Maharashtra University of Health Sciences,

Nashik, Maharashtra

CLINICAL ACTIVITY BOOK

NAME OF THE INSTITUTE WITH LOGO

ROGA NIDAN EVAM VIKRITI VIGYAN

(AYURVEDA DIAGNOSTICS AND PATHOLOGY)

Name of the student:…………………………………………………………

Registration number:………………………………………………………..

Academic year:………………………………………………………………
 NAME OF THE INSTITUTE WITH LOGO

ROGA NIDAN EVAM VIKRITI VIGYAN

(AYURVEDA DIAGNOSTICS AND PATHOLOGY)
(Subject code: AyUG-RN)

University course code:

 DEPARTMENT OF ROGA NIDAN EVAM VIKRITI VIGYAN
(Name of the College)
(Approved by –National Commission for Indian System of Medicines, New Delhi &

(Name of University)

Certificate
This is to certify that, Mr.
/Ms.________________________________________

Enrollment Number- ____________________________ of

Batch___________has satisfactorily completed the course of Practical in
the ROGA NIDAN EVAM VIKRITI VIGYAN Subject prescribed by the
(Name of University)
as a part of the Second Professional B.A.M.S. Course.

Examination Date of Examination-

Seat No.:

Sign. Of Sign. Of External Examiner-

Internal
Examiner-

Sign. of Sign. of
Teacher H.O.D
 Internal Assessment Distribution of Practical Exam I st Term End

S.No Heads Marks

Spotting/ Identification: (10 Questions X 2 Marks):
(Note:Minimum of one spotting should be kept mandatorily from all the 20
01
different heads mentioned in syllabus)
Long Case: History taking, Examination, Investigation (Order
andinterpretation), Differential Diagnosis, Provisional Diagnosis
(1 Case X 20 Marks )
02 a. History taking (Including communication skills) - 05 Marks 20
b. Examination & Order and interpretation of investigations – 10 Marks
c. Differential Diagnosis, Provisional Diagnosis, and Final diagnosis. – 05
Marks

Demonstration: Clinical examination on the simulator or a patient

10
03 or Simulated patient (SP)
(1 Demonstration X 10 Marks
Viva mark distribution:
1. Viva on activity book = 10 Marks

2.Conceptual and theoretical questions

 M.K= 15 Marks
04
 D.K= 05 Marks
50
3. Link to existing literature and critical thinking:

 M.K= 15 Marks

 D.K= 05 Marks
Total 100
 Internal Assessment Distribution of Practical Exam IInd Term End

S.No Heads Marks

Spotting/ Identification: (10 Questions X 3 Marks):
01 (Note:Minimum of one spotting should be kept mandatorily from all the 30
different heads mentioned in syllabus)

Long Case: History taking, Examination, Investigation (Order

andinterpretation), Differential Diagnosis, Provisional Diagnosis
(1 Case X 20 Marks)
d. History taking (Including communication skills) - 05 Marks 20
02
e. Examination & Order and interpretation of investigations – 10 Marks
f. Differential Diagnosis, Provisional Diagnosis, and Final diagnosis. – 05
Marks

Demonstration: Clinical examination on the simulator or a patient or

03 Simulated patient (SP) 10
(1 Demonstration X 10 Marks)
Viva mark distribution:
1. Viva on activity book = 10 Marks

2.Conceptual and theoretical questions

 M.K= 10 Marks

 D.K= 05 Marks
04 40
3. Link to existing literature and critical thinking:

 M.K= 10 Marks

 D.K= 05 Marks

Total 100
 CLINICAL ACTIVITY CONTENTS
(Index of Activity Book)
Sl. No Name of the clinical activity Page Date Instructor Remarks
No. Signature
A. Survey 5 Cases (Assessment of Dosh Vikruti) (5 cases)
1

B. Methods of Rogi Pariksha (5 cases)

1

1 to 4 ART OF HISTORY TAKING

C 1.1 Chief complaint & history of
to 1.2 present illness (2 cases)
C 2.1 Past illness & treatment history
(1 case)
C 3.1 Family history with pedigree chart,
Social history, Environmental
history, Seasonal history &
Occupational history (1 case)
C 4.1 Personal history (1 case)
5 GENERAL PHYSICAL EXAMINATION
C 5.1 A comprehensive general
to 5.2 physical Examination (2 cases)

6 COMPREHENDING SYSTEMIC INTRICACIES

C 6.1 Respiratory system examination
& 6.3 (2 cases)
C 6.2 Cardiovascular system
& 6.4 Examination (2 cases)
C 6.5 Oral & Abdominal examination
& 6.7 (2 cases)
C 6.6 Nervous system examination
& 6.8 (2 cases)
C 6.9 Musculoskeletal system
& 6.11 Examination (2 cases)
C 6.10 Integumentary systemexamination
& 6.12 (2 cases)
C 10.1 to 10.8 CASE TAKING: Case taking
(History to diagnosis & prognosis) (8 cases)
(Activity No. 7 & 8 Demontration Bedside /Simulated Cases )
Diagnosis:
Case 1
Case 2
Case 3
Case 4
Case 5
Case 6
Case 7
Case 8

Teacher’s signature
 Survey Proforma (Activity No.1)
ASSESSMENT OF DOSHA VIKRUTI
Rog-Nidan Vikruti Vigyan Department
PROFORMA CASE NO 1
Name:-
Age:- Religion:-
Sex:- Occupation:-
Residence:-
Date of examination:-

Pradhana Vedana with Kala Prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of Present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Hetu (Nidan) :-

Hetu Prakara (Type Of Nidan) :-

Vyadhi Janak Hetu:-

Agni Bheda & Vikruti:-

Dosha Vruddhi:-

Dosha Kshaya:-

Dushta Karma:-

Sansargaja:-

Sannipataja:-

Dosha Swabhava (Leena/Parichedita/):-

Paridhavamana Dosha:-

Final Assessment Of Dosha Vikruti:

Name and sign of student Sign of teacher

1
 Survey Proforma (Activity No.1)
ASSESSMENT OF DOSHA VIKRUTI
Rog-Nidan Vikruti Vigyan Department
PROFORMA CASE NO 2
Name:-
Age:- Religion:-
Sex:- Occupation:-
Residence:-
Date of examination:-

Pradhana Vedana with Kala Prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of Present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Hetu (Nidan) :-

Hetu Prakara (Type Of Nidan) :-

Vyadhi Janak Hetu:-

Agni Bheda & Vikruti:-

Dosha Vruddhi:-

Dosha Kshaya:-

Dushta Karma:-

Sansargaja:-

Sannipataja:-

Dosha Swabhava (Leena/Parichedita/):-

Paridhavamana Dosha:-

Final Assessment Of Dosha Vikruti:

Name and sign of student Sign of teacher

2
 Survey Proforma (Activity No.1)
ASSESSMENT OF DOSHA VIKRUTI
Rog-Nidan Vikruti Vigyan Department
PROFORMA CASE NO 3
Name:-
Age:- Religion:-
Sex:- Occupation:-
Residence:-
Date of examination:-

Pradhana Vedana with Kala Prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of Present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Hetu (Nidan) :-

Hetu Prakara (Type Of Nidan) :-

Vyadhi Janak Hetu:-

Agni Bheda & Vikruti:-

Dosha Vruddhi:-

Dosha Kshaya:-

Dushta Karma:-

Sansargaja:-

Sannipataja:-

Dosha Swabhava (Leena/Parichedita/):-

Paridhavamana Dosha:-

Final Assessment Of Dosha Vikruti:

Name and sign of student Sign of teacher

3
 Survey Proforma (Activity No.1)
ASSESSMENT OF DOSHA VIKRUTI
Rog-Nidan Vikruti Vigyan Department
PROFORMA CASE NO 4
Name:-
Age:- Religion:-
Sex:- Occupation:-
Residence:-
Date of examination:-

Pradhana Vedana with Kala Prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of Present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Hetu (Nidan) :-

Hetu Prakara (Type Of Nidan) :-

Vyadhi Janak Hetu:-

Agni Bheda & Vikruti:-

Dosha Vruddhi:-

Dosha Kshaya:-

Dushta Karma:-

Sansargaja:-

Sannipataja:-

Dosha Swabhava (Leena/Parichedita/):-

Paridhavamana Dosha:-

Final Assessment Of Dosha Vikruti:

Name and sign of student Sign of teacher

4
 Survey Proforma (Activity No.1)
ASSESSMENT OF DOSHA VIKRUTI
Rog-Nidan Vikruti Vigyan Department
PROFORMA CASE NO 5
Name:-
Age:- Religion:-
Sex:- Occupation:-
Residence:-
Date of examination:-

