Major and minor criteria for pediatric Mizaj (temperament) in Persian Medicine: A four-round Delphi study

Major and minor criteria for pediatric Mizaj (temperament) in Persian Medicine: A four-round Delphi study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Major and minor criteria for pediatric Mizaj (temperament) in Persian Medicine: A four-round Delphi study Morteza Mojahedi, Zahra Salehi, Majid Nimrouzi, Mostafa Alizadeh, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6591318/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Mizaj (temperament) is a basic component of diagnosis and treatment in Persian Medicine (PM). It evaluates individual characteristics by ten group indices. Personalized lifestyle according to Mizaj for maintaining health and treatment is essential in all people and children are not an exception. Considering that the importance of each Mizaj index in pediatrics has not been determined so far, we conducted this study. Methods In a four-round Delphi study, the indices of Mizaj determination according to PM references were evaluated to extract major and minor Mizaj criteria in pediatrics. To assess the applicability of indices in expert practice, open-ended questions were first used. Subsequently, a checklist of the extracted indices was sent to PM experts via email in two consecutive Delphi rounds as second and third rounds. Before participation, the research design was explained to all experts via email, and they were asked to provide their agreement (consent) to participate. Additionally, it was mentioned that non-author contributors would be acknowledged in the study. In the second and third rounds, the experts rated the importance of each index in determining pediatric Mizaj using an 11-point Likert scale (ranging from zero to ten). The analysis of Likert scales was conducted in the final round, and the major and minor criteria for pediatric Mizaj were finalized. Results In the first round, 13 PM experts discussed and extracted 26 indices for pediatrics Mizaj identification. Out of 37 invited PM experts, 19 took part in both the second and third rounds. According to the final expert panel, six major criteria including physical functions, impressibility of weather and food, tactile condition, speech, and psychicfunctions were extracted for hotness-coldness, as well as five major criteria including fat/ muscle, sleep depth and duration, tactile condition, and hairstyle as major criteria for wetness-dryness. Conclusions The extracted criteria based on PM manuscripts and expert (consensus) agreement can be used for pediatric Mizaj identification in the clinic and standard scale development in this field. Children Pediatric Mizaj Persian Medicine Traditional Medicine Background Having healthy children is a matter of national interest, as healthy children can learn more effectively and are more likely to grow into healthy adults who contribute positively to society and the workforce in the long term. Children who adopt healthy practices through their formative years are more likely to become productive adults. Health surveillance and monitoring systems are built upon health models that prioritizing prevention and lifestyle improvement ( 1 ). World Health Organization (WHO) has motivated governments to notice pediatric health and its needs ( 2 ). A healthy lifestyle significantly affects the quality of life and helps to improve diseases faster ( 3 , 4 ). Personalized medicine as a novel approach in the healthcare system is based on attention to the differences between patients with the same disease ( 5 ). Individual lifestyle information is helpful in personalized care, reduces the costs of treatment, and makes it more effective with fewer adverse effects ( 6 , 7 ). Complementary and integrative interventions is a holistic medicine that impacts on whole people`s health ( 8 ). Fortunately, complementary medicine (CM) use among children and adolescents is high and widespread ( 9 ). As recommended by the WHO standardization of diagnosis and treatment in CM schools and greater surveys on child health are necessary ( 10 , 11 ). Therefore, researchers must establish standardized evidence-based guidelines for the use of CM. Persian Medicine (PM) is one of the ancient forms of CM which has a history of thousands of years and is rooted in ancient Persian civilization. This school emphasizes that the maintenance of health is superior to the treatment of disease ( 12 , 13 ). According to the principles of PM, individual differences as a basic applicable aspect described in the concept of Mizaj (temperament). This viewpoint corresponds to the idea of personalized medicine. According to the basic theories of Mizaj, most lifestyle modifications, as well as diagnosis and treatment of diseases, are recommended based on individuals' Mizaj differences. This approach is practical in all age groups, especially in pediatrics ( 14 ). Identifying Mizaj is a fundamental prerequisite for diagnosing health status and illness ( 14 , 15 ). From this viewpoint, therapeutic intervention and lifestyle recommendations are deficient without Mizaj identification ( 16 , 17 ). Mizaj is classified into two domains of hotness-coldness, and wetness-dryness. Individuals with each Mizaj are predisposed to certain disorders and require specific management and lifestyle advice to maintain their health ( 18 , 19 ). Therefore, personalized medicine according to Mizaj is an appropriate approach for patients ( 6 , 20 ). Several indices including physical, psychic, and physiological functions as well as phenotype characteristics of each person have been used for Mizaj identification ( 17 , 21 ). These indices are categorized into ten group indices including: Touch or tactile condition (hotness-coldness, and wetness-dryness of skin from the examiner's point of view) fat tissue and muscle mass (evaluation of general appearance as being fatty or thin, and the type of tissue in terms of muscle or fat) Physique (including anthropometric factors such as the size of extremities, joints, chest, pulse, prominent vessels, etc.) Hair conditions (growth of hair, amount, color, hairstyle, and diameter) Skin color Sleep (duration, depth of sleep, and induction of sleep) Physical function (quantity and speed of physical activity, speech frequency, speed, and loudness- growth according to weight and height, and appetite) Waste matter (stool, urine, sweat) Impressibility speed (the responsiveness of the body's main organs to different temperatures or types of food) Psychic function (personality and comprehension) ( 19 , 22 ). In the PM manuscripts application of each index and its indication to Mizaj were explained but the value and priority of them were not clarified. Therefore extraction of major and minor criteria for Mizaj identification and developing standard scale in this field is one of the most critical issues in PM research ( 23 ). There are several studies have been conducted to set quantitative criteria for Mizaj in adults ( 22 , 24 ). To the best of our knowledge, despite the importance of determining the value of Mizaj indices in children for developing a valid and reliable pediatric Mizaj questionnaire, no study has been conducted in this area. It is important to assign value to the proposed indices to come up with new valid and reliable questionnaires and other diagnostic tools. This research aimed to develop a consensus survey regarding the major and minor criteria for evaluation of pediatric Mizaj as the first step in developing and standardization of pediatric Mizaj questionnaire. Due to the dispersion of PM practitioners in the country and not having access to them, the Delphi method is a good choice. Methods This is a four-round Delphi study. The Delphi method is a flexible structured approach for collecting and classifying the knowledge of experts. It is done via several survey rounds in which each expert individually scores the statements ( 25 – 27 ). The current study was performed from June 2023 to December 2023 at the Research Center of Traditional Medicine and History of Medical Sciences in Shiraz University of Medical Sciences, Iran. Participants The inclusion criteria for experts were all physicians with PhD degrees in PM who graduated from universities had at least five years of clinical experience and were interested in pediatric courses. They were asked to answer the questions based on their knowledge and experience. Also, in all rounds, they were asked to mention more important and practical indices that each expert has used in the practice. Each round was conducted by email using Microsoft Word forms. After each round was completed, results were shared with all participants by email. To avoid any bias findings of each round were shared anonymously. Three members of the research team carefully supervised the survey. Round 1 Before starting the first round, a review of the available PM books and related literature was done. We did not find different indices for the evaluation of pediatric Mizaj from adults. All ten group indices of whole-body Mizaj identification in PM were extracted and arranged via a checklist ( 22 ). At the beginning of the project, PM specialists were invited by announcements in virtual spaces. Then according to arranged items in the checklist, by open-ended questions, experts were encouraged to freely explain their clinical viewpoints on the pediatric Mizaj evaluation. Participant`s comment who completed the checklist were extracted into a final list. The recommendation was discussed by three supervisors. Then the percentages of using ten group indices by expert reported. Round 2 Based on the first round, all indices for determining whole body Mizaj were occluded in a table which was developed for this study (Supplementary file 1). Due to the variety of items in some of the ten group indices, several subdomains were considered according to the PM expert`s viewpoints. At the end of the table, we put a statement as “others” to add other indices by experts. We informed PM faculties in all the universities of medical sciences around the country about our research and asked them to introduce their practitioners who were experts and interested in the pediatric field. The prepared statements were sent to the introduced PM experts. At the same time, the goal and method of the research were explained to them. The experts were asked to rate the value (or importance) of each index in determining the hotness-coldness of pediatric Mizaj as well as the wetness-dryness in a healthy child aged 6–9 years old on an 11-point Likert scale. A score of 0 meant that the index had no role in determining a pediatric whole-body Mizaj, and a score of 10 meant that the index had a crucial role. At the end of the table, we put a statement as “others” to add other indices by experts. After data collection mean of each item scores and the Kendall’s coefficient of concordance (KCC) of the checklist of hotness/coldness and wetness/dryness separately were analyzed. If the KCC is below 0.5, we will hold another round. Round 3 The third round was conducted in the same format as the second round. Anonymous feedback on the second round was sent too. In this round, experts were asked to revise or confirm their rank of pediatric Mizaj indices in the second round. In this round mean of each item and KCC were analyzed. In addition, the mean and rank of each index were assessed after consideration of both rounds. We decided to stop another round if not significant change in the KCC score or with considerable agreement (KCC above 0.7). Round 4 The participants were invited to a final online meeting for a group discussion, and the data were reviewed. The mean, standard deviation (SD), and coefficient of variation (CV) of each index in the second and third rounds are explained separately to assess the wideness of the expert`s idea