A study on Ashta sara status among patients at different stages of chronic kidney disease in Western Province, Sri Lanka

Abstract

The assessment of Ashta sara, which reflects an individual’s Bala pramana (strength), is essential in evaluating patient health from an Ayurveda perspective, particularly in chronic illnesses like chronic kidney disease. This study aimed to assess Ashta sara status (tissue excellence status in Sapta dhatu and Sattva) among patients at different stages of chronic kidney disease in Western Province, Sri Lanka. The Ashta sara status of a total of 113 patients with chronic kidney disease (CKD stages 1–5), diagnosed according to the Western Medical System, were evaluated using a validated questionnaire which expresses an individual's overall Dhatu sarata based on weighted mean scores. A calculated percentage of each Sarata was categorized into three: 66.7 – 100% as Pravara, 33.4 – 66.6% as Madhyama and 0 – 33.3% as Avara. In stages 1 and 2, tissues from Rasa (plasma) to Shukra (semen/ovum) predominantly exhibited Pravara sara (optimal status). However, a gradual decline in Sara status was noted with disease progression. By stage 3, Pravara sara was seen only up to Medas (fat), while later Dhatu showed Madhyama sara (moderate status). In stages 4 and 5, most Dhatu showed Avara sara (inferior status), with even Rasa showing signs of deterioration. A consistent pattern of declining mean percentage scores from Rasa to Shukra indicated impaired Dhatu nourishment, aligning with the Ayurveda concept of Dhatu poṣaṇa. A notable drop between Medas and Asthi (bone) may be linked to the role of Vrikka (kidneys) in Medovaha srotas, affecting downstream tissue strength. Interestingly, Sattva sara (mental strength) was reduced even in stage 1, highlighting potential psychological effects of chronic kidney disease. Statistical analysis revealed a significant association (p<0.05) between chronic kidney disease stage and Ashta sarata, where declining Sara scores reflected lower Bala pramana and deteriorating health.