Pradhana Vedana with Kala Prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of Present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Hetu (Nidan) :-

Hetu Prakara (Type Of Nidan) :-

Vyadhi Janak Hetu:-

Agni Bheda & Vikruti:-

Dosha Vruddhi:-

Dosha Kshaya:-

Dushta Karma:-

Sansargaja:-

Sannipataja:-

Dosha Swabhava (Leena/Parichedita/):-

Paridhavamana Dosha:-

Final Assessment Of Dosha Vikruti:

Name and sign of student Sign of teacher

5
 Department of Rog-Nidan V.V.
Clinical Activity- Head No. 5
Methods Of Rogi Pariksha
Proforma CASE NO 1
Patient’s Name :-
Age :- OPD No. :-
Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration): -

Vedanasammuchraya (History of present illness) : -

Poorvavyadhi Vruttanta (History of Past illness) : -

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-

6
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशश रूपरसगन्धम-:
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha / Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata / Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)
7
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Teacher’s Signature Student’s Signature

Date :- Date :-

8
 Department of Rog-Nidan V.V.
Clinical Activity- Head No. 5
Methods Of Rogi Pariksha
Proforma CASE NO 2
Patient’s Name :-
Age :- OPD No. :-
Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration): -

Vedanasammuchraya (History of present illness) : -

Poorvavyadhi Vruttanta (History of Past illness) : -

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-

9
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशश रूपरसगन्धम-:
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha / Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata / Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)
10
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Teacher’s Signature Student’s Signature

Date :- Date

11
 Department of Rog-Nidan V.V.
Clinical Activity- Head No. 5
Methods Of Rogi Pariksha
Proforma CASE NO 3
Patient’s Name :-
Age :- OPD No. :-
Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration): -

Vedanasammuchraya (History of present illness) : -

Poorvavyadhi Vruttanta (History of Past illness) : -

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-

12
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशश रूपरसगन्धम-:
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha / Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata / Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)
13
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Teacher’s Signature Student’s Signature

Date :- Date

14
 Department of Rog-Nidan V.V.
Clinical Activity- Head No. 5
Methods of Rogi Pariksha
Proforma CASE NO 4
Patient’s Name :-
Age :- OPD No. :-
Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration): -

Vedanasammuchraya (History of present illness) : -

Poorvavyadhi Vruttanta (History of Past illness) : -

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-

15
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशश रूपरसगन्धम-:
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha / Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata / Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)
16
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Teacher’s Signature Student’s Signature

Date :- Date

17
 Department of Rog-Nidan V.V.
Clinical Activity- Head No. 5
Methods Of Rogi Pariksha
Proforma CASE NO 5
Patient’s Name :-
Age :- OPD No. :-
Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration): -

Vedanasammuchraya (History of present illness) : -

Poorvavyadhi Vruttanta (History of Past illness) : -

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-

18
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशश रूपरसगन्धम-:
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha / Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata / Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)
19
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Teacher’s Signature Student’s Signature

Date :- Date

20
 1. Activity Name: Chief complaint & history of present illness

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

21
___________________________________________________________________________

Write your inference on below mentioned points (As applicable tochief complaints and history of present illness):

Sl. Parameters to beassessed Item observed inpatient Rationality

No
1 a) Dosha vridhhi and kshaya

b) Dhatu vridhhi and kshaya

2 Sama/ Nirama Doshaavastha

3 Srotas involved

4 System/ systems involved

5 Any other

Teacher’s signature

Medical Instruments

22
 1. Activity Name: Chief complaint & history of present illness

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

23
___________________________________________________________________________

Write your inference on below mentioned points (As applicable tochief complaints and history of present illness):

Sl. Parameters to beassessed Item observed inpatient Rationality

No
1 c) Dosha vridhhi and kshaya

d) Dhatu vridhhi and kshaya

2 Sama/ Nirama Doshaavastha

3 Srotas involved

4 System/ systems involved

5 Any other

Teacher’s signature

Medical Instruments

24
 2. Activity Name: Past illness & treatment history

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala Prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana Sammuchraya (History of present illness :)

25
3. Vedana Sammuchraya (History of present illness :)

4. Chikitsa Vruttanta (Treatment history):

26
 Clinical condition **Treatment/ Surgery doneor Duration Outcome &
on-going Remarks
(If Not Applicable mentionNA)

Adverse Effects of Medicine (असात्म्यता):

Sl. Parameters to beassessed Item observed inpatient Rationality

No
1 e) Dosha vridhhi and kshaya

f) Dhatu vridhhi and kshaya

2 Sama/ Nirama Doshaavastha

3 Srotas involved

4 System/ systems involved

5 Any other

Teacher’s signature

Medical Instruments
3. Activity Name: Family history with pedigree chart, social history, environmental
27
 history, seasonal history and occupational history

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Kula vruttanta (Family history) Along with pedigree chart:

Family Member & Medical Condition *Details of the Write your inference
Relation to patient (Relevant to family medical condition with relevance to
history – common current condition of
and rare conditions) patient if applicable

28
2. Symbols for drawing Pedigree chart:

Affected by history female and male

3. Draw the Pedigree chart for the patient:

29
 4. Inference of Family/Hereditary History:

Sl. Parameters to beassessed Observations in Any relation

No familymember to the current
illness
1 Bija dushti (Specify Bija,Bija Yes/ No
bhaga, Bija bhaga avayava
dushti if
possible)

2 Adibala (Hereditary) Yes/ No

3 Janmabala (Congenital) Yes/ No

5. Samajika Vruttanta (Social history):

Areas to be enquired Observations Relevance in terms of

(Refer the above paragraph) shareerika dosha
and Manasikabhava
1
Living Situation
2
Marital/Relationship Status
3
Education
4
Social Support Network
5
Substance Use History
6
Sexual History
7
Cultural and Religious
Background
8
Hobbies and Recreational
Activities
9
Financial Status
10
Social Stressors and
Challenges
11
Other Relevant SocialFactors

6. Desha (Environmental history):

Areas to be enquired Observations Relevance in terms of

shareerika dosha
and manasika bhava

30
 1. Climate and geographical
location of Residential
area
2. Duration of stay in the
residential area with
location

3. Duration of stay (If

shiftedfrom previous
residence to a new
location - mentiondetails)
4. Travel history and
exposures related to travel

7. Kala (Seasonal):

8. Occupational history:

*Occupational history *Write Your observation Relevance to shareerika

dosha andmanasika bhava
Physical environment

Psychologicalenvironment

Teacher’s signature

31
 4. Activity Name: C 4. 1
Enquire and record about personal history.

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Vaiyaktika Vruttanta (Personal history):

a. Ahara, Agni, Koshta, Mala – Pureesha/ Bowel: Ahara: ( Tick appropriate:)
Ahara matra or Abhyavaharana shakti (Poorvakaleena) –

Heena: Madhyama: Pravara:

Ahara matra or Abhyavaharana shakti (Adyatana) –

Heena: Madhyama: Pravara:

Most commonly consumed Identify the predominant Write your Write

food items Rasa, Guna and classify in your inference
terms of satvika, rajasika, regarding influence
tamasa on Agni, Dosha
(Manasika and
Shareerika), and
Dushya

32
Ahara vidhi:
 Regular/Irregular;
 Interval between two consumptions…………Hrs;
 Frequency of meals per day………..

Upavasa:
 Engaging/ Not engaging. If engaging mention pattern offasting…………..
 Mention Asatmya with reference to Aahaara (If any):

Agni (*Agni bheda - Teekshna/ Manda/ Vishama/ Sama agni):

Pattern of Digestion Tick the type of agni

Even small quantity of regular meal (easily
digestible) may take longer time to digest & reduced
appetite for the next scheduled meal. Mandagni

Regular serving of meal consumed on regular

intervals gets digested normally and goodappetite for
next scheduled meal. Samagni

Regular serving size of regular meal gets digested

quickly with frequent hunger pangs &making the
person to eat at frequent intervals before next meal Teekshnagni
scheduled time. Even heavy meals get digested easily
before the nextscheduled meal time.

Irregular phase of digestion & indigestion whichmay

also be associated with regular bowel movement and
constipation. Vishamagni

Mala pravrutti – Pureesha/ Bowel:

Parameters to be Write your observation Write your inference

enquired
Frequency (Per day) ……..Per day. Sama/ Nirama
Vitiated Dosha
Consistency  Ati grathita (Knotty or
hardstool)/ Ati drava
(Watery)
 Picchila (Slimy)/
 Any other…….

