Manual (Of Standard Operative Procedures For ) Prakriti Assessment

The Science of Ayurveda has evolved through rigorous experimentation by generating tangible and reproducible evidence on preventive, health promotive and therapeutic modalities. The evidences are later documented into formal classical texts such as Samhitas. The concept of personalized and holistic approach towards lifestyle advocacy and rationalizing the therapeutic modalities is pivotal on which the diagnostics and prescriptions are based.

Of several approaches such as Vikriti, Agni etc. the assessment of Prakriti (bio-identity or constitution of an individual) is determinant factor for a physician to realize the concept of personalized medicine in an effective manner.

The Modalities of assessment of Prakriti have been vividly documented in classical texts of Ayurveda while diverse approaches are being adopted by Ayurvedic physicians across the country and globe. The adoption of different approaches administering varied format may possibly lead to certain variations.

In view of the above, there has been a great demand for developing a uniform and validated approach for assessment of Prakriti. Central Council for Research in Ayurvedic Sciences (CCRAS) under Ministry of AYUSH being an apex body has taken this challenging task & realized the same through rigorous consultative process and multicenter clinical validation which is highly appreciated.

This validated approach could be well utilized for generating uniform results in determining Prakriti of an individual in clinical setups, academic institutions and research organizations as well.

It also gives me immense pleasure to learn that the Council has also developed a 'Web-based Digital Prakriti Assessment Tool' based on this validated approach which would be more user friendly and cater the contemporary needs of Ayurveda physicians and researchers:

I congratulate the Central Council for Research in Ayurvedic Sciences for their un-tired efforts in bringing out this comprehensive document.

Basic and natural frame work of living universe is decided in very primitive stage of fertilization and this psycho-somatic frame work is coined as Prakriti,' a Sanskrit definitive term literally meaning nature/constitution / temperament in medical terms. Prakriti is an important basic concept of Ayurveda which describes constitution of an individual in relation to one's physical, physiological, psychological and behavioural characters and is an integral constituent of Ayurvedic diagnosis, treatment and disease prognosis.

Since last one decade, modern scientists and doctors have generated their belief in P4 i.e. Predictive, Preventive, Personalized and Participatory medicine. In spite of all modern researches, person to person variation in manifestation of disease and response of medicines in different individuals has led the scientists to look forward to understand the individualized approach of Ayurveda in treating the patients. Thus, the concept of Prakriti i.e. 'Individual constitution' has emerged as an interesting area for the researchers. With the emerging epidemic of NCDs (Non-communicable diseases), role of preventive and promotive medicine has gained a prime attention of the medical fraternity across the globe. Both these aspects need an individual participative approach for which the concept of Prakriti has main role to play. For promotion of health and prevention of diseases, lifestyle and diet advocacies vary from person to person according to Prakriti. However, the other influencing factors viz region, profession, age etc. should also be considered.

Thus, it is very important to assess the Prakriti of a person carefully before any advice related to health and disease. Otherwise, it may lead a negative impact on the health status of a person. The characteristic features/ predictors mentioned in classical Ayurvedic texts are subjective in nature and the clinicians/Ayurvedic experts apply their own wisdom and experience to capture these predictors. At present, physicians, academic and research organizations researchers are using different questionnaires for assessment of Prakriti which are based on one or other classics. But the available questionnaires lack national consensus and standardization in content, format and methods to capture each predictor for assessment of Prakriti. This leads to variation in determination of Prakriti across time and space. Therefore need emerged to develop a uniform method for capturing the attributes for Prakriti assessment for wider applicability based on scientific footings. Hence, a Standardized Prakriti Assessment Tool is the need of the hour.

Considering the above facts, Central Council for Research in Ayurvedic Sciences (CCRAS), being an apex organization under Ministry of AYUSH, Govt. of India, New Delhi has undertaken the initiative to develop the Prakriti Assessment Scale' with rationality, reliability, validity & reproducibility.

Capturing of each predictor is clinically important to decide the Prakriti. The method of capturing the predictors have been discussed in great detail with learned physicians, researchers and academicians of Ayurveda and various specialties of modern science in light of Classical texts of Ayurveda. After multiple national consultations, the methodology to capture each and every predictor clinically has been decided / developed by adopting necessary sequential steps on scientific lines in consultation with Biostatistician and a Prakriti Assessment Questionnaire/Scale has been prepared.

The predictors are broadly grouped into four traits viz. physical, physiological, psychological and behavioural traits, which are further sub-grouped into various domains e.g. built, appearance, skin texture etc. One of the following three methods (as applicable) has been adopted for capturing the Prakriti deciding predictors:

(i) The Anthropometric predictors which could be quantified may be measured by appropriate scale.

(ii) Some predictors can be easily captured by simple observation like skin colour, hair colour and other physical appearances etc.

(iii) Specific questionnaires have been developed to capture various subjective predictors pertaining to Physiological (Sleep, Appetite, Sweating, etc.), Psychological (Indecisiveness, Memory, Friendship, etc.) and Behavioural traits (Brave, Egoist, Forgiving etc.). Likert scale has been used for capturing the answers of most of the questionnaire.

Primary feasibility / inter- rater agreement study (double blind) for validation of the Prakriti Assessment Questionnaire/ Scale has been carried out through multi-centric studies. The Questionnaire/ Scale has been assessed on 50 participants by two Investigators separately at 10 participating centers which includes 06 CCRAS Institutes MSRARIED Jaipur; CARICD New Delhi; CARIHD Bhubaneswar; RRAPCARIC Mumbai; CARIDD Kolkata; RARISD, Vijayawada and 04 other reputed Institutes of Ayurveda viz. NIA Jaipur; AIIA, New Delhi; CBPACS, New Delhi and LPGT&RA, Jamnagar. The data generated on 500 healthy volunteers at 10 centers has been subjected for Kappa analysis to see inter rater agreement. The questions framed for Prakriti assessment which showed moderate, good or very good agreement (kappa > 0.41) were taken as valid questions and included in the scale.

Accordingly the results were discussed in consultative meet with the investigators and experts. During this meet few non-specific questions were dropped and few others were modified accordingly. The modified Questionnaire/Scale was again subjected to data generation for 10 healthy volunteers at each identified centre (10 in total). Thus the data generated on 100 volunteers in this phase was again analyzed statistically using Kappa. The modified questions showed statistically significant Inter rater agreement and thus were accepted in the scale.

This document embodies the Standard Operative Procedures (SoPs) for capturing each and every predictor for assessment of Prakriti. For the easy application of this questionnaire, a software has also been designed which is more user friendly.

The Standardized Questionnaire/ Scale may be used in future by Researchers, Clinicians and Academicians of Ayurveda. However, all the rights of its application are reserved with Director General, CCRAS, Ministry of AYUSH, Govt. of India. Some of the photographs have been used from various open sources just as an example for academic interest only, for which there is no claim or copyright of CCRAS. Training for assessors is required before putting this Questionnaire/ Scale in use for Prakriti assessment which in due course of time may be provided by CCRAS.

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