in the evaluation of an index. Indices with an average score of less than 5 were considered weak criteria, between 5 and 7.5 and equal to 5 and 7.5 as "minor criteria", and above 7.5 as "major criteria". This final analysis is presented to confirm major and minor criteria of pediatrics Mizaj by final expert discussion. Statistical analysis was performed using the R version 4.3.3 software. Results In the first round, 13 experts with accepted inclusion criteria answered questions. Their responses showed that all ten group indices were used by PM practitioners, but there was controversy about their value of them. Table 1 determines how many experts use each group of indices for pediatric Mizaj identification in the clinic. Table 1 The most practical indices of Mizaj in pediatrics and the number (%) of experts who use these indices in round 1 Index Number of experts* (%) Fat/ Muscle 10 (76.9) Psychic functions 10 (76.9) Physical functions 9 (69.2) Tactile condition 7 (53.8) Skin color 7 (53.8) Impressibility speed 6 (46.1) Sleep 6 (46.1) Hair condition 5 (38.4) Physique 2 (15.3) Waste matter 2 (15.3) *Total number of experts: 13 According to the expert`s explanation in round 1, all ten group indices were evaluated in the next rounds. Due to the unequal value of the characters of some groups of indices including hair conditions, skin color, sleep items, physical function, impressibility speed, and psychic function the supervisors suggested designing subdomain indices. In the statement of “other suggestions”, some experts asked to mention appetite and growth separately accepted by the supervisor team. In addition, experts mentioned that pulse, tongue, and abdominal examination are important for pediatric Mizaj determination. However physical examination was not included in our study. Other suggestions that were not included were memory and intellectual quotient. Finally, 26 items were prepared for scoring from 0 to 10 for the second round (Table 2 , 3 ). Out of 37 PM experts who were invited in the second round, 25 experts sent back the questionnaires. KCC was 0.498 for hotness-coldness and 0.400 for wetness-dryness showing low concordance between experts. For the third round, the result of the second round was sent to all 25 experts, and were asked to reconsider or revise their Likert scores of items. Out of them, 19 participants resent their answers. To unify the analysis condition, the second round was analyzed again to evaluate the answers of these 19 experts (Table 2 , 3 ). According to the results, physical functions received the highest score for hotness-coldness, while fat/muscle composition and sleep received the highest score for wetness-dryness. Based on the consensus of CV, physical functions and speech were considered the most reliable indices for evaluating hotness-coldness. In the case of wetness-dryness, fat/muscle composition and sleep received lower CV scores, indicating greater agreement among experts. In the second and third rounds, no other criteria were added by experts. Table 2 Consensus scores in round 2 and 3 for hotness-coldness Number of responses Score (0–10)- Mean ± SD CV Mean Rank R2 R3 R2 R3 R2 R3 Total Total Tactile condition 19 19 8.26 ± 1.85 8.58 ± 1.43 0.22 0.17 8.42** 3 Fat/ Muscle 17 19 7.65 ± 1.94 7.26 ± 2.49 0.25 0.34 7.46* 9 Physique 18 18 7.67 ± 1.88 8.00 ± 1.33 0.24 0.17 7.84** 7 Hair conditions Growth Amount Color Hairstyle Diameter 18 19 19 19 17 19 18 19 19 19 18 19 5.94 ± 2.84 5.45 ± 2.54 5.68 ± 2.06 5.21 ± 2.90 3.88 ± 3.55 4.26 ± 2.81 5.94 ± 2.56 5.71 ± 2.23 5.37 ± 2.22 5.16 ± 2.73 3.67 ± 3.25 4.53 ± 2.76 0.48 0.47 0.36 0.56 0.92 0.66 0.43 0.39 0.41 0.53 0.89 0.61 5.94* 5.58* 5.53* 5.19* 3.78 4.40 13 16 17 19 25 21 Skin color Body Face 19 18 19 17 6.84 ± 2.43 6.72 ± 1.13 6.11 ± 2.69 6.82 ± 1.33 0.36 0.17 0.44 0.20 6.48* 6.77* 12 11 Sleep conditions Duration Depth Induction 18 18 16 17 19 19 18 18 5.84 ± 2.91 5.68 ± 2.82 4.72 ± 2.89 4.12 ± 2.53 6.00 ± 2.29 5.63 ± 2.81 4.69 ± 2.54 3.83 ± 2.50 0.51 0.49 0.61 0.57 0.38 0.50 0.54 0.65 5.84* 5.68* 4.72 4.12 14 15 20 24 Wast matter Urine Feces Sweat 18 17 17 18 18 18 3.94 ± 2.82 3.24 ± 3.09 3.53 ± 3.04 4.33 ± 2.38 3.72 ± 2.70 4.83 ± 1.79 0.71 0.95 0.86 0.55 0.73 0.37 4.14* 3.48 4.18 23 26 22 Physical functions Speech Growth Appetite 17 19 19 19 19 19 19 19 8.94 ± 1.03 8.21 ± 1.32 7.11 ± 1.97 5.47 ± 2.82 9.26 ± 0.73 8.26 ± 1.05 7.37 ± 2.39 5.13 ± 2.72 0.12 0.16 0.28 0.51 0.08 0.13 0.32 0.53 9.10** 8.24** 7.24* 5.30* 1 5 10 18 Psychic functions Comprehension Personality 19 19 19 19 7.84 ± 1.71 7.16 ± 2.46 8.00 ± 1.37 7.87 ± 1.18 0.22 0.34 0.17 0.15 7.92** 7.52** 6 8 Impressibility Temperature Food 16 16 18 18 8.75 ± 1.39 8.56 ± 1.21 8.17 ± 1.38 8.03 ± 1.50 0.16 0.14 0.17 0.19 8.46** 8.30** 2 4 SD: Standard deviation, CV: coefficient of variation, R: Round ** Considered as major criteria * Considered as minor criteria Underlined: Changed index value by fourth round Table 3 Consensus scores in round 2 and 3 for wetness-dryness Number of responses Score (0–10)- Mean ± SD CV Mean Rank R2 R3 R2 R3 R2 R3 Total Total Tactile condition 19 19 7.42 ± 2.17 7.47 ± 1.84 0.29 0.25 7.45** 5 Fat/ Muscle 19 19 8.79 ± 1.27 8.58 ± 1.12 0.14 0.13 8.68** 1 Physique 17 18 7.29 ± 2.26 6.00 ± 2.61 0.31 0.44 6.65* 6 Hair conditions Growth Amount Color Hairstyle Diameter 18 17 17 17 19 17 18 18 19 19 18 19 5.78 ± 2.34 4.00 ± 3.28 3.88 ± 2.85 2.59 ± 2.62 6.53 ± 2.27 3.24 ± 2.41 5.44 ± 2.33 4.22 ± 2.82 4.00 ± 2.85 2.95 ± 2.72 6.39 ± 2.68 3.37 ± 3.06 0.40 0.82 0.73 1.01 0.35 0.74 0.43 0.67 0.71 0.92 0.42 0.91 5.61* 4.11 3.94 2.77 6.46** 3.31 11 17 18 25 7 23 Skin color Body Face 17 17 19 17 3.29 ± 2.54 3.76 ± 2.14 3.42 ± 2.76 3.65 ± 2.00 0.77 0.57 0.81 0.55 3.36 3.71 22 19 Sleep conditions Duration Depth Induction 19 17 19 17 19 19 18 18 7.74 ± 1.41 7.00 ± 2.03 7.11 ± 1.66 5.53 ± 2.92 8.58 ± 2.00 7.95 ± 1.93 8.03 ± 1.27 5.06 ± 2.53 0.18 0.29 0.23 0.53 0.16 0.24 0.16 0.50 8.16** 7.48 * 7.57** 5.30* 2 4 3 13 Wast matter Urine Feces Sweat 17 18 18 18 17 17 1.94 ± 2.41 3.50 ± 3.09 3.33 ± 3.33 2.33 ± 2.38 3.82 ± 2.96 3.71 ± 2.97 1.24 0.88 1.00 1.02 0.78 0.80 2.14 3.66 3.52 26 20 21 Physical functions Speech Growth Appetite 16 16 17 17 19 19 19 19 6.19 ± 1.76 4.00 ± 2.83 4.88 ± 2.83 2.82 ± 2.58 6.58 ± 1.74 4.42 ± 2.89 4.79 ± 2.55 3.79 ± 2.76 0.28 0.71 0.62 0.91 0.26 0.65 0.53 0.73 6.39* 4.21 4.84 3.30 8 16 15 24 Psychic functions Comprehension Personality 16 16 19 19 4.63 ± 2.53 5.25 ± 2.08 5.45 ± 2.23 5.68 ± 2.52 0.55 0.40 0.41 0.44 5.04* 5.47* 14 12 Impressibility Temperature Food 16 16 18 18 6.19 ± 2.51 6.19 ± 2.07 6.50 ± 2.04 6.33 ± 2.28 0.41 0.33 0.31 0.36 6.35* 6.26* 9 10 SD: Standard deviation, CV: coefficient of variation, R: Round ** Considered as major criteria * Considered as minor criteria Underlined: Changed index value by fourth round KCC for hotness-coldness was 0.498 vs 0.496 (P-value = 0.0001) in the second and third rounds respectively. In the category of wetness-dryness, the KCC changed from 0.400 to 0.526 (P-value = 0.0001) in two consecutive rounds. As a result, the Delphi study terminated. In the fourth round, the research team contained 8 experts via an online session to evaluate the analysis and confirm the major and minor criteria of pediatric Mizaj. In this round, all criteria were accepted except three indices which had some changes. The first one was urine condition which was omitted in the previous rounds whereas it is considered as a minor index for hotness-coldness. Other criteria were hairstyle and tactile condition, which were considered minor indices for wetness-dryness, which were regarded as major criteria. (Table 4 ). No other criteria were added by experts. Table 4 Major and minor criteria of pediatric Mizaj Major Minor Weak Hotness-Coldness Physical functions Impressibility Tactile condition Speech Psychic functions Physique Fat/ Muscle Growth Skin color Hair growth Hair amount Sleep duration Appetite Hair color Urine Sleep depth Hair diameter Sweat Sleep induction Hairstyle Feces Wetness-Dryness Fat/ Muscle Sleep depth Sleep duration Tactile condition Hairstyle Physique Physical functions Impressibility Sleep induction Psychic function Growth Speech Hair growth Hair amount Skin color Feces Sweat Hair diameter Appetite Hair color Urine Discussion This research aimed to extract the major and minor criteria of pediatric Mizaj for the first time. A key strength of this study was the use of the Delphi technique, which allowed participants to share their opinions based on real-life clinical experiences without the influence of others' views. For homogeneous Delphi samples, the literature recommended that a minimum of 10 to 15 people is an appropriate sample size to ensure the reliability of the data ( 26 , 28 ). Considering the lack of prior studies, the controversies, and the potential for participant attrition, we recruited a larger number of PM practitioners to ensure robust findings. To enhance the practical relevance of our study, we included professionals from various cities in Iran. Based on the findings, we identified six criteria that can be categorized as major in the assessment of Mizaj within the hotness-coldness domain including physical functions, speech, tactile condition, impressibility (weather and food), psychological factors (comprehension and personality), and physique. Furthermore, when measuring pediatric Mizaj in terms of wetness-dryness, we identified five criteria including fat/ muscle, sleep depth& duration, tactile condition, and hairstyle that may also be considered major criteria. The current findings can be the first study for prioritizing and giving special value to all indices for pediatric Mizaj identification. There isn’t any similar study, whose findings can be compared to that of the current study. Nevertheless, our review of the available PM books and related literature revealed no significant differences between the criteria for evaluating the Mizaj of children and adults. ( 14 , 15 , 29 ). Consequently, our findings can be compared with similar studies examining both minor and major Mizaj indices in adults. Several researchers evaluated the major criteria of Mizaj identification. Most of them applied for organ Mizaj ( 30 – 32 ). Among these studies, three surveys were applied regarding adult whole-body Mizaj. Firstly, Mozaffarpur et al. in a cross-sectional study assessed the Mizaj of 150 healthy volunteers by three PM specialists ( 33 ). Secondly, In 2018 Mojahedi et al. designed another survey to determine the Mizaj of 74 medical students by ten PM experts ( 24 ). Both studies evaluated the agreement between PM experts in the usage of just ten group indices and reported the mostly used Mizaj indices in their surveys ( 24 , 33 ). The third study was done by Mojahedi et al. (2023) which was the most similar study to ours. In this Delphi study the major and minor criteria of determining adults Mizaj were extracted. In the third study, only the index of physique was divided into three subdomains including “anthropometry or size of the body”, “pulse” and “superficial veins”( 22 ). However, in our study as a novel kind of evaluation in a Mizaj study, we asked about the importance of various subdomain indices as well as the ten group indices. We are aware that the usage of ten group indices is popular in PM, but it is time to notice the details and application of Mizaj indices. Therefore, PM experts can have novel viewpoints on applicable Mizaj indices instead of repeating the usual approach according to just the ten group indices. Because each index has some subdomains that as we show the value of them is not the same. It is not necessary to determine Mizaj based on only ten group indices. Mojahedi et al. (2018) and Mozaffarpur et al. (2017) mentioned psychic& physical functions and Impressibility as criteria with the high agreement among PM experts in determining hotness-coldness ( 24 , 33 ). In our study, these indices extracted as major criteria too. But in the study of Mojahedi et al. ( 2023) psychic function`s score was not excellent, so it was not a major criterion ( 22 ). Although Mojahedi et al. studies not identify tactile condition as a critical index of hotness-coldness ( 22 , 24 ), Mozaffarpur et al. considered tactile condition as a high agreement criterion ( 33 ) and we extracted it as a major criterion as well. Also, speech characters emerged as a major criterion in our study, which was not evaluated separately in any of the adult research ( 22 , 24 , 33 ). In the other hand, our study corroborates prior research ( 22 , 24 , 33 ) indicating that additional indices, such as body waste, hair condition, and sleep/wakefulness, do not significantly influence the assessment of pediatric Mizaj in terms of hotness-coldness. In terms of wetness-dryness, Mojahedi et al.