33
 Colour & Appearance  Tila pishta nibha (Pale or
Clay coloured)/
 Peeta (Yellowish)/
 Shyava (Blackish)/
 Rakta (Reddish)/
 Harita (Greenish)/
 Anyother…..
Pravahika Yes/ No
(With tenesmus)
Evacuation Complete/ Incomplete (Kricchra
pureesha,
Alpapureesha, etc.)

Faecal incontinence Present/ Absent

Any other complaints Sa shoola/ Any other….

Mutra pravrutti – Micturition:

Urine characteristics Write yourobservation Write your inference on

dosha involved

Frequency at day
Frequency at night
Stream Forceful/ Weak/
Dribbling/ Split/
Spraying/ Narrow

Colour Pale yellow/ Dark

yellow/ Amber/ Brown/
Pink or
red/ Orange

Burning sensation Yes/ No

LUTS* Yes/ No
Any other

Koshta (Mridu/ Madhyama/ Krura):

Influence of mentioned items on koshta observed and other Tick the type of
features in koshta
the patient

34
 Has regular bowel movements, typicallyonce or twice daily.
Stools are either semi-formed or fully formed, making defecation
easy and requiring less time. Experiences satisfaction after bowel Mridu koshta
movements. Weak laxatives and the consumption of Ikshu,
Ksheera, Payasa,Sarpi, Draksha, and Ushna jala can easily lead to
loose stools.
Has daily bowel movements, passing formed stools with minimal
stress and taking a slightly longer time compared toa mridu
koshta. Experiences satisfaction after defecation and rarely Madhyama
encounters loose stools or hard stools. koshta

Irregular bowel movements with infrequent stool passage. Stools

are hardand dry, necessitating straining and an extended time for
defecation. Bowel clearance is unsatisfactory, and hard stool is Krura koshta
more prevalent than loose stools.Generally requires laxatives to
clear stools.

Work, Nidra, Vyasana:

Nature of work Write your observationand Inference for

inference shareerika dosha and
manasika dosha

Type of karma (Work) Shareerika/ Manasika/Vachika

*Nature of work(Refer
below)
Timing/ Duration ofwork

If shifting duties(Specify Morning/ Evening/ Night/Any

pattern) other….
Sedentary Yes/ No
Exertional Yes/ No; If Yes - Physically/
Mentally/
Both
Performs beyond or less More/ Less
than Ardha shakti
(Shareerika)**Refer
Below

35
Nidra:

Nidra Write your observationand Inference for

inference shareerika dosha andmanasika
dosha
Status of nidra Normal (Sufficient sleepand
Freshness after getting up or
not)/Excess/ Disturbed*
*If disturbed - Difficulty in getting thesleep/
Difficulty in maintaining the sleep/
Early morning awakening

Duration in hrs
per dayand night

Divasavpna Present/ Absent (If present specify

duration)

Ratri jagarana Present/ Absent (If present specify

duration)

Vyasana:

Addictions/ Duration & Dependence Inference for shareerika doshaand

Habits Quantity Yes/ No manasika dosha

Smoking

Alcohol

Tobacco
chewing
Screen time

Any Others

36
Raja pravrutti – Menstrual history:

Menstruation and Menstrualcycle Write yourobservation Inference for

characteristics shareerika dosha
Raja pravrutti - Regular/Irregular

Days of flow

Duration of cycle

Nature of flow - Quantity (E.g.No. of

Pads, or menstrual cup, etc.)

Clots, odour, etc.

Any other complaints orobservation

Obstetric History (Mention G P L A D with details of delivery andcomplications, if any):

G - Gravida, P - Parity, L - Living Child, A – Abortion D – Death afterlive birth

*G P L A D (Write as sub script here. Ex - G3 P1 L1A2D0)

Delivery Mode of delivery (Normal Post-partum complication

(First/Second/ etc.) vaginal/ Forceps/LSCS) (Yes/ No; If Yes elaborate)

37
Write inference based on your observation:

Manasika bhava (Emotional makeup): *(Write the manasika bhava experienced by the
patient such as Shoka, Chinta, Bhaya, Dvesha, Krodha, Lobha, Mada, or any other)

*Manasika bhava (Emotion) Write your inference (Regarding manasikadosha affected)

experiencedby the patient

Vegadharana: Present/ Absent (If present, specify with durationand frequency)

Any other relevant information to be furnished in personal history:

Teacher’s signature

38
 4. Activity Name: C 4. 1
SERIAL NO: 5 CLINICAL NO: C 5.1 & 5.2
A comprehensive general physical examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

General physical examination:

Sangya jnana (Consciousness):

Write the observations on Sangya Write your inference

jnana (Consciousness) –
Subjectiveassessment

Vitals:

Pulse examination/ Nadi pareeksha:Site:

Parameters to be Write the observationson Write your inference

examined Pulse (Regarding dosha involved)
Palpable Yes/ No
Rate ……. Per minute(Tachycardia/
Bradycardia)
Rhythm Regular/ Irregular (If
irregular – Regularly
irregular, Irregularlyirregular)
Character Water-Hammer Pulse
(Corrigan's Pulse)/ Pulsus
Parvus et Tardus/ Any
other……..
Predominant Dosha Hin Madhya Avar

1. Vaat

39
 2. Pitta

3. Kapha

Collective Observation

Heart rate: *(Furnish details on rate and rhythm)

Parameters to beassessed *Write the observations Inference

Heart rate
Rhythm

Blood pressure:

Patient position Write the observationson Write your inference

Blood pressure (Palpatory (Normotensive/
and Hypertensive/
Auscultatory method) Hypotensive)
Supine
Sitting
Standing

Temperature:

Site of measurement Time of Temperaturein Write your inference

measurement Celsius or (Low grade,
Fahrenheit Moderate
grade, High grade)

Respiratory rate:

Write the observations on Respiratory Write your inference (Tachypnoea,

rate (per minute) Bradypnea)

Observe for Pallor, Icterus and Cyanosis. Write your inferencebelow:

Pallor (Pandutvam):

40
 Site Pallor (Yes/No) Write your inference
Palpebral
conjunctiva

Lips

Oral mucosa

Tongue

Face

Skin (Palm/ Sole/

General)

Nails

Icterus (Peeta mukha, netra, tvak):

Site Icterus (Yes/No) Write your inference

Sclera

Oral cavity

Sublingual
mucosa
Skin (Palm/ Sole/
General)

Nails

Cyanosis (Central and Peripheral) (Shyava varna):

41
 Site Cyanosis (Yes/No) Write your inference
Nose tip
(Central)

Lips (Central)

Tongue (Central)

Finger/ Toe tip

(Peripheral)

Nails
(Peripheral)

Peripheral parts
of body
(Peripheral)

Nakha pareeksha (Examination of nail & nail bed):

Parameters to be observed Write your observations and inference (Eg: Rough

nails indicate rookshata, Shinynails indicate snigdhata,
etc.)
Nail clubbing (With grade)

Spooning of nail (Koilonychia)

Brittleness and crumbling

Colour of the nail bed

Capillary refill of nail bed

Tenderness of nail bed

Shareera pramana, Akriti, Samhanana, Sara and other features (Height, Weight, Body
Mass Index, Built, Nutrient deficiency):

42
Parameter to be Observation Inference
assessed
Shareera pramana
*Height (Refer above) Deergha/ Hrsva/ Prakruta
Weight (Weight in Ati sthoulya/ Atikrisha
Kilograms
Body Mass Index Ati sthoulya/ Atikrisha
(Refer BMI Chart
below)* Formula: Weight (kg) /
Height (m)2
(BMI) calculation.

Ati sthoulya/
Atikrisha
Akriti - Built - Ati sthoulya/ Atikrisha
Endomorphic,
ectomorphic, and
mesomorphic

Nourishment status
Muscle bulk (Left mid Over nourished/ Well-
upper arm nourished/ Under nourished
circumference in
centimetres)

Subcutaneous fat
thickness (Triceps skin
fold thickness ofmid
arm in
millimetres)

Macronutrient Absent/ Present (If present

deficiency (Protein/ specify)
Carbohydrate/ Fat)

Micronutrient (Vitamin Absent/ Present (If present

& Mineral specify)
deficiency)

43
Sparsha pareeksha:Oedema (Shotha):

*Site of Observation Darshana – Observation Write your inferencein

oedema Inspection Sparshana – terms of dosha and
examined Palpation dushya
(Refer
above)

Visible swelling –Present/ Consistency –Firm/

Absent Soft

Symmetry – Symmetrical/ Temperature –

Asymmetrical Normal/ Altered(If
altered
mention)

Skin colour – Normal/

Altered (If altered Tenderness –
mention)……. Present/ Absent

Pitting/ Non –
pitting oedema

Circumference
……..

