Concepts of Prakriti (Human Constitution) and its Association with Hematological Parameters, Body Mass Index (BMI), Blood Groups and Genotypes

Background: Ayurveda is an ancient system of personalized medicine, documented and practiced in India since 1500 B.C. According to this system an individual’s basic constitution to a large extent determines predisposition and prognosis to diseases as well as the therapy and life-style regime . Ayurveda describes seven broad Prakriti (Physical constitution) Prakriti is de fined as the sum of physical, physiological, psychological traits of an individual which represents genotypes. Objective: In this article we have attempted to narrate concepts of Prakriti and its relation with hematological parameter, body mass index, blood groups and genotypes. Material and Method: Present article is based on critical review of Ayurvedic textual information, published research works, modern literature and research works conducted at various institutes. The possible correlation has been made between collected information and has been presented in systematic way. Result: In Pitta Prakriti individual’s hematological parameters like Hemoglobin (Hb%), Packed cell volume (PCV), and Red blood corpuscles (RBC) count are significantly on the higher side of normal range in comparison to Vata and Kapha Prakriti . Higher level of cluster of differentiation (CD) 14 markers in Pitta Prakriti , CD25 and CD56 in Kapha Prakriti individuals. Vata Prakriti individuals have “A” blood group, maximum Pitta Prakriti individuals have “O” blood group while maximum Kapha Prakriti individuals have “B” blood group and genotype correlation shows that HLA DRB1 ((human leukocyte antigen, dimer beta chain) gene polymorphism, CYP2C19 (Cytochrome P450 2C19) gene polymorphism and PGM1 ( Phosphoglucomutase 1 ) polymorphism have scientific variations with the human Prakriti concept. Conclusion: Prakriti of individual has strong relation with Hematological parameters (CBC, lipid profile, Liver function test (LFT)), Body mass index (BMI), anthropometry, blood groups and genotypes.


Introduction
Ayurveda, unani (arabic medicinal system), sasang constitution (Korean medicinal system), and Chinese medicinal system are well recognized branches of traditional medicine in the world, which classify individuals based on body temperament by deciphering specific characters for health management 1 -3 . The purpose of Ayurveda has been described as to protect the health of a healthy person and to eliminate the ailments

Observation and Results
Based on the critical review of classical and recent information, the following observations have been found pertinent to this study.

Concept of Prakriti (Human Constitution)
Prakriti (human constitution) comprises of both "physical constitution" as well as "psychological constitution". Prakrita Dosha quanta are present in a person since birth till death without changing. If changed, death is definite 26 . Prakriti type can be represented in terms of their body structure, mental makeup, tolerance to various types of food & environment and susceptibility to various diseases including the prognosis. Prakriti, also establishes the knowledge regarding the effects of various diet, lifestyle, environment, and treatment on different Prakriti individuals 27 . Prakriti assessment can be done of a diseased man 4 . Prakriti is the sum total of physical, physiological and psychological characteristics of any individual and represents the genotype 5 . Knowledge of Prakriti can help in prevention and diagnosis of diseases, in determining the treatment guidelines and forecast future diseases 6 , 7 . It explains unique traits that are decided by specific and permanent arrangement of Doshas in an individual 8 . One or more than one Dosha predominates at the time of conception, and reflects the Doshika Prakriti of the individuals and can be manifested by Dosha specific characteristics 9 .
Vata is considered as an originator for the actions of Kapha (K) and Pitta (P). Pitta is generally responsible for metabolism, thermoregulation, pigmentation and energy homeostasis whereas the anabolism function, growth and maintenance of structure are functions of Kapha 10 , 11 .
Prakriti is not only determined by Shukra & Shonita (genetically) but also influenced by various other factors such as Matur Ahara Vihara (maternal diet and lifestyle), Kala-Garbhashaya (season of conception) and panch mahabhuta vikara 12 . Acharya Charaka also explained some other extra uterine factors which influenced Prakriti of individuals such as, Racial/ Caste (Jati-Prasakta) Familial (Kula-Prasakta), Country or place (Desh-anupatinee), Natural change according to age (Vayo-nupatinee) Time period of life (Kala-nupatini) and individual specific character (Pratyatmaniyata) 13 . Ayurvedic scholars have divided the human constitution (Prakriti) into seven types on the basis of relative preponderance of three basic Doshas 14 -17 . The Prakriti (human constitution) of an individual is finalized at conception and is articulated through physical, physiological and psychological traits as described elaborately in original Ayurvedic texts written by Acharya Charaka, Sushruta, Vagbhata, Sharangadhara and Harita 18 -22 . Prakriti influences the manifestation of diseases, course of diseases and response to treatment in an individual 23 -25 .
In present era many supportive parameters have been developed for confirmation of Prakriti such as hematological parameters, Body Mass Index (BMI), blood groups and genetic parameters. Hence, the present article explores the details about concept of Prakriti (Human body constitution) in Ayurveda and by a questionnaire prepared on the basis of Prakriti characteristics mentioned in different textbooks of Ayurveda 28 . Traditional Ayurvedic method of Prakriti determination assessed by Trividha pariksha of Ayurveda as Darshan (visual assessment), Sparshana (tactile assessment) and Prashana (interrogative assessment) 29 , 30 . Morphological features can be assessed by visual assessment (Darshan Pariksha) such as color of skin, color of hair, consistency of hair and bony tissue proportions etc. Tactile assessment (Sparshana pariksha) for dryness/oiliness of skin, body temperature and pulse (Nadi) pariksha. Physical findings can be assessed by interrogation such as physical strength, endurance, hunger, sleep and dream patterns, bowel habit, memory and anger response. Knowledge of Prakriti can guide the parents for prevention of expected disorders and deciding to choose carrier at a very early age 31 .