( 2018) identified fat/ muscle, tactile condition, and physique as primary factors in the Mizaj assessment ( 24 ). This aligns with findings from Mozaffarpur et al., where fat/ muscle, tactile condition, and sleep/wakefulness were also highlighted as indices with high agreement in determining wetness-dryness ( 33 ). Our study supports the conclusions of Mozaffarpur et al., whereas we consider hairstyle as a major criterion too. Overall, our results suggested that among the ten group indices of Mizaj factors such as hair condition except hairstyle, body waste, physical functions, and skin color exhibit the least influence on the wetness-dryness assessment of pediatric Mizaj in practice. The findings of our study indicate that, among the ten group indices of pediatric Mizaj feces and sweat as body wastes play a minimal role in the overall assessment of pediatric Mizaj in clinical practice. However, we cannot dismiss their potential significance in evaluating the Mizaj of specific organs, such as the liver and brain. Further research is needed to investigate this aspect more thoroughly. It is important to use the appropriate statistical method in evidencing the basic contents of ancient PM. In this study, we introduced a new analysis method in the field of Mizaj surveys. For instance, it was determined that PM practitioners showed more agreement in the evaluation of hotness-coldness than in wetness-dryness. This novel comparison was analyzed using the KCC, which had not been evaluated in previous related studies. In addition, the request for scoring the indices was repeated in two rounds, and finalized with a discussion in another round wideness of expert`s idea assessed by CV, in contrast to the most similar research in adults Mizaj which was only one round contain just reporting the Mean ± SD. For scoring the expert`s Mizaj evaluation we chose Likert 0 to 10 the same as Mojahedi et al. in 2018, in contrast to Mozaffarpur et al., who scored from 1 to 7 ( 24 , 33 ). Although our study has had some novelty, it had limitations too. Firstly, in the PM references there was not a separate chapter for pediatric Mizaj. Secondly, there was a delay in the expert`s responses. Variability in the evaluation methods employed by different experts may lead to differences in the value assigned to each criterion in determining Mizaj. Consequently, the establishment of a standardized and consistent method for evaluating each criterion could yield more definitive results. The absence of a precise guideline for assessing the pediatric and adult Mizaj identification indices is the big gap in this field which its development should be considered as the aim of future studies. Conclusions According to the result of our study six criteria including tactile condition, physique, speed of physical functions, speech, psychic function, impressibility of weather and food were extracted as major criteria for hotness-coldness, as well as five criteria including tactile condition, fat/ muscle, hairstyle, sleep depth and duration as major criteria for wetness-dryness in pediatric Mizaj identification. Design and validation of a pediatric Mizaj questionnaire using the result of this survey is suggested. These criteria can be used in clinic by practitioners for pediatric Mizaj identification. Abbreviations CM Complementary Medicine CV Coefficient of variation KCC Kendall’s coefficient of concordance PM Persian Medicine R Round SD Standard deviation WHO World Health Organization Declarations Ethics Approval: The current study is part of a great study for designing the pediatric Mizaj questionnaire according to PM. The Approval Committee was Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1401.704). Data availability: The data of this study can be obtained from the corresponding author upon request. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding: There was no funding for Delphi study Authors' contributions: MM: Design of the work, Conceptualization, Supervision, Writing, Review & Editing; ZS: Design of the work, Conceptualization, Investigation, Resources, Data Curation, Writing; MN: Supervision, Writing - Review & Editing; MA: Investigation, Resources; NB: Software, Methodology, Formal analysis; MSF: Investigation, Resources; ZA: Investigation, Resources; PR: Investigation, Resources; RA: Writing, Review & Editing; EK: Investigation, Resources; SV: Investigation, Resources; MRC: Resources; EA: Resources All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work. Clinical trial number: Not applicable Consent to participate: The experts who agreed to participate in this study via an informed email were included in the Delphi study. In the main project regarding to pediatric Mizaj informed consent was obtained from parents. Acknowledgements: All experts who contributed to this project deserve our gratitude. Experts who were not among the authors and without whose valuable presence this project would not have been possible include: Mahdi Alizadeh, Amir Mohammad Jaladat, Armaghan Sadat Keyhanmehr, Roshanak Mokaberi Nejad, Maryam Monfared, Monireh Sadat Motaharifard, Mohadeseh Ostovar, Mohammad Mahdi Parvizi, Ali Tavakkoli, Yasaman Vazani, Mahdi Yousefi, Seyyede Sedighe Yousefi. References Council NR, Do B, Bo C. Youth, Health CoEoCs. Children's health, the nation's wealth: assessing and improving child health. 2004. Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, et al. A future for the world's children? A WHO–UNICEF–Lancet Commission. Lancet. 2020;395(10224):605–58. Hadavand MB, Esmaeili Saber SS, Montazeri Moghadam A, Jafari F, Gholami Fesharaki M, Abedi M. Effect of health education based on Iranian Traditional Medicine (Hefz-Alsehe) on treatment costs of the Iranian Health Insurance Organization. Daneshvar Med. 2020;26(4):11–8. Marcos-Delgado A, Hernández-Segura N, Fernández-Villa T, Molina AJ, Martín V. The effect of lifestyle intervention on health-related quality of life in adults with metabolic syndrome: a meta-analysis. Int J Environ Res Public Health. 2021;18(3):887. Ingelman-Sundberg M. Personalized medicine into the next generation. Wiley Online Library; 2015. pp. 152–4. Yamamoto Y, Kanayama N, Nakayama Y, Matsushima N. Current status, issues and future prospects of personalized medicine for each disease. J Pers Med. 2022;12(3):444. Delpierre C, Lefèvre T. Precision and personalized medicine: What their current definition says and silences about the model of health they promote. Implication for the development of personalized health. Front Sociol. 2023;8:1112159. Pitcher MH, Edwards E, Langevin HM, Rusch HL, Shurtleff D. Complementary and integrative health therapies in whole person resilience research. Stress Health. 2023;39(S1):55–61. Leach MJ, Veziari Y, Flanagan C, Schloss J. Prevalence of Complementary Medicine Use in Children and Adolescents: A Systematic Review. J Pediatr health care. 2024. World Health Organization. (2023a) Committing to implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016 – 2030). [Available from:. https://iris.who.int/bitstream/handle/10665/ 366978/WHO-UHL-MCA-GS-23.01-eng.pdf?sequence = 1 World Health Organization. Towards access 2030: WHO essential medicines and health products strategic framework 2016–2030. World Health Organization. [Available from: https://apps.who.int/iris/handle/10665/258757 Tafazoli V, Tavakoli A, Mosaffa-Jahromi M, Cooley K, Pasalar M. Approach of Persian medicine to health and disease. Adv Integr Med. 2022;9(1):3–8. Bahramsoltani R, Rahimi R. An evaluation of traditional Persian medicine for the management of SARS-CoV-2. Front Pharmacol. 2020;11:571434. Avicenna. The Cannon of Medicine. Tehran, Iran: Alaalami Library; 2005. khodadoost M, tM rahimi, ghods R, yousefi R, baghbani M. H, et al. Textbook of evidence based persian medicine. 5ed ed. editor. Tehran, Iran: Iranian Teb; 2017. Salmannezhad H, Mojahedi M, Ebadi A, Mozaffarpur SA, Alipoor A, Saghebi R, et al. Design and validation of Mizaj identification questionnaire in Persian medicine. Iran Red Crescent Med J. 2018;20(11):9. Ahmadi M, Shirafkan H, Mozaffarpur SA. Assessment of the Diagnostic Methods of Mizaj in Persian Medicine: A Systematic Review. Diagnostics. 2023;13(5):818. Akhtari M, Moeini R, Mojahedi M, Gorji N. Assessment the Studies on the Concept of Mizaj (temperament) in Persian Medicine. J Complement Integr Med. 2020;17(3). Tansaz M, Akhtari M, Naseri M, Majdzadeh R, Isfeedvajani MS, Shams-Ardakani MR, et al. Relationship between anthropometric indices and Mizaj (temperament) in Persian medicine. Casp J Intern Med. 2023;14(2):205. Salehi Z, Tavakoli A, Hamedi SH, Samimi S, Namjooyan F, Ansari M, et al. Efficacy of Plantago major leaf extract cream compared to placebo in preventing acute radiodermatitis in breast cancer patients: A randomized clinical trial. Eur J Integr Med. 2023;62:102284. Parvizi MM, Molayemat M, Rezaee M, Yeganeh BS, Rampp T, Hashempur MH. ABO/Rh Blood Groups and the Temperament (Mizaj) Based on Traditional Persian Medicine Perspective: A Cross-sectional Study. Galen Med J. 2023;12:e3062–e. Mojahedi M, Mozaffarpur SA, Zaidi SMA, Shirafkan H. The weight of Mizaj (temperament) indices in Persian Medicine: A Delphi study. Caspian J Intern Med. 2023;14(3):513. Mojahedi M, Mozaffarpur SA, Isfahani MM, Naseri M, Kamalinejad M, Khodadoust M et al. Research priorities in traditional Persian medicine. J Res History Med. 2016;5(2). Mojahedi M, Alipour A, Saghebi R, Mozaffarpur SA. The relationship between Mizaj and its indices in Persian medicine. Iran Red Crescent Med J. 2018;20(5):e57820. Barrett D, Heale R. What are Delphi studies? Evid Based Nurs. 2020;23(3):68–9. Ridgers ND, Denniss E, Burnett AJ, Salmon J, Verswijveren SJ. Defining and reporting activity patterns: a modified Delphi study. Int J Behav Nutr Phys Activity. 2023;20(1):89. Gattrell WT, Logullo P, van Zuuren EJ, Price A, Hughes EL, Blazey P, et al. ACCORD (ACcurate COnsensus Reporting Document): A reporting guideline for consensus methods in biomedicine developed via a modified Delphi. PLoS Med. 2024;21(1):e1004326. Trevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integr Med. 2015;7(4):423–8. L. J. Zakhireh Kharazmshahi. Tehran, Iran: Bonyade Farhang Iran; 1992. Salmannejad H, Mojahedi M, Mozaffarpur S, Saghebi R. The review of indices of Mizaj-e-Damagh (temperament of brain) identification in Persian medicine. J Babol Univ Med Sci. 2016;18(11):71–9. Hakimi F, Jafari P, Mojahedi M, Movahhed M, Tansaz M, Choopani R, et al. The review of indices of liver temperament (Mizaj) in the Iranian traditional medicine (Persian Medicine). Med History J. 2019;11:97–109. Parsa E, Mojahedi M, Ilkhani R, Zareiyan A, Mokaberinejad R, Alizadeh Vaghasloo M, et al. A review of the indices of mizaj-e-meda (temperament of stomach) identification in Persian medicine. J Babol Univ Med Sci. 2018;20(7):63–70. Mozaffarpur SA, Saghebi R, Khafri S, Mojahedi M. An assessment of the agreement between Persian medicine experts on mizaj identification. Traditional Integr Med. 2017:113–8. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 10 May, 2026 Reviews received at journal 03 Jul, 2025 Reviewers agreed at journal 02 Jul, 2025 Reviewers invited by journal 24 Jun, 2025 Editor assigned by journal 18 Jun, 2025 Editor invited by journal 29 May, 2025 Submission checks completed at journal 28 May, 2025 First submitted to journal 28 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6591318","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475802303,"identity":"6832edab-de9d-4f68-84f6-e33b97cdf7a2","order_by":0,"name":"Morteza Mojahedi","email":"","orcid":"","institution":"Traditional Medicine and History of Medical Sciences Research Center, Babol University of Medical Sciences, Babol","correspondingAuthor":false,"prefix":"","firstName":"Morteza","middleName":"","lastName":"Mojahedi","suffix":""},{"id":475802305,"identity":"7503c776-84e0-47c7-944f-35ad2dc15f02","order_by":1,"name":"Zahra Salehi","email":"data:image/png;base64,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","orcid":"","institution":"Allergy Research Center, Shiraz University of Medical Sciences, Shiraz","correspondingAuthor":true,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Salehi","suffix":""},{"id":475802307,"identity":"4c0751aa-29a5-45af-9666-dd6f30e3b1be","order_by":2,"name":"Majid Nimrouzi","email":"","orcid":"","institution":"Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz","correspondingAuthor":false,"prefix":"","firstName":"Majid","middleName":"","lastName":"Nimrouzi","suffix":""},{"id":475802309,"identity":"8bd3eba3-b795-4d4c-98ac-ce712d51e7e6","order_by":3,"name":"Mostafa Alizadeh","email":"","orcid":"","institution":"Traditional Medicine and History of Medical Sciences Research Center, Babol University of Medical Sciences, Babol","correspondingAuthor":false,"prefix":"","firstName":"Mostafa","middleName":"","lastName":"Alizadeh","suffix":""},{"id":475802311,"identity":"d5edffe8-4a30-440a-bf40-5e4669a0bf3e","order_by":4,"name":"Naser Behnampoor","email":"","orcid":"","institution":"Department of Biostatistics, Faculty of Health, Golestan University of Medical Sciences, Gorgan","correspondingAuthor":false,"prefix":"","firstName":"Naser","middleName":"","lastName":"Behnampoor","suffix":""},{"id":475802312,"identity":"d95cad3e-82df-40af-8f2f-b8ebd7277349","order_by":5,"name":"Mahboubeh Sadat Fateminasab","email":"","orcid":"","institution":"Traditional Medicine and Materia Medica Research Center and Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran","correspondingAuthor":false,"prefix":"","firstName":"Mahboubeh","middleName":"Sadat","lastName":"Fateminasab","suffix":""},{"id":475802313,"identity":"9fc797bb-702e-4503-8354-74e8cceef4d7","order_by":6,"name":"Zahra Aghanouri","email":"","orcid":"","institution":"Isfahan Endocrine and Metabolic Research Center, Isfahan University of Medical Sciences, Isfahan","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Aghanouri","suffix":""},{"id":475802314,"identity":"de759487-fca5-45d9-ba18-0d6a770286e0","order_by":7,"name":"Pyruz Rezaei","email":"","orcid":"","institution":"Department of Clinical Psychology, Faculty of Medicine, AJA University of Medical Sciences, Tehran","correspondingAuthor":false,"prefix":"","firstName":"Pyruz","middleName":"","lastName":"Rezaei","suffix":""},{"id":475802315,"identity":"6ce2c821-7a81-420f-8dc8-700ad1011a7c","order_by":8,"name":"Reihane Alipour","email":"","orcid":"","institution":"Traditional Medicine and Materia Medica Research Center and Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran","correspondingAuthor":false,"prefix":"","firstName":"Reihane","middleName":"","lastName":"Alipour","suffix":""},{"id":475802316,"identity":"fb23c6f0-1917-4db3-afb6-870c47974439","order_by":9,"name":"Elmira Kalantari","email":"","orcid":"","institution":"Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran","correspondingAuthor":false,"prefix":"","firstName":"Elmira","middleName":"","lastName":"Kalantari","suffix":""},{"id":475802318,"identity":"e873e8c0-3052-4417-98f4-81d4e7e2d049","order_by":10,"name":"Saeed Vahedi","email":"","orcid":"","institution":"Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil","correspondingAuthor":false,"prefix":"","firstName":"Saeed","middleName":"","lastName":"Vahedi","suffix":""},{"id":475802319,"identity":"6809336c-7562-4522-905d-70c4d2a1af7d","order_by":11,"name":"Mahsa Rostami Chaiijan","email":"","orcid":"","institution":"Department of Persian Medicine, Fasa University of Medical Sciences, Fasa","correspondingAuthor":false,"prefix":"","firstName":"Mahsa","middleName":"Rostami","lastName":"Chaiijan","suffix":""},{"id":475802320,"identity":"898788c0-66be-4bd3-a15d-7d3b8b98fc47","order_by":12,"name":"Elham Akbarzadeh","email":"","orcid":"","institution":"Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz","correspondingAuthor":false,"prefix":"","firstName":"Elham","middleName":"","lastName":"Akbarzadeh","suffix":""}],"badges":[],"createdAt":"2025-05-05 05:24:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6591318/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6591318/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85576470,"identity":"2c8223f2-8be8-4b9f-b08f-4eddac8476d5","added_by":"auto","created_at":"2025-06-27 18:59:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":883368,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6591318/v1/a986f971-50d7-463c-a836-618fbae1e2d9.pdf"},{"id":85576077,"identity":"b357a0b2-521b-4840-8170-e201e2cce26d","added_by":"auto","created_at":"2025-06-27 18:43:13","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16589,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-6591318/v1/b2a49df579dc368e13571e1d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Major and minor criteria for pediatric Mizaj (temperament) in Persian Medicine: A four-round Delphi study","fulltext":[{"header":"Background","content":"\u003cp\u003eHaving healthy children is a matter of national interest, as healthy children can learn more effectively and are more likely to grow into healthy adults who contribute positively to society and the workforce in the long term. Children who adopt healthy practices through their formative years are more likely to become productive adults. Health surveillance and monitoring systems are built upon health models that prioritizing prevention and lifestyle improvement (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). World Health Organization (WHO) has motivated governments to notice pediatric health and its needs (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). \u003cb\u003eA healthy lifestyle significantly affects the quality of life and\u003c/b\u003e helps to improve diseases faster (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Personalized medicine as a novel approach in the healthcare system is based on attention to the differences between patients with the same disease (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Individual lifestyle information is helpful in personalized care, reduces the costs of treatment, and makes it more effective with fewer adverse effects (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Complementary and integrative interventions is a holistic medicine that impacts on whole people`s health (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Fortunately, complementary medicine (CM) use among children and adolescents is high and widespread (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs recommended by the WHO standardization of diagnosis and treatment in CM schools and greater surveys on child health are necessary (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Therefore, researchers must establish standardized evidence-based guidelines for the use of CM.\u003c/p\u003e \u003cp\u003ePersian Medicine (PM) is one of the ancient forms of CM which has a history of thousands of years and is rooted in ancient Persian civilization. This school emphasizes that the maintenance of health is superior to the treatment of disease (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e13\u003c/span\u003e). According to the principles of PM, individual differences as a basic applicable aspect described in the concept of Mizaj (temperament). This viewpoint corresponds to the idea of personalized medicine. According to the basic theories of Mizaj, most lifestyle modifications, as well as diagnosis and treatment of diseases, are recommended based on individuals' Mizaj differences. This approach is practical in all age groups, especially in pediatrics (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIdentifying Mizaj is a fundamental prerequisite for diagnosing health status and illness (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e15\u003c/span\u003e). From this viewpoint, therapeutic intervention and lifestyle recommendations are deficient without Mizaj identification (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMizaj is classified into two domains of hotness-coldness, and wetness-dryness. Individuals with each Mizaj are predisposed to certain disorders and require specific management and lifestyle advice to maintain their health (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Therefore, personalized medicine according to Mizaj is an appropriate approach for patients (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral indices including physical, psychic, and physiological functions as well as phenotype characteristics of each person have been used for Mizaj identification (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e). These indices are categorized into ten group indices including:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTouch or tactile condition (hotness-coldness, and wetness-dryness of skin from the examiner's point of view)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003efat tissue and muscle mass (evaluation of general appearance as being fatty or thin, and the type of tissue in terms of muscle or fat)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePhysique (including anthropometric factors such as the size of extremities, joints, chest, pulse, prominent vessels, etc.)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHair conditions (growth of hair, amount, color, hairstyle, and diameter)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSkin color\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSleep (duration, depth of sleep, and induction of sleep)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePhysical function (quantity and speed of physical activity, speech frequency, speed, and loudness- growth according to weight and height, and appetite)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWaste matter (stool, urine, sweat)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImpressibility speed (the responsiveness of the body's main organs to different temperatures or types of food)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePsychic function (personality and comprehension) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn the PM manuscripts application of each index and its indication to Mizaj were explained but the value and priority of them were not clarified. Therefore extraction of major and minor criteria for Mizaj identification and developing standard scale in this field is one of the most critical issues in PM research (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e). There are several studies have been conducted to set quantitative criteria for Mizaj in adults (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e). To the best of our knowledge, despite the importance of determining the value of Mizaj indices in children for developing a valid and reliable pediatric Mizaj questionnaire, no study has been conducted in this area. It is important to assign value to the proposed indices to come up with new valid and reliable questionnaires and other diagnostic tools. This research aimed to develop a consensus survey regarding the major and minor criteria for evaluation of pediatric Mizaj as the first step in developing and standardization of pediatric Mizaj questionnaire.