Features to be observed for shotha in Tick the type of shotha

patient
The migrating pitting oedema, primarily
localized in the lower extremities, amplifies
throughout the day (diva bali), yet Vataja
significantlydiminishes by night.

44
The non-pitting or slowly pitting oedema,
predominantly affecting the upper body,
notably the face, escalates during the night Kaphaja
(ratri bali), reaching its peak visibility in the
early morning hours, and gradually
diminishes as theday progresses.
The swiftly advancing localized edema
exhibits diverse hues like brown, reddish,
coppery red, or black. It presents warmth, Pittaja
tenderness upon touch, and intense burning
sensations. Occasionally, systemic
indications hint at potential suppuration.

Lymphadenopathy:

*Site/ ** Write the ** Write the Write your inference

Lymph observations on observations on (Include comments on
node Lymph node Lymph node involvement of drainage
examined Examination – Examination – areas of respective node if
(Refer 1Darshana – 2Sparshana – involved)
above) Inspection; Palpation

Visible swelling – Tenderness –

Present/ Absent Present/ Absent
Symmetry – Consistency –
Symmetrical/ Firm/ Soft/
Asymmetrical Rubbery/ Hard
Size (Measure
using finger
breadth or
measuring tape
or callipers) –

Mobility – Freely
movable/Fixed

45
Shabdha pareeksha – Examining voice and speech of patient:
Parameter Observation Inference
Voice Prakruta/ Vaikruta
Speech Prakruta/ Vaikruta
Dosha assessment (Kapha -
Guru; Pitta - Sphuta (broken,
split); Vata - Khara, Parusha)

Jihwa pareeksha (Tongue examination):

*(Varna – Pandu, Rakta, Haridra, Harita, Krishna, Neela, Shweta;Pramana – Tanu,

Sama, Sandra; Upalepa; Chalana)

Parameters *Write the observations on Write your inference

Jihwa
Colour

Contour and size

Coating

Appearance

Dosha assessment (Vata - Khara

sparsha, sphutita, Sheeta; Pitta –
Raktashyama varna; Kapha -
Shweta, Atipicchila)

Jugular Venous Pressure (JVP): Present/Absent (If presentmention in centimetres):

Mention the height of JVP on diagram

above sternum

Any other relevant information to be

furnished in general physical
examination:

Teacher’s signature

46
 4. Activity Name: C 4. 1
SERIAL NO: 5 CLINICAL NO: C 5.1 & 5.2
A comprehensive general physical examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

General physical examination:

Sangya jnana (Consciousness):

Write the observations on Sangya Write your inference

jnana (Consciousness) –
Subjectiveassessment

Vitals:

Pulse examination/ Nadi pareeksha:Site:

Parameters to be Write the observationson Pulse Write your inference

examined (Regarding dosha involved)
Palpable Yes/ No
Rate ……. Per minute(Tachycardia/
Bradycardia)
Rhythm Regular/ Irregular (If
irregular – Regularly
irregular, Irregularlyirregular)
Character Water-Hammer Pulse
(Corrigan's Pulse)/ PulsusParvus
et Tardus/ Any
other……..
Predominant Dosha Hin Madhya Avar

1. Vaat

47
 2. Pitta

3. Kapha

Collective
Observation

Heart rate: *(Furnish details on rate and rhythm)

Parameters to beassessed *Write the observations Inference

Heart rate
Rhythm

Blood pressure:

Patient position Write the observationson Write your inference

Blood pressure (Palpatory (Normotensive/
and Hypertensive/
Auscultatory method) Hypotensive)
Supine
Sitting
Standing

Temperature:

Site of measurement Time of Temperaturein Write your inference

measurement Celsius or (Low grade,
Fahrenheit Moderate
grade, High grade)

Respiratory rate:

Write the observations on Respiratory Write your inference (Tachypnoea,

rate (per minute) Bradypnea)

Observe for Pallor, Icterus and Cyanosis. Write your inferencebelow:

Pallor (Pandutvam):

48
 Site Pallor (Yes/No) Write your inference
Palpebral
conjunctiva

Lips

Oral mucosa

Tongue

Face

Skin (Palm/ Sole/

General)

Nails

Icterus (Peeta mukha, netra, tvak):

Site Icterus (Yes/No) Write your inference

Sclera

Oral cavity

Sublingual
mucosa
Skin (Palm/ Sole/
General)

Nails

49
Cyanosis (Central and Peripheral) (Shyava varna):

Site Cyanosis (Yes/No) Write your inference

Nose tip
(Central)

Lips (Central)

Tongue (Central)

Finger/ Toe tip

(Peripheral)

Nails
(Peripheral)

Peripheral parts
of body
(Peripheral)

Nakha pareeksha (Examination of nail & nail bed):

Parameters to be observed Write your observations and inference (Eg: Rough

nails indicate rookshata, Shinynails indicate snigdhata,
etc.)
Nail clubbing (With grade)

Spooning of nail (Koilonychia)

Brittleness and crumbling

Colour of the nail bed

Capillary refill of nail bed

Tenderness of nail bed

50
Shareera pramana, Akriti, Samhanana, Sara and other features (Height, Weight, Body
Mass Index, Built, Nutrient deficiency):

Parameter to be Observation Inference

assessed
Shareera pramana
*Height (Refer above) Deergha/ Hrsva/ Prakruta
Weight (Weight in Ati sthoulya/ Atikrisha
Kilograms
Body Mass Index Ati sthoulya/ Atikrisha
(Refer BMI Chart
below)* Formula: Weight (kg) /
Height (m)2
(BMI) calculation.

Ati sthoulya/
Atikrisha
Akriti - Built - Ati sthoulya/ Atikrisha
Endomorphic,
ectomorphic, and
mesomorphic

Nourishment status
Muscle bulk (Left mid Over nourished/ Well-
upper arm nourished/ Under nourished
circumference in
centimetres)
Subcutaneous fat
thickness (Triceps skin
fold thickness ofmid
arm in
millimetres)
Macronutrient Absent/ Present (If present
deficiency (Protein/ specify)
Carbohydrate/ Fat)

Micronutrient (Vitamin Absent/ Present (If present

& Mineral specify)
deficiency)

51
Sparsha pareeksha:Oedema (Shotha):

*Site of Observation Darshana – Observation Write your inferencein

oedema Inspection Sparshana – terms of dosha and
examined Palpation dushya
(Refer
above)

Visible swelling –Present/ Consistency –Firm/

Absent Soft

Symmetry – Symmetrical/ Temperature –

Asymmetrical Normal/ Altered(If
altered
mention)

Skin colour – Normal/

Altered (If altered Tenderness –
mention)……. Present/ Absent

Pitting/ Non –
pitting oedema

Circumference
……..

Features to be observed for shotha in Tick the type of shotha

patient
The migrating pitting oedema, primarily
localized in the lower extremities, amplifies
throughout the day (diva bali), yet Vataja
significantlydiminishes by night.
The non-pitting or slowly pitting oedema,
predominantly affecting the upper body,
notably the face, escalates during the night Kaphaja
(ratri bali), reaching its peak visibility in the
early morning hours, and gradually
diminishes as theday progresses.

52
 The swiftly advancing localized edema
exhibits diverse hues like brown, reddish,
coppery red, or black. It presents warmth, Pittaja
tenderness upon touch, and intense burning
sensations. Occasionally, systemic
indications hint at potential suppuration.