Prakriti (Human constitution) and
Hematological Parameters

Prakriti (Human Constitution) and BMI
The BMI or Quetelet index is a value derived from the mass (weight) and height of an individual. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kilograms/meters 2 . BMI can be helpful in deciding and also for the conformation of the dominant Prakriti in the individual. BMI (body mass index) can be broadly classified into three groups like BMI less than 20 (low), in between 20 to 25 (moderate) and more than 25 (high). In one study maximum cases of Vata Prakriti (71%) have less than 20 BMI followed by Pitta Prakriti, (19%) and Kapha (10%) Prakriti respectively. The moderate BMI (20)(21)(22)(23)(24)(25) was found more in Kapha Prakriti individuals (47%) followed by Vata Prakriti (32%) and Pitta Prakriti (21%), respectively. BMI more than 25 were mainly found in Kapha Prakriti individuals (79%) followed by Vata Prakriti, (11%) and Pitta Prakriti, (44%) respectively 36 .
Anthropometry can be helpful in deciding and for the conformation of the dominant Prakriti in the in children. Vata Prakriti children are Krisha Sharira (lean and thin) or Alpasharira (short stature) and will have lower weight, CHL (Crown Heel Length) etc.; while Kapha Prakriti or Pitta-Kapha Prakriti infants are Sthulanga (stout body built) with better weight and CHL (crown heel length) as well as Mahalalata i.e. higher head circumference and Prithu Peena Vaksha (big and elevated chest) 37 .

Prakriti (Human Constitution) and
Blood Groups The ABO system was first discovered by Landsteiner and Weiner and it comprises four type blood types like A, B, AB and O blood groups 38

Prakriti (Human Constitution) and Genetic Study
The concepts of Ayurveda pulsate with the aims, observations and assure of contemporary P4 -it is predictive, preventive, personalized and participatory medicine 41 -43 . Ayurgenomics is the new division in the field of research between genomics and Ayurveda which describes differences between individuals in response to the treatment for different diseases 44 . Evidences are being generated regarding the association between Prakriti and various genes which explain their working mechanism 45 . In one genetic study it was found that PGM1 gene was associated with energy production which was more homogenous in Pitta Prakriti individual than in Kapha Prakriti and Vata Prakriti. Characteristics of Pitta in Ayurveda is digestion, metabolism and energy production. This study shows that PGM1 (Phosphoglucomutase 1) gene is in the center of many metabolic pathways i.e. glycolysis and sucrose metabolism. This finding suggests that the function of the gene directly correlates with the role of Pitta in metabolism as described in Ayurveda 46 .
Another study shows the link between HLA (Human Leukocyte Antigen) allele and Tridoshabased constitutional types. The HLA (human leukocyte antigen) complex helps the immune system by foreign invaders such as viruses and bacteria. The complete absence of the HLA DRB1*02 ((human leukocyte antigen, dimer beta chain) allele in the Vata Prakriti and of HLA DRB1*13 in the Kapha Prakriti are significant. HLA DRB1*10 had higher allele frequency in the Kapha Prakriti than in the Pitta and Vata Prakriti 47 .
The basic concept behind Ayurgenomics is the fact that if the system of Tridosha is prevalent in all organisms then there must be ways in which it is inherited. Prakriti must be a phenotypic phenomenon arising from a particular genotype.

Discussion
The practice of Ayurveda, the traditional medicine of India, is based on the concept of three major constitutional types (Vata, Pitta and Kapha) defined as "Prakriti". In Ayurveda, Prakriti determination is very essential for diagnostics, management, and prognosis of a disease. Prakriti also plays a very important role in prevention of diseases and Pathyapathya ahara and vihara of life. Method of Prakriti determination includes pulse detection, development of questionnaires, software such as AyuSoft 49 (especially for adult Prakriti) and PRS-IPA (especially for children Prakriti) 50

Conclusion
Prakriti (body constitution) is an important concept of Ayurveda which is decided at the time of conception. It shows differences in physical, physiological and psychological characteristics of an individual. Prakriti is important in preventive and curative aspects. Prakriti of an individual has strong relation to Hematological parameters (blood groups, complete blood count, lipid profile, Liver function test, BMI, Anthropometry, Human Leukocyte Antigen (HLA) DRB1, CYP2C19 (Cytochrome P450 2C19) polymorphism and PGM1 polymorphism. These parameters can help in confirmation of Prakriti which is decided by Prakriti characteristics based questionnaires as described in Ayurveda. The importance of each individual's variations in health and disease is an important basic principle rightly described hundreds of years ago as 'every individual is different from another and hence should be considered as a different entity; as many variations are there in the Universe.

Conflict of Interest
None Declared