\u003c/p\u003e \u003cp\u003eDue to the dispersion of PM practitioners in the country and not having access to them, the Delphi method is a good choice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis is a four-round Delphi study. The Delphi method is a flexible structured approach for collecting and classifying the knowledge of experts. It is done via several survey rounds in which each expert individually scores the statements (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study was performed from June 2023 to December 2023 at the Research Center of\u003c/p\u003e \u003cp\u003eTraditional Medicine and History of Medical Sciences in Shiraz University of Medical Sciences, Iran.\u003c/p\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eThe inclusion criteria for experts were all physicians with PhD degrees in PM who graduated from universities had at least five years of clinical experience and were interested in pediatric courses. They were asked to answer the questions based on their knowledge and experience. Also, in all rounds, they were asked to mention more important and practical indices that each expert has used in the practice.\u003c/p\u003e \u003cp\u003eEach round was conducted by email using Microsoft Word forms.\u003c/p\u003e \u003cp\u003eAfter each round was completed, results were shared with all participants by email. To avoid any bias findings of each round were shared anonymously.\u003c/p\u003e \u003cp\u003eThree members of the research team carefully supervised the survey.\u003c/p\u003e \u003cp\u003eRound 1\u003c/p\u003e \u003cp\u003eBefore starting the first round, a review of the available PM books and related literature was done. We did not find different indices for the evaluation of pediatric Mizaj from adults. All ten group indices of whole-body Mizaj identification in PM were extracted and arranged via a checklist (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e). At the beginning of the project, PM specialists were invited by announcements in virtual spaces. Then according to arranged items in the checklist, by open-ended questions, experts were encouraged to freely explain their clinical viewpoints on the pediatric Mizaj evaluation. Participant`s comment who completed the checklist were extracted into a final list. The recommendation was discussed by three supervisors. Then the percentages of using ten group indices by expert reported.\u003c/p\u003e \u003cp\u003eRound 2\u003c/p\u003e \u003cp\u003eBased on the first round, all indices for determining whole body Mizaj were occluded in a table which was developed for this study (Supplementary file 1). Due to the variety of items in some of the ten group indices, several subdomains were considered according to the PM expert`s viewpoints. At the end of the table, we put a statement as \u0026ldquo;others\u0026rdquo; to add other indices by experts.\u003c/p\u003e \u003cp\u003eWe informed PM faculties in all the universities of medical sciences around the country about our research and asked them to introduce their practitioners who were experts and interested in the pediatric field. The prepared statements were sent to the introduced PM experts. At the same time, the goal and method of the research were explained to them. The experts were asked to rate the value (or importance) of each index in determining the hotness-coldness of pediatric Mizaj as well as the wetness-dryness in a healthy child aged 6\u0026ndash;9 years old on an 11-point Likert scale. A score of 0 meant that the index had no role in determining a pediatric whole-body Mizaj, and a score of 10 meant that the index had a crucial role. At the end of the table, we put a statement as \u0026ldquo;others\u0026rdquo; to add other indices by experts.\u003c/p\u003e \u003cp\u003eAfter data collection mean of each item scores and the Kendall\u0026rsquo;s coefficient of concordance (KCC) of the checklist of hotness/coldness and wetness/dryness separately were analyzed. If the KCC is below 0.5, we will hold another round.\u003c/p\u003e \u003cp\u003eRound 3\u003c/p\u003e \u003cp\u003eThe third round was conducted in the same format as the second round. Anonymous feedback on the second round was sent too. In this round, experts were asked to revise or confirm their rank of pediatric Mizaj indices in the second round. In this round mean of each item and KCC were analyzed. In addition, the mean and rank of each index were assessed after consideration of both rounds. We decided to stop another round if not significant change in the KCC score or with considerable agreement (KCC above 0.7).\u003c/p\u003e \u003cp\u003eRound 4\u003c/p\u003e \u003cp\u003eThe participants were invited to a final online meeting for a group discussion, and the data were reviewed. The mean, standard deviation (SD), and coefficient of variation (CV) of each index in the second and third rounds are explained separately to assess the wideness of the expert`s idea in the evaluation of an index.\u003c/p\u003e \u003cp\u003eIndices with an average score of less than 5 were considered weak criteria, between 5 and 7.5 and equal to 5 and 7.5 as \"minor criteria\", and above 7.5 as \"major criteria\".\u003c/p\u003e \u003cp\u003eThis final analysis is presented to confirm major and minor criteria of pediatrics Mizaj by final expert discussion. Statistical analysis was performed using the R version 4.3.3 software.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the first round, 13 experts with accepted inclusion criteria answered questions. Their responses showed that all ten group indices were used by PM practitioners, but there was controversy about their value of them. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e determines how many experts use each group of indices for pediatric Mizaj identification in the clinic.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe most practical indices of Mizaj in pediatrics and the number (%) of experts who use these indices in round 1\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of experts* (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat/ Muscle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychic functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (69.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTactile condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (53.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin color\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (53.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpressibility speed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (46.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (46.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHair condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (38.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaste matter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e*Total number of experts: 13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the expert`s explanation in round 1, all ten group indices were evaluated in the next rounds. Due to the unequal value of the characters of some groups of indices including hair conditions, skin color, sleep items, physical function, impressibility speed, and psychic function the supervisors suggested designing subdomain indices. In the statement of \u0026ldquo;other suggestions\u0026rdquo;, some experts asked to mention appetite and growth separately accepted by the supervisor team. In addition, experts mentioned that pulse, tongue, and abdominal examination are important for pediatric Mizaj determination. However physical examination was not included in our study. Other suggestions that were not included were memory and intellectual quotient. Finally, 26 items were prepared for scoring from 0 to 10 for the second round (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOut of 37 PM experts who were invited in the second round, 25 experts sent back the questionnaires. KCC was 0.498 for hotness-coldness and 0.400 for wetness-dryness showing low concordance between experts.\u003c/p\u003e \u003cp\u003eFor the third round, the result of the second round was sent to all 25 experts, and were asked to reconsider or revise their Likert scores of items. Out of them, 19 participants resent their answers. To unify the analysis condition, the second round was analyzed again to evaluate the answers of these 19 experts (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). According to the results, physical functions received the highest score for hotness-coldness, while fat/muscle composition and sleep received the highest score for wetness-dryness. Based on the consensus of CV, physical functions and speech were considered the most reliable indices for evaluating hotness-coldness. In the case of wetness-dryness, fat/muscle composition and sleep received lower CV scores, indicating greater agreement among experts.\u003c/p\u003e \u003cp\u003eIn the second and third rounds, no other criteria were added by experts.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConsensus scores in round 2 and 3 for hotness-coldness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of responses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eScore (0\u0026ndash;10)- Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eCV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTactile condition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.42**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFat/ Muscle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.46*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysique\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.84**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHair conditions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eGrowth\u003c/p\u003e \u003cp\u003eAmount\u003c/p\u003e \u003cp\u003eColor\u003c/p\u003e \u003cp\u003eHairstyle\u003c/p\u003e \u003cp\u003eDiameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e \u003cp\u003e5.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003cp\u003e5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55\u003c/p\u003e \u003cp\u003e4.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56\u003c/p\u003e \u003cp\u003e5.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e \u003cp\u003e5.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e \u003cp\u003e5.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e \u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003cp\u003e0.47\u003c/p\u003e \u003cp\u003e0.36\u003c/p\u003e \u003cp\u003e0.56\u003c/p\u003e \u003cp\u003e0.92\u003c/p\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003cp\u003e0.39\u003c/p\u003e \u003cp\u003e0.41\u003c/p\u003e \u003cp\u003e0.53\u003c/p\u003e \u003cp\u003e0.89\u003c/p\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.94*\u003c/p\u003e \u003cp\u003e5.58*\u003c/p\u003e \u003cp\u003e5.53*\u003c/p\u003e \u003cp\u003e5.19*\u003c/p\u003e \u003cp\u003e3.78\u003c/p\u003e \u003cp\u003e4.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSkin color\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBody\u003c/p\u003e \u003cp\u003eFace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e \u003cp\u003e6.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003cp\u003e6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.48*\u003c/p\u003e \u003cp\u003e6.77*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep conditions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDuration\u003c/p\u003e \u003cp\u003eDepth\u003c/p\u003e \u003cp\u003eInduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003cp\u003e4.