Lymphadenopathy:

*Site/ ** Write the ** Write the Write your inference

Lymph observations onLymph observations on (Include comments on
node node Examination – Lymph node involvement of drainage
examined 1Darshana – Examination – areas of respective node if
(Refer Inspection; 2Sparshana – involved)
above) Palpation

Visible swelling – Tenderness –

Present/ Absent Present/ Absent

Symmetry – Consistency –
Symmetrical/ Firm/ Soft/
Asymmetrical Rubbery/ Hard

Size (Measure
using finger
breadth or
measuring tape
or callipers) –

Mobility – Freely
movable/Fixed

Shabdha pareeksha – Examining voice and speech of patient:

Parameter Observation Inference

Voice Prakruta/ Vaikruta
Speech Prakruta/ Vaikruta
Dosha assessment (Kapha -
Guru; Pitta - Sphuta (broken,
split); Vata - Khara, Parusha)

53
Jihwa pareeksha (Tongue examination):

*(Varna – Pandu, Rakta, Haridra, Harita, Krishna, Neela, Shweta;Pramana – Tanu,

Sama, Sandra; Upalepa; Chalana)

Parameters *Write the observations on Write yourinference

Jihwa
Colour

Contour and size

Coating

Appearance

Dosha assessment (Vata -

Khara sparsha, sphutita,
Sheeta; Pitta - Raktashyama
varna; Kapha - Shweta, Ati
picchila)

Jugular Venous Pressure (JVP): Present/Absent (If presentmention in centimetres):

Mention the height of JVP on diagram

above sternum

Any other relevant information to be

furnished in general physical
examination:

Teacher’s signature

54
 SERIAL NO: 6 CLINICAL NO: C 6.1
Activity Name: Respiratory system examination

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):

55
8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara:

b. Agni:

c. Koshta:

d. Mala – Pureesha/ Bowel):

e. Mutra pravrutti:

f. Nidra:

g. Vyasana:

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:
Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:
Pallor: Icterus: Cyanosis:
Oedema (Shotha): Lymphadenopathy:
Height: meter/cm; Weight: Kg; Body Mass Index:
General Built (Akruiti):
Nutrient deficiency:
Respiratory system examination:

*Site of *Observations Inference

examination
Nasa pareeksha

Gal
Talu
Kandh
Gilayu
Other

56
Shape of chest: Normal/ Abnormal ……..

Antero-posterior diameter of Chest:……Transverse diameter of Chest:……

1Mention shape of chest Sahaja/ Jataja Inference

(Refer above)

2Harrison’s sulcus(Present/ Inference

Absent)

3Trail’s sign (Present/Absent) Inference

4Apex beat (Observed/Not Inference

observed) If observed
approximate
location

Symmetry of chest: Symmetrical/ AsymmetricalRespiratory movements:

Respiratory movements: Equal/ Diminished Right/ Left
Movement of accessory respiratory muscle:

*Name of *Movement Present/Absent Inference (**Mention the outcome

Accessory of laboured breathing)
respiratory
muscle

Nishteevana (Examination of sputum):

Mention features ofnishteevana Observation Inference

Character - Shushkakapha, Sa kapha (If
kapha present - Tanu Kapha, Ghana
Kapha,Alpa kapha)
Colour - Peeta nishteevana, Raktayukta
kapha, Harita kapha, Puyopama kapha
Consistency - Alpatam vrajet (Non –

57
 sticky and little), Krcchran muktva (thick
tenacious sputum),Snigdha kapha
Odour - Durgandhayukta kapha (As per
patient’s statement)
Special observations - Poorva kaasate
sushkam tat shteevate sa shonitam,
Shleshma aavruta mukhasrota kapha
(frothy sputum)
Any other -

Sl.No Parameters to be Item observed in Rationality

assessed patient
1 Dosha – Anubandhya
andAnubandha dosha
2 Sama/ Nirama Dosha
Avastha

Sparshana pareeksha of Kantha and Uras - Palpation:

 Position of trachea: Central/ Deviated ----- Right/ Left............
 Expansion of the chest --------------------------- cms
 Movement of the chest: Equal/ Diminished
 Tenderness: Absent/ Present (If present mention the location)
 Tactile vocal fremitus: Present/ Absent
Shabdha prakshobha pareeksha - Percussion:

Shrotrendriyataha pareeksha - Auscultation: (Breath sounds):

Breath Sounds Audible /Not Unilateral/Bilateral Observation

Audible (Specify area) with
interpretation
Vesicular

Bronchial

Bronchovesicular

58
Added sounds: (Crackle/Crepitation, wheeze or rhonchi Plural Rub etc.)

Unilateral/ Audible/ Inspiratory Expiratory Both Observation with

Bilateral Not (Early/ Late) Interpretation
(Specify Audible (Intensity and
area) Character)
Left Lung

Right Lung

Voice sounds:

Voice Sounds Audible/ Not Unilateral/ Observation with interpretation

Audible Bilateral
Bronchophony

Aegophony

Whispering
pectoriloquy

Summarise your observations:

11. Investigations (Available reports and suggested
investigations):

12.Differential diagnosis/ 7:

13.Vyadhi vinischaya (Diagnosis):

59
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:
 Primary srotas

60
 Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Respiratory Exam: Resp

Sound System

61
 SERIAL NO: 6 CLINICAL NO: C 6.3
Activity Name: Respiratory system examination

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):

62
8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara:

b. Agni:

c. Koshta:

d. Mala – Pureesha/ Bowel):

e. Mutra pravrutti:

f. Nidra:

g. Vyasana:

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:
Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:
Pallor: Icterus: Cyanosis:
Oedema (Shotha): Lymphadenopathy:
Height: meter/cm; Weight: Kg; Body Mass Index:
General Built (Akruiti):
Nutrient deficiency:
Respiratory system examination:

*Site of *Observations Inference

examination
Nasa pareeksha

Gal
Talu
Kandh
Gilayu
Other

63
Shape of chest: Normal/ Abnormal ……..

Antero-posterior diameter of Chest:……Transverse diameter of Chest:……

1Mention shape of chest Sahaja/ Jataja Inference

(Refer above)

2Harrison’s sulcus(Present/ Inference

Absent)

3Trail’s sign (Present/Absent) Inference

4Apex beat (Observed/Not Inference

observed) If observed
approximate
location

Symmetry of chest: Symmetrical/ AsymmetricalRespiratory movements:

Respiratory movements: Equal/ Diminished Right/ Left
Movement of accessory respiratory muscle:

*Name of *Movement Present/Absent Inference (**Mention the outcome

Accessory of laboured breathing)
respiratory
muscle

Nishteevana (Examination of sputum):

Mention features ofnishteevana Observation Inference

Character - Shushkakapha, Sa kapha (If
kapha present - Tanu Kapha, Ghana
Kapha,Alpa kapha)
Colour - Peeta nishteevana, Raktayukta
kapha, Harita kapha, Puyopama kapha
Consistency - Alpatam vrajet (Non –

64
 sticky and little), Krcchran muktva (thick
tenacious sputum),Snigdha kapha
Odour - Durgandhayukta kapha (As per
patient’s statement)
Special observations - Poorva kaasate
sushkam tat shteevate sa shonitam,
Shleshma aavruta mukhasrota kapha
(frothy sputum)
Any other -

Sl.No. Parameters to be Item observed inpatient Rationality

assessed
1 Dosha – Anubandhya and
Anubandha dosha
2 Sama/ Nirama Dosha
Avastha

Sparshana pareeksha of Kantha and Uras - Palpation:

 Position of trachea: Central/ Deviated ----- Right/ Left............
 Expansion of the chest --------------------------- cms
 Movement of the chest: Equal/ Diminished
 Tenderness: Absent/ Present (If present mention the location)
 Tactile vocal fremitus: Present/ Absent
Shabdha prakshobha pareeksha - Percussion:

Shrotrendriyataha pareeksha - Auscultation: (Breath sounds):

Breath Sounds Audible /Not Unilateral/Bilateral Observation

Audible (Specify area) with
interpretation
Vesicular

Bronchial

Bronchovesicular

65
Added sounds: (Crackle/Crepitation, wheeze or rhonchi Plural Rub etc.)

Unilateral/ Audible/ Inspiratory Expiratory Both Observation with

Bilateral Not (Early/ Late) Interpretation
(Specify Audible (Intensity and
area) Character)
Left Lung

Right Lung

Voice sounds:

Voice Sounds Audible/ Not Unilateral/ Observation with interpretation

Audible Bilateral
Bronchophony

Aegophony

Whispering
pectoriloquy

Summarise your observations:

11. Investigations (Available reports and suggested
investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

66
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:
 Primary srotas

67
 Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Respiratory Exam: Resp

Sound System

68
 SERIAL NO: 6 CLINICAL NO: C 6.2
Activity Name: Cardiovascular system examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):
8. Occupational history:

69
9. Vaiyaktika Vruttanta (Personal history):

a. Ahara:

b. Agni:

c. Koshta:

d. Mala – Pureesha/ Bowel):

e. Mutra pravrutti:

f. Nidra,:

g. Vyasana:

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:

Pulse:

Nakha pareeksha:

Blood Pressure:

Jihwa pareeksha (Tongue examination):

Jugular Venous Pressure (JVP): Present/Absent:

Pallor: Icterus: Cyanosis:

Oedema (Shotha): Lymphadenopathy:

Height: meter/cm; Weight: Kg; Body Mass Index:

General Built (Akruiti):

Nutrient deficiency:

Darshana Pareeksha - Inspection:

70
 Features to beobserved Observation Inference
Precordial bulge

Location of apeximpulse

Double apical beat

Neck pulsation

Sparshanendriyataha pareeksha - Palpation:

