Parinah greater than 16 anguli.

Graph no. 7

Table no. 8 – Aratni wise distribution

The above table reveals that -

In Asthi Sara – Group A – majority of the patients i.e. 23 (79.31 %) were having Aratni ayam greater than 22 anguli and 6 (20.69 %)

patients were having Aratni ayam less than or equal to 22 anguli.

Where in Asthi Asara – Group B – maximum number of the patients i.e. 24 (82.76 %) were having Aratni ayam less than or equal to 22 anguli and 5 (17.24 %) patients were having Aratni ayam greater than 22 anguli.

Graph no. 8

Table no. 9 – Chibuk wise distribution

The above table reveals that -

In Asthi Sara – Group A – all of the patients i.e. 29 (100 %) were having Chibuk ayam less than or equal to 4 anguli.

Where in Asthi Asara – Group B – all of the patients i.e. 29 (100 %) were having Chibuk ayam less than or equal to 4 anguli.

Graph no. 9

Statistical analysis

Asthi Sarata and Serum Calcium

Chi square test – It is applied to prove whether there is association between the Asthi Sarata and Serum Calcium.

• Null hypothesis

There is no association between the Asthi Sarata and Serum Calcium.

• Alternate hypothesis

There is an association between the Asthi Sarata and Serum Calcium.

Chi square table

Chi square (X2) value of the above table is 58.

Degrees of freedom ( df )

= (Column – 1) (Row – 1)

= (2 – 1) (2 – 1) = (1) (1) = 1

Chi square (X2) tabulated value of df = 1 is 3.84 at P<0.05 i.e. at 95 % level of significance.

Conclusion: As the calculated chi square (X2) value is greater than the tabulated (X2) value, we should reject the null hypothesis and accept the alternate hypothesis.Probability of the difference occurring in Asthi Sarata and Serum Calcium by chance is less than 5 out of 100 Asthi Sara, i.e. probability of not getting the difference between Asthi Sarata and Serum Calcium in nature is 95 %. So the Asthi Sarata and Serum Calcium are associated or interdependent.

Result- The Asthi Sarata and Serum Calcium are associated or interdependent in postmenopausal condition.

Discussion

This project was designed to achieve the apparent conclusion on the concepts of Ayurveda. The title of this project is...

A comparative study of Asthi Sarata and Asthi ASarata in Postmenopausal condition: An Observational study.

Here, the correlation between AsthiSarata and Asthiasarta in postmenopausal condition is studied using observational and statistical analysis. The discussion is designed in various aspects and plotted as follows

Discussion on Importance and Selection of Topic

1. • Discussion on concept of Sarata and AsthiSarata
   • Discussion on Bone and Calcium.
   • Discussion on AsthiSarata and calcium Discussion on relation between AsthiSarata and AsthiaSarata in postmenopausal with the help of Blood Calcium level.
   • Discussion on observation and statistical analysis.
   • Scope for further study
2. Discussion on importance and the selection of topic:

As per the importance of Dhatu Sarata examination, it is helpful for the individual to choose between career options according to ones ability, as individual with particular dhatu Sarata can choose suitable field where particular physical and mental characters are required. Dhatu Sarata of specific dhatu can be improved by treatment which is required for their field of that respected person. The Excellence of Asthi dhatu is known as AsthiSarata. The purpose of this study is to check the Asthi Sarata and Asthi asarta in postmenopausal condition with the help of blood calcium level. Many research works have been carried on Asthisrata. No study was done to analyze a particular relation between Asthi Sarata and Asthi Asarta in Postmenopausal condition. For all of above-mentioned points, this topic is selected for research work. To accomplish the desired target, this study has been carried out into two sections:

• Conceptual part: It includes concept of Sarata, AsthiSarata, calcium level, and detailed information on anthropometry.
• Observation part: evaluation of AsthiSarata with the help of M.U.H.S. proforma, assessment of physical characters in volunteers with the help of anthropometry, assessment of calcium level, statistical analysis of collected data.

1. Discussion on concept of Sarata and AsthiSarata

Sarata is important concept of Ayurveda. Physician should not consider a person as strong or weak only by his appearance. Some individuals appear to be thin but they may possess strength and vice versa. This feature is provided by Sarata of particular dhatu of that respected individual. The Sarata of particular dhatu can be improved by improving nourishment of that dhatu. This Sarata is determined by specific physical and mental characteristics described in Ayurveda text. AsthiSarata means Excellence of Asthi dhatu in that individual. The main function of Asthi dhatu is sustenance i. e. dharana and this sustenance is predominantly provided by Asthi dhatu due to its properties. Asthi is considered as most hard prakriti bhav of the body. The person with excellence of Asthi dhatu is said to be AsthiSarata. As it is fifth dhatu with excellent quality that means previous dhatu are well nourished and it is responsible for nourishment of further dhatus means they will also get-well nourishment. So here we can state that person with AsthiSarata will have all over good quality of all seven dhatus so they possess longevity.

1. Discussion on relation between calcium level & Postmenopausal condition.

Calcium is a mineral which is essential for bone formation. We obtain calcium from our diet and it is absorbed from the gut into the blood circulation. Before menopause, you should have about 1,000 mg of calcium daily. After menopause, you should have up it to1,200 mg of calcium per day. Due to a decrease in estrogen production after menopause, women's bodies are less able to retain calcium from dietary sources. On the basis of this point, this study is more focused on establishing the correlation between the calcium level and postmenopausal condition.