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003cp\u003e5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81\u003c/p\u003e \u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e \u003cp\u003e3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003cp\u003e0.49\u003c/p\u003e \u003cp\u003e0.61\u003c/p\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003cp\u003e0.50\u003c/p\u003e \u003cp\u003e0.54\u003c/p\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.84*\u003c/p\u003e \u003cp\u003e5.68*\u003c/p\u003e \u003cp\u003e4.72\u003c/p\u003e \u003cp\u003e4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWast matter\u003c/b\u003e\u003c/p\u003e \u003cp\u003eUrine\u003c/p\u003e \u003cp\u003eFeces\u003c/p\u003e \u003cp\u003eSweat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003cp\u003e3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003cp\u003e3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003cp\u003e3.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003cp\u003e4.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003cp\u003e0.95\u003c/p\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003cp\u003e0.73\u003c/p\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e4.14*\u003c/span\u003e\u003c/p\u003e \u003cp\u003e3.48\u003c/p\u003e \u003cp\u003e4.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical functions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSpeech\u003c/p\u003e \u003cp\u003eGrowth\u003c/p\u003e \u003cp\u003eAppetite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003cp\u003e8.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003cp\u003e7.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003cp\u003e5.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003cp\u003e8.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e \u003cp\u003e5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003cp\u003e0.16\u003c/p\u003e \u003cp\u003e0.28\u003c/p\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003cp\u003e0.13\u003c/p\u003e \u003cp\u003e0.32\u003c/p\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.10**\u003c/p\u003e \u003cp\u003e8.24**\u003c/p\u003e \u003cp\u003e7.24*\u003c/p\u003e \u003cp\u003e5.30*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychic functions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eComprehension\u003c/p\u003e \u003cp\u003ePersonality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e \u003cp\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003cp\u003e7.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.92**\u003c/p\u003e \u003cp\u003e7.52**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpressibility\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTemperature\u003c/p\u003e \u003cp\u003eFood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003cp\u003e8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e \u003cp\u003e8.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.46**\u003c/p\u003e \u003cp\u003e8.30**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eSD: Standard deviation, CV: coefficient of variation, R: Round\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e** Considered as major criteria\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e* Considered as minor criteria\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eUnderlined: Changed index value by fourth round\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConsensus scores in round 2 and 3 for wetness-dryness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of responses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eScore (0\u0026ndash;10)- Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eCV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTactile condition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e7.45**\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFat/ Muscle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.68**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysique\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.65*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHair conditions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eGrowth\u003c/p\u003e \u003cp\u003eAmount\u003c/p\u003e \u003cp\u003eColor\u003c/p\u003e \u003cp\u003eHairstyle\u003c/p\u003e \u003cp\u003eDiameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e \u003cp\u003e2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62\u003c/p\u003e \u003cp\u003e6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003cp\u003e3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e \u003cp\u003e2.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e \u003cp\u003e6.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e \u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003cp\u003e0.82\u003c/p\u003e \u003cp\u003e0.73\u003c/p\u003e \u003cp\u003e1.01\u003c/p\u003e \u003cp\u003e0.35\u003c/p\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003cp\u003e0.67\u003c/p\u003e \u003cp\u003e0.71\u003c/p\u003e \u003cp\u003e0.92\u003c/p\u003e \u003cp\u003e0.42\u003c/p\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.61*\u003c/p\u003e \u003cp\u003e4.11\u003c/p\u003e \u003cp\u003e3.94\u003c/p\u003e \u003cp\u003e2.77\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e6.46**\u003c/span\u003e\u003c/p\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSkin color\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBody\u003c/p\u003e \u003cp\u003eFace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e \u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.36\u003c/p\u003e \u003cp\u003e3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e22\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep conditions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDuration\u003c/p\u003e \u003cp\u003eDepth\u003c/p\u003e \u003cp\u003eInduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003cp\u003e7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e \u003cp\u003e7.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003cp\u003e5.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00\u003c/p\u003e \u003cp\u003e7.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e \u003cp\u003e8.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003cp\u003e5.06\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003cp\u003e0.29\u003c/p\u003e \u003cp\u003e0.23\u003c/p\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003cp\u003e0.24\u003c/p\u003e \u003cp\u003e0.16\u003c/p\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.16**\u003c/p\u003e \u003cp\u003e7.48 *\u003c/p\u003e \u003cp\u003e7.57**\u003c/p\u003e \u003cp\u003e5.30*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWast matter\u003c/b\u003e\u003c/p\u003e \u003cp\u003eUrine\u003c/p\u003e \u003cp\u003eFeces\u003c/p\u003e \u003cp\u003eSweat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003cp\u003e3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003cp\u003e0.88\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003cp\u003e0.78\u003c/p\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003cp\u003e3.66\u003c/p\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical functions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSpeech\u003c/p\u003e \u003cp\u003eGrowth\u003c/p\u003e \u003cp\u003eAppetite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e \u003cp\u003e4.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e \u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003cp\u003e4.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e \u003cp\u003e3.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003cp\u003e0.71\u003c/p\u003e \u003cp\u003e0.62\u003c/p\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003cp\u003e0.65\u003c/p\u003e \u003cp\u003e0.53\u003c/p\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.39*\u003c/p\u003e \u003cp\u003e4.21\u003c/p\u003e \u003cp\u003e4.84\u003c/p\u003e \u003cp\u003e3.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychic functions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eComprehension\u003c/p\u003e \u003cp\u003ePersonality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003cp\u003e5.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.04*\u003c/p\u003e \u003cp\u003e5.47*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpressibility\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTemperature\u003c/p\u003e \u003cp\u003eFood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003cp\u003e6.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003cp\u003e6.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.35*\u003c/p\u003e \u003cp\u003e6.26*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eSD: Standard deviation, CV: coefficient of variation, R: Round\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e** Considered as major criteria\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e* Considered as minor criteria\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eUnderlined: Changed index value by fourth round\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eKCC for hotness-coldness was 0.498 vs 0.496 (P-value\u0026thinsp;=\u0026thinsp;0.0001) in the second and third rounds respectively. In the category of wetness-dryness, the KCC changed from 0.400 to 0.526 (P-value\u0026thinsp;=\u0026thinsp;0.0001) in two consecutive rounds. As a result, the Delphi study terminated.\u003c/p\u003e \u003cp\u003eIn the fourth round, the research team contained 8 experts via an online session to evaluate the analysis and confirm the major and minor criteria of pediatric Mizaj. In this round, all criteria were accepted except three indices which had some changes. The first one was urine condition which was omitted in the previous rounds whereas it is considered as a minor index for hotness-coldness. Other criteria were hairstyle and tactile condition, which were considered minor indices for wetness-dryness, which were regarded as major criteria. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). No other criteria were added by experts.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMajor and minor criteria of pediatric Mizaj\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMajor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWeak\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHotness-Coldness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical functions\u003c/p\u003e \u003cp\u003eImpressibility\u003c/p\u003e \u003cp\u003eTactile condition\u003c/p\u003e \u003cp\u003eSpeech\u003c/p\u003e \u003cp\u003ePsychic functions\u003c/p\u003e \u003cp\u003ePhysique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFat/ Muscle\u003c/p\u003e \u003cp\u003eGrowth\u003c/p\u003e \u003cp\u003eSkin color\u003c/p\u003e \u003cp\u003eHair growth\u003c/p\u003e \u003cp\u003eHair amount\u003c/p\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003cp\u003eAppetite\u003c/p\u003e \u003cp\u003eHair color\u003c/p\u003e \u003cp\u003eUrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep depth\u003c/p\u003e \u003cp\u003eHair diameter\u003c/p\u003e \u003cp\u003eSweat\u003c/p\u003e \u003cp\u003eSleep induction\u003c/p\u003e \u003cp\u003eHairstyle\u003c/p\u003e \u003cp\u003eFeces\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWetness-Dryness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFat/ Muscle\u003c/p\u003e \u003cp\u003eSleep depth\u003c/p\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003cp\u003eTactile condition\u003c/p\u003e \u003cp\u003eHairstyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysique\u003c/p\u003e \u003cp\u003ePhysical functions\u003c/p\u003e \u003cp\u003eImpressibility\u003c/p\u003e \u003cp\u003eSleep induction\u003c/p\u003e \u003cp\u003ePsychic function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGrowth\u003c/p\u003e \u003cp\u003eSpeech\u003c/p\u003e \u003cp\u003eHair growth\u003c/p\u003e \u003cp\u003eHair amount\u003c/p\u003e \u003cp\u003eSkin color\u003c/p\u003e \u003cp\u003eFeces\u003c/p\u003e \u003cp\u003eSweat\u003c/p\u003e \u003cp\u003eHair diameter\u003c/p\u003e \u003cp\u003eAppetite\u003c/p\u003e \u003cp\u003eHair color\u003c/p\u003e \u003cp\u003eUrine\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis research aimed to extract the major and minor criteria of pediatric Mizaj for the first time. A key strength of this study was the use of the Delphi technique, which allowed participants to share their opinions based on real-life clinical experiences without the influence of others' views. For homogeneous Delphi samples, the literature recommended that a minimum of 10 to 15 people is an appropriate sample size to ensure the reliability of the data (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Considering the lack of prior studies, the controversies, and the potential for participant attrition, we recruited a larger number of PM practitioners to ensure robust findings. To enhance the practical relevance of our study, we included professionals from various cities in Iran.