Feature to beexamined Observation Inference

Location of apex beat Not palpable/ Palpable (If

palpable mention the
Intercostal space)

Thrills Present/ Absent

Shabdha prakshobha pareeksha - Percussion:

Shrotrendriyataha pareeksha - Auscultation:

Feature to be examined with observation Inference

Heart Rate & Rhythm
Intensity of S1
Intensity of S2
Character of S1: ................. split............
(Physiological/ Pathological)
Character of S2: .................... split.........
(Physiological/ Pathological – Wide, Widefixed,
Paradoxical)

S3 and S4: Present/Absent

Gallop: Present/Absent

71
 Added sounds to be examined with Inference
observation (Specify area)

Ejection clicks: Present/Absent

Opening snaps: Present/Absent
Murmurs (Daraa – Dara darika): Intensity Pitch Manoeuvres
*Present/Absent *(If present answer
below)
*Systolic murmur - Pan systolic, Long
systolic/Early systolic, Mid systolic,
Latesystolic: Present/ Absent
*Diastolic murmur - Early diastolic,
Middiastolic, Pre systolic

Continuous murmur: Present/ Absent

Carey Coombs murmur: Present/

Absent

Austin Flint murmur: Present/ Absent

Summarise your observations:

11. Investigations (Available reports and suggested
investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

72
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava

73
 Srotas:
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti
Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda
Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Exam: CVS

Heart Sounds

74
 SERIAL NO: 6 CLINICAL NO: C 6.4
Activity Name: Cardiovascular system examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):

75
8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:

Pulse:

Nakha pareeksha:

Blood Pressure:

Jihwa pareeksha (Tongue examination):

Jugular Venous Pressure (JVP): Present/Absent:

Pallor: Icterus: Cyanosis:

Oedema (Shotha): Lymphadenopathy:

Height: meter/cm; Weight: Kg; Body Mass Index:

General Built (Akruiti):

Nutrient deficiency:

76
Darshana Pareeksha - Inspection:

Features to beobserved Observation Inference

Precordial bulge

Location of apeximpulse

Double apical beat

Neck pulsation

Sparshanendriyataha pareeksha - Palpation:

Feature to beexamined Observation Inference

Location of apex beat Not palpable/ Palpable (If

palpable mention the
Intercostal space)

Thrills Present/ Absent

Shabdha prakshobha pareeksha - Percussion:

Shrotrendriyataha pareeksha - Auscultation:

Feature to be examined with observation Inference

Heart Rate & Rhythm
Intensity of S1
Intensity of S2
Character of S1: ................. split............
(Physiological/ Pathological)
Character of S2: .................... split.........
(Physiological/ Pathological – Wide, Widefixed,
Paradoxical)

S3 and S4: Present/Absent

Gallop: Present/Absent

77
 Added sounds to be examined with Inference
observation (Specify area)

Ejection clicks: Present/Absent

Opening snaps: Present/Absent
Murmurs (Daraa – Dara darika): Intensity Pitch Manoeuvres
*Present/Absent *(If present answer
below)
*Systolic murmur - Pan systolic, Long
systolic/Early systolic, Mid systolic,
Latesystolic: Present/ Absent
*Diastolic murmur - Early diastolic,
Middiastolic, Pre systolic

Continuous murmur: Present/ Absent

Carey Coombs murmur: Present/

Absent

Austin Flint murmur: Present/ Absent

Summarise your observations:

11. Investigations (Available reports and suggested
investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

78
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava

79
 Srotas:
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Exam: CVS

Heart Sounds

80
SERIAL NO: 6 CLINICAL NO: C 6.5
Activity Name: Oral & Abdominal examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

81
7. Kala (Seasonal):

8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:
Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:
Pallor: Icterus: Cyanosis:
Oedema (Shotha): Lymphadenopathy:
Height: meter/cm; Weight: Kg; Body Mass Index:
General Built (Akruiti):
Nutrient deficiency:

82
Oral examination:
 Aushtha: (Lips):-

 Jihvwa: (Tounge)

 Danta (Teeth)

 Danta-Veshtan (Gums)

Per abdominal examination:

Udara akriti (Shape of the abdomen):

Feature to be inspected for Observation Inference

1
Udara akriti

2
Nabhi pareeksha

3
Sira santhata Present/ Absent

4
Raji janma Present/ Absent

5
Varna Normal/ Abnormal

Movement of the differentparts Present/ Absent

of the abdomen

Visible pulsation Present/ Absent

Divarication of rectus Present/ Absent

abdominis

Scars and sinuses Present/ Absent

Visible mass Present/ Absent

Sister Mary Joseph nodule Present/ Absent

83
 6
Visible peristalsis Present/ Absent

7
Antra vruddhi Visible/ Not visible

Size of the abdomen:

Sparshanendriyataha Pareeksha:

Palpation Observation Inference

Sparsha asahata -Tenderness Present/ Absent

Ashaya vruddhi – Present/ Absent

Organomegaly. (If
organomegaly present
answer for below)

Yakrut vruddhi - Liver Size………..

Surface: Regular/
Irregular

Basti vruddhi - Kidney Right/ Left

Pleeha vruddhi - Spleen Not palpable/Palpable

Mootra ashaya vruddhi - Not palpable/Palpable

Urinary bladder

Mark and mention the observations regarding palpation on the diagramgiven below:

84
Shabdha Prakshobha Pareeksha (Akothan)– Percussion:

Per Abdominal -Percussion Observation Yes/ No Inference

note (If Yes specify area)
Hyper resonant

Resonant

Dull

Stony dull

Special test for ascites:

Special test for ascites - Observation Inference

Percussion
Puddle sign Present/ Absent

Shifting dullness - Udaka Present/ Absent

poorna druti shabdha

Horseshoe-shaped dullness Present/ Absent

- Udaka poorna drutishabdha

Fluid thrill - Udaka poorna Present/ Absent

druti sparsha

Mark and mention the observations regarding percussion on the diagramgiven below:
Shrotrendriyataha pareeksha – Auscultation:

Auscultation Observation Inference

Bowel sounds If Yes, mention number
per minute

Succussion splash over Present/ Absent

abdomen

Arterial bruits/ venoushums Present/ Absent

85
Summarise your observations:

11. Investigations (Available reports and suggested

investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

14.Samprapti ghataka (Samprapti ghataka of the

patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

86
 /Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

87
Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Teacher’s signature

Oral Cavity Exam:

Adominal

88
SERIAL NO: 6 CLINICAL NO: C 6.7
Activity Name: Oral & Abdominal examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):

89
8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:

Pulse:

Nakha pareeksha:

Blood Pressure:

Jihwa pareeksha (Tongue examination):

Jugular Venous Pressure (JVP): Present/Absent:

Pallor: Icterus: Cyanosis:

Oedema (Shotha): Lymphadenopathy:

Height: meter/cm; Weight: Kg; Body Mass Index:

General Built (Akruiti):

Nutrient deficiency:

90
Oral examination:
 Aushtha: (Lips):-

 Jihvwa: (Tounge)

 Danta (Teeth)

 Danta-Veshtan (Gums)

Per abdominal examination:

Udara akriti (Shape of the abdomen):

Feature to be inspected for Observation Inference

1
Udara akriti

2
Nabhi pareeksha

3
Sira santhata Present/ Absent

4
Raji janma Present/ Absent

5
Varna Normal/ Abnormal

Movement of the differentparts Present/ Absent

of the abdomen

Visible pulsation Present/ Absent

Divarication of rectus Present/ Absent

abdominis

Scars and sinuses Present/ Absent

Visible mass Present/ Absent

Sister Mary Joseph nodule Present/ Absent

91
 6
Visible peristalsis Present/ Absent

7
Antra vruddhi Visible/ Not visible

Size of the abdomen:

Sparshanendriyataha Pareeksha:

Palpation Observation Inference

Sparsha asahata -Tenderness Present/ Absent

Ashaya vruddhi – Present/ Absent

Organomegaly. (If
organomegaly present
answer for below)

Yakrut vruddhi - Liver Size………..