1. calcium and Bone

Calcium is a mineral which is essential for bone formation. We obtain calcium from our diet and it is absorbed from the gut into the blood circulation. If blood levels of calcium fall, we produce parathyroid hormone, which increases the resorption of bone, freeing-up calcium from the skeleton and putting this back in the circulation, to keep the blood level of calcium within normal limits.

1. Discussion on post menopause and AsthiSarata relation

Postmenopausal women are more susceptible to osteoporosis and more likely to have fractures because of low estrogen level. Theories like Asthi Dhatu Sarata parikshan should be understood by co relating it with the help of modern tools like blood calcium levels, Bone Mineral Density. Asthi dhatu Sarata parikshan is very important to check the quality of bones in elderly women so that the risk of fractures can be reduced to some extent.

1. Discussion on Observations and statistical analysis:

Anthropometry- Anthropometric measurements of specific body parts associated with the characteristics of AsthiSarata are considered for this research.

A. Height, weight and BMI

In Asthi Sarata - Out of 29 volunteers studied in this project, it was observed that maximum volunteers were seen in the height group 150-160 cm and weight group 50-60kg and. Maximum volunteers were found in the normal BMI group. (18.1-25kg/m2).

In AsthiAsarta

Out of 29 volunteers studied in this project, it was observed that maximum volunteers were seen in the height group 150-160 cm and weight group 60-70kg and. Maximum volunteers were found in the normal BMI group. (18.1-25kg/m2)

B. AsthiSarata and Calcium

Out of 29 volunteers in group A have calcium level in normal proportion. And In a Group B have calcium level below the normal proportion.

Probability of the difference occurring in Asthi Sarata and Serum Calcium by chance is less than 5 out of 100 Asthi Sara, i.e. probability of not getting the difference between Asthi Sarata and Serum Calcium in nature is 95 %. So the Asthi Sarata and Serum Calcium are associated or interdependent in Postmenopausal condition.

The anthropometric measurements of associated body parts in the present study indicates that Shira (head), as well as Janu (knee), Aratni(forearm), are found to be robust i.e. gross in nature and bulk(Sthool) after trividh Pareeksha i.e. darshan, sparshan and prashan as described in the characteristics of AsthiSarata individual. Asthi has predominance of pruthvi mahabhuta. It is considered as parthiv bhav. It means it possesses all the qualities of pruthvi mahabhuta. Sthoolta is one of the qualities of pruthvi mahabhuta. Sustenance (dharan) is the main function of Asthi dhatu which indicates quality of sthirata (stability) of pruthvi mahabhuta. The body parts i.e. Shira, Janu, Aratni studied in the present study are combination of multiple bones as a joints which means the ultimate formation of Asthi dhatu. It is representative of parthiva bhava in the body. So Sthoolata (bulkiness) have been observed in these body parts. While considering these anthropometric measurements of individual Pratyanga and grades of AsthiSarata (as uttam, madhyam), the association between them is analysed by independent sample t-test for two independent samples. It gives negative association between them. It means anthropometric measurements described above are independent of uttam and Madhyam Sara of an individual. There is no significant difference between anthropometric measurements of Pratyanga and its grades of AsthiSarata. AsthiSarata means Excellency of Asthi dhatu. As described above, Asthi dhatu provides sustenance as it has dominance of pruthvi mahabhuta. AsthiSarata individual have great quality of covering over the body parts due to mansa dhatu. All these qualities give great level of strength to such individuals which increase their physical and mental capacity. They become to tolerate physical and mental stress. Therefore, these individuals are able to take part in many activities. Asthi dhatu and vata dosha have correlation with each other. Excellency of Asthi dhatu tends to proper functioning of vata dosha which remains in equilibrium state. Enthusiasm and activeness are chief functions of vata dosha. Ultimately these qualities are observed in AsthiSarata individuals. While considering this conclusion, the association between Asthi Sarata and calcium level are associated or interdependent. It was analysed by chi-square test. It gives positive association between Postmenopausal womens were Asthi sara had a normal or within a range of blood calcium levels. It is mainly due to Sthool guna of pruthvi mahabhuta, which is the composition of Asthi dhatu.

Conclusion

1. Probability of the difference occurring in Asthi Sarata and Serum Calcium by chance is less than 5 out of 100 Asthi Sara, i.e. probability of not getting the difference between Asthi Sarata and Serum Calcium in nature is 95 %. So the Asthi Sarata and Serum Calcium are associated or interdependent.
2. According to anthropometric measurements, Shira (head)- Ayam (length) and parinah (circumference) are found to be Sthool (robust/bulky) as per described in characteristic of AsthiSarata individual.
3. Janu(knee) Ayam (Length) and parinah (circumference), aratni (forearm) length are also found to be Sthool (robust/bulky) as per described in characteristics of AsthiSarata individuals.
4. There is significant association between AsthiSarata and calcium levels.

There is no significant association between grades of AsthiSarata (uttam or madhyam) and anthropometric measurements of different pratyanga of those respective individuals.