\u003c/p\u003e \u003cp\u003eBased on the findings, we identified six criteria that can be categorized as major in the assessment of Mizaj within the hotness-coldness domain including physical functions, speech, tactile condition, impressibility (weather and food), psychological factors (comprehension and personality), and physique. Furthermore, when measuring pediatric Mizaj in terms of wetness-dryness, we identified five criteria including fat/ muscle, sleep depth\u0026amp; duration, tactile condition, and hairstyle that may also be considered major criteria.\u003c/p\u003e \u003cp\u003eThe current findings can be the first study for prioritizing and giving special value to all indices for pediatric Mizaj identification. There isn\u0026rsquo;t any similar study, whose findings can be compared to that of the current study. Nevertheless, our review of the available PM books and related literature revealed no significant differences between the criteria for evaluating the Mizaj of children and adults. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Consequently, our findings can be compared with similar studies examining both minor and major Mizaj indices in adults.\u003c/p\u003e \u003cp\u003eSeveral researchers evaluated the major criteria of Mizaj identification. Most of them applied for organ Mizaj (\u003cspan additionalcitationids=\"CR31\" citationid=\"CR31\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Among these studies, three surveys were applied regarding adult whole-body Mizaj. Firstly, Mozaffarpur et al. in a cross-sectional study assessed the Mizaj of 150 healthy volunteers by three PM specialists (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Secondly, In 2018 Mojahedi et al. designed another survey to determine the Mizaj of 74 medical students by ten PM experts (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Both studies evaluated the agreement between PM experts in the usage of just ten group indices and reported the mostly used Mizaj indices in their surveys (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The third study was done by Mojahedi et al. (2023) which was the most similar study to ours. In this Delphi study the major and minor criteria of determining adults Mizaj were extracted. In the third study, only the index of physique\u003c/p\u003e \u003cp\u003ewas divided into three subdomains including \u0026ldquo;anthropometry or size of the body\u0026rdquo;, \u0026ldquo;pulse\u0026rdquo; and \u0026ldquo;superficial veins\u0026rdquo;(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, in our study as a novel kind of evaluation in a Mizaj study, we asked about the importance of various subdomain indices as well as the ten group indices. We are aware that the usage of ten group indices is popular in PM, but it is time to notice the details and application of Mizaj indices. Therefore, PM experts can have novel viewpoints on applicable Mizaj indices instead of repeating the usual approach according to just the ten group indices. Because each index has some subdomains that as we show the value of them is not the same. It is not necessary to determine Mizaj based on only ten group indices.\u003c/p\u003e \u003cp\u003eMojahedi et al. (2018) and Mozaffarpur et al. (2017) mentioned psychic\u0026amp; physical functions and Impressibility as criteria with the high agreement among PM experts in determining hotness-coldness (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In our study, these indices extracted as major criteria too. But in the study of Mojahedi et al. ( 2023) psychic function`s score was not excellent, so it was not a major criterion (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough Mojahedi et al. studies not identify tactile condition as a critical index of hotness-coldness (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e), Mozaffarpur et al. considered tactile condition as a high agreement criterion (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and we extracted it as a major criterion as well.\u003c/p\u003e \u003cp\u003eAlso, speech characters emerged as a major criterion in our study, which was not evaluated separately in any of the adult research (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the other hand, our study corroborates prior research (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e) indicating that additional indices, such as body waste, hair condition, and sleep/wakefulness, do not significantly influence the assessment of pediatric Mizaj in terms of hotness-coldness.\u003c/p\u003e \u003cp\u003eIn terms of wetness-dryness, Mojahedi et al.( 2018) identified fat/ muscle, tactile condition, and physique as primary factors in the Mizaj assessment (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This aligns with findings from Mozaffarpur et al., where fat/ muscle, tactile condition, and sleep/wakefulness were also highlighted as indices with high agreement in determining wetness-dryness (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Our study supports the conclusions of Mozaffarpur et al., whereas we consider hairstyle as a major criterion too. Overall, our results suggested that among the ten group indices of Mizaj factors such as hair condition except hairstyle, body waste, physical functions, and skin color exhibit the least influence on the wetness-dryness assessment of pediatric Mizaj in practice.\u003c/p\u003e \u003cp\u003eThe findings of our study indicate that, among the ten group indices of pediatric Mizaj feces and sweat as body wastes play a minimal role in the overall assessment of pediatric Mizaj in clinical practice. However, we cannot dismiss their potential significance in evaluating the Mizaj of specific organs, such as the liver and brain. Further research is needed to investigate this aspect more thoroughly.\u003c/p\u003e \u003cp\u003eIt is important to use the appropriate statistical method in evidencing the basic contents of ancient PM. In this study, we introduced a new analysis method in the field of Mizaj surveys. For instance, it was determined that PM practitioners showed more agreement in the evaluation of hotness-coldness than in wetness-dryness. This novel comparison was analyzed using the KCC, which had not been evaluated in previous related studies. In addition, the request for scoring the indices was repeated in two rounds, and finalized with a discussion in another round wideness of expert`s idea assessed by CV, in contrast to the most similar research in adults Mizaj which was only one round contain just reporting the Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. For scoring the expert`s Mizaj evaluation we chose Likert 0 to 10 the same as Mojahedi et al. in 2018, in contrast to Mozaffarpur et al., who scored from 1 to 7 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough our study has had some novelty, it had limitations too. Firstly, in the PM references there was not a separate chapter for pediatric Mizaj. Secondly, there was a delay in the expert`s responses.\u003c/p\u003e \u003cp\u003eVariability in the evaluation methods employed by different experts may lead to differences in the value assigned to each criterion in determining Mizaj. Consequently, the establishment of a standardized and consistent method for evaluating each criterion could yield more definitive results. The absence of a precise guideline for assessing the pediatric and adult Mizaj identification indices is the big gap in this field which its development should be considered as the aim of future studies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAccording to the result of our study six criteria including tactile condition, physique, speed of physical functions, speech, psychic function, impressibility of weather and food were extracted as major criteria for hotness-coldness, as well as five criteria including tactile condition, fat/ muscle, hairstyle, sleep depth and duration as major criteria for wetness-dryness in pediatric Mizaj identification.\u003c/p\u003e \u003cp\u003eDesign and validation of a pediatric Mizaj questionnaire using the result of this survey is suggested. These criteria can be used in clinic by practitioners for pediatric Mizaj identification.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComplementary Medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoefficient of variation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKendall\u0026rsquo;s coefficient of concordance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePersian Medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval:\u003c/p\u003e\n\u003cp\u003eThe current study is part of a great study for designing the pediatric Mizaj questionnaire according to PM. The Approval Committee was Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1401.704).\u003c/p\u003e\n\u003cp\u003eData availability:\u003c/p\u003e\n\u003cp\u003eThe data of this study can be obtained from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThere was no funding for Delphi study\u003c/p\u003e\n\u003cp\u003eAuthors' contributions:\u003c/p\u003e\n\u003cp\u003eMM: Design of the work, Conceptualization,\u0026nbsp;Supervision, Writing, Review \u0026amp; Editing; ZS:\u0026nbsp;Design of the work, Conceptualization, Investigation,\u0026nbsp;Resources, Data Curation, Writing; MN: Supervision, Writing - Review \u0026amp; Editing; MA:\u0026nbsp;Investigation,\u0026nbsp;Resources; NB: Software,\u0026nbsp;Methodology, Formal analysis;\u0026nbsp;MSF: Investigation,\u0026nbsp;Resources; ZA:\u0026nbsp;Investigation,\u0026nbsp;Resources; PR:\u0026nbsp;Investigation,\u0026nbsp;Resources; RA: Writing, Review \u0026amp; Editing; EK:\u0026nbsp;Investigation,\u0026nbsp;Resources; SV:\u0026nbsp;Investigation,\u0026nbsp;Resources; MRC: Resources; EA: Resources\u003c/p\u003e\n\u003cp\u003eAll authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003eClinical trial number:\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eConsent to participate:\u003c/p\u003e\n\u003cp\u003eThe experts who agreed to participate in this study via an informed email were included in the Delphi study. In the main project regarding to pediatric Mizaj informed consent was obtained from parents.\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eAll experts who contributed to this project deserve our gratitude. Experts who were not among the authors and without whose valuable presence this project would not have been possible include: Mahdi Alizadeh, Amir Mohammad Jaladat, Armaghan Sadat Keyhanmehr, Roshanak Mokaberi Nejad, Maryam Monfared, Monireh Sadat Motaharifard, Mohadeseh Ostovar, Mohammad Mahdi Parvizi, Ali Tavakkoli, Yasaman Vazani, Mahdi Yousefi, Seyyede Sedighe Yousefi.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCouncil NR, Do B, Bo C. Youth, Health CoEoCs. Children's health, the nation's wealth: assessing and improving child health. 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, et al. A future for the world's children? A WHO\u0026ndash;UNICEF\u0026ndash;Lancet Commission. Lancet. 2020;395(10224):605\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHadavand MB, Esmaeili Saber SS, Montazeri Moghadam A, Jafari F, Gholami Fesharaki M, Abedi M. Effect of health education based on Iranian Traditional Medicine (Hefz-Alsehe) on treatment costs of the Iranian Health Insurance Organization. Daneshvar Med. 2020;26(4):11\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcos-Delgado A, Hern\u0026aacute;ndez-Segura N, Fern\u0026aacute;ndez-Villa T, Molina AJ, Mart\u0026iacute;n V. The effect of lifestyle intervention on health-related quality of life in adults with metabolic syndrome: a meta-analysis. Int J Environ Res Public Health. 2021;18(3):887.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIngelman-Sundberg M. Personalized medicine into the next generation. Wiley Online Library; 2015. pp. 152\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamamoto Y, Kanayama N, Nakayama Y, Matsushima N. Current status, issues and future prospects of personalized medicine for each disease. J Pers Med. 2022;12(3):444.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelpierre C, Lef\u0026egrave;vre T. Precision and personalized medicine: What their current definition says and silences about the model of health they promote. Implication for the development of personalized health. Front Sociol. 2023;8:1112159.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitcher MH, Edwards E, Langevin HM, Rusch HL, Shurtleff D. Complementary and integrative health therapies in whole person resilience research. Stress Health. 2023;39(S1):55\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeach MJ, Veziari Y, Flanagan C, Schloss J. Prevalence of Complementary Medicine Use in Children and Adolescents: A Systematic Review. J Pediatr health care. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. (2023a) Committing to implementation of the Global Strategy for Women\u0026rsquo;s, Children\u0026rsquo;s and Adolescents\u0026rsquo; Health (2016\u0026thinsp;\u0026ndash;\u0026thinsp;2030). [Available from:. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/bitstream/handle/10665/ 366978/WHO-UHL-MCA-GS-23.01-eng.pdf?sequence\u0026thinsp;=\u0026thinsp;1\u003c/span\u003e\u003cspan address=\"https://iris.who.int/bitstream/handle/10665/ 366978/WHO-UHL-MCA-GS-23.01-eng.pdf?sequence\u0026thinsp;=\u0026thinsp;1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Towards access 2030: WHO essential medicines and health products strategic framework 2016\u0026ndash;2030. World Health Organization.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e[Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apps.who.int/iris/handle/10665/258757\u003c/span\u003e\u003cspan address=\"https://apps.who.int/iris/handle/10665/258757\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTafazoli V, Tavakoli A, Mosaffa-Jahromi M, Cooley K, Pasalar M. Approach of Persian medicine to health and disease. Adv Integr Med. 2022;9(1):3\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahramsoltani R, Rahimi R. An evaluation of traditional Persian medicine for the management of SARS-CoV-2. Front Pharmacol. 2020;11:571434.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAvicenna. The Cannon of Medicine. Tehran, Iran: Alaalami Library; 2005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ekhodadoost M, tM rahimi, ghods R, yousefi R, baghbani M. H, et al. Textbook of evidence based persian medicine. 5ed ed. editor. Tehran, Iran: Iranian Teb; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalmannezhad H, Mojahedi M, Ebadi A, Mozaffarpur SA, Alipoor A, Saghebi R, et al. Design and validation of Mizaj identification questionnaire in Persian medicine. Iran Red Crescent Med J. 2018;20(11):9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmadi M, Shirafkan H, Mozaffarpur SA. Assessment of the Diagnostic Methods of Mizaj in Persian Medicine: A Systematic Review. Diagnostics. 2023;13(5):818.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkhtari M, Moeini R, Mojahedi M, Gorji N. Assessment the Studies on the Concept of Mizaj (temperament) in Persian Medicine. J Complement Integr Med. 2020;17(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTansaz M, Akhtari M, Naseri M, Majdzadeh R, Isfeedvajani MS, Shams-Ardakani MR, et al. Relationship between anthropometric indices and Mizaj (temperament) in Persian medicine. Casp J Intern Med. 2023;14(2):205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalehi Z, Tavakoli A, Hamedi SH, Samimi S, Namjooyan F, Ansari M, et al. Efficacy of Plantago major leaf extract cream compared to placebo in preventing acute radiodermatitis in breast cancer patients: A randomized clinical trial. Eur J Integr Med. 2023;62:102284.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParvizi MM, Molayemat M, Rezaee M, Yeganeh BS, Rampp T, Hashempur MH. ABO/Rh Blood Groups and the Temperament (Mizaj) Based on Traditional Persian Medicine Perspective: A Cross-sectional Study. Galen Med J. 2023;12:e3062\u0026ndash;e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMojahedi M, Mozaffarpur SA, Zaidi SMA, Shirafkan H. The weight of Mizaj (temperament) indices in Persian Medicine: A Delphi study. Caspian J Intern Med. 2023;14(3):513.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMojahedi M, Mozaffarpur SA, Isfahani MM, Naseri M, Kamalinejad M, Khodadoust M et al. Research priorities in traditional Persian medicine. J Res History Med. 2016;5(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMojahedi M, Alipour A, Saghebi R, Mozaffarpur SA. The relationship between Mizaj and its indices in Persian medicine. Iran Red Crescent Med J. 2018;20(5):e57820.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrett D, Heale R. What are Delphi studies? Evid Based Nurs. 2020;23(3):68\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRidgers ND, Denniss E, Burnett AJ, Salmon J, Verswijveren SJ. Defining and reporting activity patterns: a modified Delphi study. Int J Behav Nutr Phys Activity. 2023;20(1):89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGattrell WT, Logullo P, van Zuuren EJ, Price A, Hughes EL, Blazey P, et al. ACCORD (ACcurate COnsensus Reporting Document): A reporting guideline for consensus methods in biomedicine developed via a modified Delphi. PLoS Med. 2024;21(1):e1004326.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integr Med. 2015;7(4):423\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL. J. Zakhireh Kharazmshahi. Tehran, Iran: Bonyade Farhang Iran; 1992.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalmannejad H, Mojahedi M, Mozaffarpur S, Saghebi R. The review of indices of Mizaj-e-Damagh (temperament of brain) identification in Persian medicine. J Babol Univ Med Sci. 2016;18(11):71\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHakimi F, Jafari P, Mojahedi M, Movahhed M, Tansaz M, Choopani R, et al. The review of indices of liver temperament (Mizaj) in the Iranian traditional medicine (Persian Medicine). Med History J. 2019;11:97\u0026ndash;109.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParsa E, Mojahedi M, Ilkhani R, Zareiyan A, Mokaberinejad R, Alizadeh Vaghasloo M, et al. A review of the indices of mizaj-e-meda (temperament of stomach) identification in Persian medicine. J Babol Univ Med Sci. 2018;20(7):63\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMozaffarpur SA, Saghebi R, Khafri S, Mojahedi M. An assessment of the agreement between Persian medicine experts on mizaj identification. Traditional Integr Med. 2017:113\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Children, Pediatric Mizaj, Persian Medicine, Traditional Medicine","lastPublishedDoi":"10.21203/rs.3.rs-6591318/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6591318/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eMizaj (temperament) is a basic\u003cstrong\u003e \u003c/strong\u003ecomponent of diagnosis and treatment in Persian Medicine (PM). It evaluates individual characteristics by ten group indices. Personalized lifestyle according to Mizaj for maintaining health and treatment is essential in all people and children are not an exception. Considering that the importance of each Mizaj index in pediatrics has not been determined so far, we conducted this study.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eIn a four-round Delphi study, the indices of Mizaj determination according to PM references were evaluated to extract major and minor Mizaj criteria in pediatrics. To assess the applicability of indices in expert practice, open-ended questions were first used. Subsequently, a checklist of the extracted indices was sent to PM experts via email in two consecutive Delphi rounds as second and third rounds. Before participation, the research design was explained to all experts via email, and they were asked to provide their agreement (consent) to participate. Additionally, it was mentioned that non-author contributors would be acknowledged in the study. In the second and third rounds, the experts rated the importance of each index in determining pediatric Mizaj using an 11-point Likert scale (ranging from zero to ten).\u003c/p\u003e\n\u003cp\u003eThe analysis of Likert scales was conducted in the final round, and the major and minor criteria for pediatric Mizaj were finalized.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eIn the first round, 13 PM experts discussed and extracted 26 indices for pediatrics Mizaj identification. Out of 37 invited PM experts, 19 took part in both the second and third rounds. According to the final expert panel, six major criteria including physical functions, impressibility of weather and food, tactile condition, speech, and psychicfunctions were extracted for hotness-coldness, as well as five major criteria including fat/ muscle, sleep depth and duration, tactile condition, and hairstyle as major criteria for wetness-dryness.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eThe extracted criteria based on PM manuscripts and expert (consensus) agreement can be used for pediatric Mizaj identification in the clinic and standard scale development in this field.\u003c/p\u003e","manuscriptTitle":"Major and minor criteria for pediatric Mizaj (temperament) in Persian Medicine: A four-round Delphi study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-27 18:43:08","doi":"10.21203/rs.3.rs-6591318/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"73365746273215921477617880932152066523","date":"2026-05-10T09:08:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-03T16:04:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83196017416180125206970925197449312253","date":"2025-07-02T06:11:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-24T13:36:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-18T10:02:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-29T06:11:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-28T17:24:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-05-28T17:23:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b6e7140c-d6f3-41e9-99e5-578878ec9277","owner":[],"postedDate":"June 27th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"73365746273215921477617880932152066523","date":"2026-05-10T09:08:29+00:00","index":91,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-27T18:43:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-27 18:43:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6591318","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6591318","identity":"rs-6591318","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}