Surface: Regular/
Irregular

Basti vruddhi - Kidney Right/ Left

Pleeha vruddhi - Spleen Not palpable/Palpable

Mootra ashaya vruddhi - Not palpable/Palpable

Urinary bladder

Mark and mention the observations regarding palpation on the diagramgiven below:

92
Shabdha Prakshobha Pareeksha (Akothan)– Percussion:

Per Abdominal -Percussion Observation Yes/ No Inference

note (If Yes specify area)
Hyper resonant

Resonant

Dull

Stony dull

Special test for ascites:

Special test for ascites - Observation Inference

Percussion
Puddle sign Present/ Absent

Shifting dullness - Udaka Present/ Absent

poorna druti shabdha

Horseshoe-shaped dullness Present/ Absent

- Udaka poorna drutishabdha

Fluid thrill - Udaka poorna Present/ Absent

druti sparsha

Mark and mention the observations regarding percussion on the diagramgiven below:
Shrotrendriyataha pareeksha – Auscultation:

Auscultation Observation Inference

Bowel sounds If Yes, mention number
per minute

Succussion splash over Present/ Absent

abdomen

Arterial bruits/ venoushums Present/ Absent

93
Summarise your observations:

11. Investigations (Available reports and suggested

investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

14.Samprapti ghataka (Samprapti ghataka of the

patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

94
 /Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

95
Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Teacher’s signature

Exam:
Oral Cavity Adominal

96
 SERIAL NO: 6 CLINICAL NO: C 6.6
Activity Name: Nervous System Examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):

97
8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):
Temp.: R/R Heart rate:
Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:
Pallor: Icterus: Cyanosis:
Oedema (Shotha): Lymphadenopathy:
Height: meter/cm; Weight: Kg; Body Mass Index:
General Built (Akruiti):
Nutrient deficiency:

1. Sangya jnana - Level of consciousness and orientation (Placeperson time):

Glasgow Coma Scale Scoring Inference

E - ;V- ;M-

98
 Orientated to Place Person andTime Inference

Yes/ No -

1. Vak indriya - Speech and language

Shabdha pareeksha – Examining voice and speech of patient:

Speech defect Contemporary Observation Inference

understanding

Mookha, Vak sangha, Aphasia Yes/ No

Jihvataleshvalasastu

Minmina Hyper nasal speech Yes/ No

Gadgada, Vak Dysarthria Yes/ No
stambha, Kala vak

Vakya graha Dysprosody Yes/ No

Svaraghna Hoarseness Yes/ No
Deena svara Dysphonia Yes/ No
Deena vak Scanning speech Yes/ No
Jihma vak Apraxia Yes/ No
Samutkshipta vak Cluttering speech Yes/ No

Cranial nerve examination (Sensory & Motor):Mention side (right and left) wherever
applicable
Cranial nerve Components to be examined Write your observation on
mentioned
components and concludewith
your inference
Olfactory nerve Gandha jnana –

Sense of olfaction………….

Optic nerve Netradeenam cha vaikrutim –

Visual acuity………..
Visual field…………
Colour vision…………..
Fundi…………

99
Oculomotor, Sthabdha Netra/ Netradeenamcha
Trochlear, Abducens vaikrutim –

Pupil size……. Symmetry……. Light

reflex…….
Consensual reflex……
Accommodation reflex……..
Ptosis………
Squint………
Nystagmus…..
Conjugate eye ballmovement…….
Diplopia (concomitant/
paralytic)………

Trigeminal nerve Vakrikaroti hanu/ Shankha/Shravana/

Ganda ruk –

Sensory part: Corneal reflex……

Others (Ophthalmic, Maxillary&
Mandibular branch
observations)…………

Motor part:
Jaw clenching…….
Lateral jaw movement……

Glabellar reflex……….
Facial nerve Vakri karoti nasa bhru lalata/ Mukham
jihmam/ Vrujati asyebhojana/
Kshavathu nigraha –

Motor part for Upper face:Raising

eye brow.......
Frowning the forehead.....
Bell’s phenomenon.............

Motor part for Lower face:

Nasolabial fold......
Clenching the teeth......
Whistling.........
Blowing the mouth.........

Taste sensation (Anterior 2/3rdof

tongue): ……………
Vestibulo cochlear Badyate shravana –
nerve
Cochlear component:Rinne’s
test…….
Weber’s test…… Hearing tests -
impression…………..
Conductive/ sensori neural/mixed
Vestibular component:Nystagmus/
calorie

100
 test:………….

Glossopharyngeal Bhidyate swara/ Mukhamjihmam –

nerve and vagus
nerve Position of uvula…………….
Taste perception (Posterior 1/3rd of
tongue)……………..
Gag reflex…………………..
Spinal accessory Upashoshya bahum –
nerve
Sternocleidomastoid
muscle…………….
Trapezius muscle……………
Hypoglossalnerve Mukham jihmam –

Wasting: Absent/ present…………..

Fasciculations: Absent/
present…………….
Deviation: Right side/ left side
Movements of tongue: Normal/
abnormal………….
Power of tongue……………
Summary
Affected nerve Sensory Motor

101
Karmendriya pareeksha/ Chesta - Motor system examination (Specify site examined
with side of body wherever applicable):

Limb Muscle bulk (Mention Normal/ Atrophy Inference

the side and site of (Anga shosha)/
measurement along Hypertrophy/
with comparing side) Pseudohypertrophy

Upper limbs
(Arm/ Fore
arm)
Lower limbs
(Thigh/ Calf)

*Muscle power grading chart:

Muscle Actitity
power
Grade
0 no muscle contraction visible
1 muscle contraction visible, but no movement
of joint
2 joint movement with gravity elimination
3 movement sufficient to overcome gravity
4 movement overcomes gravity with added
resistance
5 normal power with full resistance Muscle power Grade

Limb Location for examining Mention Inference

Muscle power with side Muscle power
grading*

Upper limbs

Lower limbs

102
Assess the muscle tone of various sites with observation and yourinference

Limb Location for Mention Muscle tonetype Inference

examining (Normotonic/ Hypotonic or
Muscle tone flaccid (Shaithilya)/
Hypertonic (Sankocha) –
Clasp knife, Lead pipe, Cog-
wheel)
Upper limbs

Lower limbs

Reflexes: hyperreflexia/ hyporeflexia – Shareera dhatu vyuhakara,sandhanakara

shareerasya:
Assess the reflexes of various sites with observation and yourinference. Mention grades of
reflex –
Type of Response Grade
Very brisk, with clonus (rhythmic 4
oscillations between flexion and extension)
Brisker than average; possibly but not 3
necessarily indicative of disease
(hyperactive)
Average; normal 2
Somewhat diminished, or requires 1
reinforcement (hypoactive)
Reflex absent 0

Reflex Observation (Hyper- Inference

reflexia/ Hypo-reflexia/Areflexia)

Deep tendon reflexes

Biceps jerk
Triceps jerk
Supinator jerk
Jaw jerk

103
 Knee jerk
Ankle jerk
Superficial reflexes
Cremasteric reflex
Babinski sign
Abdominal reflex

Kampa/ Vepathu – Involuntary movements - Absent/ Present (IfPresent mention details

below):

Rhythmic Absent/ Present – Resting

tremor
Non rhythmic Absent/ Present – Intention
tremor/ Chorea/ Athetosis/
Ballismus/ Hemiballismus/
Myoclonus/ Asterixis

Anga gati pareeksha/ Skalita gati pareeksha - Co-ordination assessment tests:

Name of test/condition Coordination Inference

Present/
Absent

Rapid alternating Rapid alternating

movements movements of arms
Finger tapping (Index
finger and Thumb)
Rapid alternating
movements of foot
(Touching ball of foot
with arms)

Point to point Finger nose test

movements Heel to shin test
Gait Tandem walking
Walking on toes and
heels
Hop in place
Shallow kneebending
Rising from sitting
position (without arm
support)

104
 Stance Romberg’s test

Pronator drift test

Dysdiadochokinesia Present/Absent

Gati pareeksha – Gait:

Mention type of gait observed Inference

Sparsha jnana pareeksha (Supti/ Sparsha ajnana, etc.) – Sensory system examination:
Sensation of touch:

Touch sensation Dermatome Observation Inference

Crude touch
Fine touch
Two-point discrimination

Point localization
Sensation of Pain and pressure:

Pain and pressure Dermatome Observation Inference

Pain
Pressure

Temperature sensation:

Temperature Dermatome Observation Inference

Temperature

Assess the joint position for various joints and write your observationand inference

Joint position Joint Observation Inference

105
Assess the Vibration sensation on designated sites of body and writeyour observation
and inference

Site of body Observation Inference

Assess the *Stereognosis and **Graphesthesia on designated sites ofbody and write your
observation and inference

Site of body Observation* Inference

Site of body Observation** Inference

Summarise your observations:

11. Investigations (Available reports and suggested

investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

106
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:

107
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Nervous system Cranial nerves Cerebellar Sign

108
 SERIAL NO: 6 CLINICAL NO: C 6.8
Activity Name: Nervous System Examination

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

109
7. Kala (Seasonal):

8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:

Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:

Pallor: Icterus: Cyanosis:

Oedema (Shotha): Lymphadenopathy:

Height: meter/cm; Weight: Kg; Body Mass Index:

General Built (Akruiti):

Nutrient deficiency:

110
2. Sangya jnana - Level of consciousness and orientation (Placeperson time):

Glasgow Coma Scale Scoring Inference

E - ;V- ;M-

Orientated to Place Person andTime Inference

Yes/ No -

2. Vak indriya - Speech and language

Shabdha pareeksha – Examining voice and speech of patient:

Speech defect Contemporary Observation Inference

understanding

Mookha, Vak sangha, Aphasia Yes/ No

Jihvataleshvalasastu

Minmina Hyper nasal speech Yes/ No

Gadgada, Vak Dysarthria Yes/ No
stambha, Kala vak

Vakya graha Dysprosody Yes/ No

Svaraghna Hoarseness Yes/ No
Deena svara Dysphonia Yes/ No
Deena vak Scanning speech Yes/ No
Jihma vak Apraxia Yes/ No
Samutkshipta vak Cluttering speech Yes/ No

Cranial nerve examination (Sensory & Motor):Mention side (right and left) wherever
applicable
Cranial nerve Components to be examined Write your observation on
mentioned
components and concludewith
your inference
Olfactory nerve Gandha jnana –

Sense of olfaction………….

111
Optic nerve Netradeenam cha vaikrutim –

Visual acuity………..
Visual field…………
Colour vision…………..
Fundi…………

Oculomotor, Sthabdha Netra/ Netradeenamcha

Trochlear, Abducens vaikrutim –

Pupil size……. Symmetry……. Light

reflex…….
Consensual reflex……
Accommodation reflex……..
Ptosis………
Squint………
Nystagmus…..
Conjugate eye ballmovement…….
Diplopia (concomitant/
paralytic)………

Trigeminal nerve Vakrikaroti hanu/ Shankha/Shravana/

Ganda ruk –

Sensory part: Corneal reflex……

Others (Ophthalmic, Maxillary&
Mandibular branch
observations)…………

Motor part:
Jaw clenching…….
Lateral jaw movement……

Glabellar reflex……….
Facial nerve Vakri karoti nasa bhru lalata/ Mukham
jihmam/ Vrujati asyebhojana/
Kshavathu nigraha –

Motor part for Upper face:Raising

eye brow.......
Frowning the forehead.....
Bell’s phenomenon.............

Motor part for Lower face:

Nasolabial fold......
Clenching the teeth......
Whistling.........
Blowing the mouth.........

Taste sensation (Anterior 2/3rdof

tongue): ……………

112
Vestibulo cochlear Badyate shravana –
nerve
Cochlear component:Rinne’s
test…….
Weber’s test…… Hearing tests -
impression…………..
Conductive/ sensori neural/mixed
Vestibular component:Nystagmus/
calorie
test:………….
Glossopharyngeal Bhidyate swara/ Mukhamjihmam –
nerve and vagus
nerve Position of uvula…………….
Taste perception (Posterior 1/3rd of
tongue)……………..
Gag reflex…………………..
Spinal accessory Upashoshya bahum –
nerve
Sternocleidomastoid
muscle…………….
Trapezius muscle……………
Hypoglossalnerve Mukham jihmam –

Wasting: Absent/ present…………..

Fasciculations: Absent/
present…………….
Deviation: Right side/ left side
Movements of tongue: Normal/
abnormal………….
Power of tongue……………
Summary
Affected nerve Sensory Motor

113
Karmendriya pareeksha/ Chesta - Motor system examination (Specify site examined
with side of body wherever applicable):

Limb Muscle bulk (Mention Normal/ Atrophy Inference

the side and site of (Anga shosha)/
measurement along Hypertrophy/
with comparing side) Pseudohypertrophy

Upper limbs
(Arm/ Fore
arm)
Lower limbs
(Thigh/ Calf)

*Muscle power grading chart:

Muscle Actitity
power
Grade
0 no muscle contraction visible
1 muscle contraction visible, but no movement
of joint
2 joint movement with gravity elimination
3 movement sufficient to overcome gravity
4 movement overcomes gravity with added
resistance
5 normal power with full resistance Muscle power Grade

Limb Location for examining Mention Inference

Muscle power with side Muscle power
grading*

Upper limbs

Lower limbs

114
Assess the muscle tone of various sites with observation and yourinference

Limb Location for Mention Muscle tonetype Inference

examining (Normotonic/ Hypotonic or
Muscle tone flaccid (Shaithilya)/
Hypertonic (Sankocha) –
Clasp knife, Lead pipe, Cog-
wheel)
Upper limbs

Lower limbs

Reflexes: hyperreflexia/ hyporeflexia – Shareera dhatu vyuhakara,sandhanakara

shareerasya:
Assess the reflexes of various sites with observation and yourinference. Mention grades of
reflex –
Type of Response Grade
Very brisk, with clonus (rhythmic 4
oscillations between flexion and extension)
Brisker than average; possibly but not 3
necessarily indicative of disease
(hyperactive)
Average; normal 2
Somewhat diminished, or requires 1
reinforcement (hypoactive)
Reflex absent 0

Reflex Observation (Hyper- Inference

reflexia/ Hypo-reflexia/Areflexia)

Deep tendon reflexes

Biceps jerk
Triceps jerk
Supinator jerk
Jaw jerk

115
 Knee jerk
Ankle jerk
Superficial reflexes
Cremasteric reflex
Babinski sign
Abdominal reflex

Kampa/ Vepathu – Involuntary movements - Absent/ Present (IfPresent mention details

below):

Rhythmic Absent/ Present – Resting

tremor
Non rhythmic Absent/ Present – Intention
tremor/ Chorea/ Athetosis/
Ballismus/ Hemiballismus/
Myoclonus/ Asterixis

Anga gati pareeksha/ Skalita gati pareeksha - Co-ordination assessment tests:

Name of test/condition Coordination Inference

Present/
Absent

Rapid alternating Rapid alternating

movements movements of arms
Finger tapping (Index
finger and Thumb)
Rapid alternating
movements of foot
(Touching ball of foot
with arms)

Point to point Finger nose test

movements Heel to shin test
Gait Tandem walking
Walking on toes and
heels
Hop in place
Shallow kneebending
Rising from sitting
position (without arm
support)

116
 Stance Romberg’s test

Pronator drift test

Dysdiadochokinesia Present/Absent

Gati pareeksha – Gait:

Mention type of gait observed Inference

Sparsha jnana pareeksha (Supti/ Sparsha ajnana, etc.) – Sensory system examination:
Sensation of touch:

Touch sensation Dermatome Observation Inference

Crude touch
Fine touch
Two-point discrimination

Point localization
Sensation of Pain and pressure:

Pain and pressure Dermatome Observation Inference

Pain
Pressure

Temperature sensation:

Temperature Dermatome Observation Inference

Temperature

Assess the joint position for various joints and write your observationand inference

Joint position Joint Observation Inference

117
Assess the Vibration sensation on designated sites of body and writeyour observation
and inference

Site of body Observation Inference

Assess the *Stereognosis and **Graphesthesia on designated sites ofbody and write your
observation and inference

Site of body Observation* Inference

Site of body Observation** Inference

Summarise your observations:

11. Investigations (Available reports and suggested

investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

118
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:

119
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Nervous system Cranial nerves Cerebellar Sign

120
 SERIAL NO: 6 CLINICAL NO: C 6.09

Activity Name: Musculoskeletal System Examination

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

121
7. Kala (Seasonal):

8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:

Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:
Pallor: Icterus: Cyanosis:
Oedema (Shotha): Lymphadenopathy: Musculo-Skeletal
Examination
Height: meter/cm; Weight: Kg;
General Built (Akruiti): Body Mass Index:

Nutrient deficiency:

122
Darshnendriyataha pareeksha – Inspection

Gati pareeksha – Gait:

Gait – Affected/ Not Affected; If affected mention the type

Mention type of gait observed Inference

Antalgic gait
Trendelenburg gait
Any other

Sl Joints Inspection
No Sandhi Sandhi Sandhi karma Sandhi
Shotha vaikalyata
(Swelling) vaivarnya/ (Prasaarana (Deformity)
Raga akuncana)
(Redness)
1 Temporomandibular

2 Shoulder

3 Elbow

4 Wrist and hand

5 Hip

6 Knee joint

7 Ankle and foot

Sparshanendriyataha pareeksha – Palpation (Mention locationand side of examination

wherever applicable):

Sl Joints Palpation
No Sandhi Shotha Sandhi ushnata Sandhi sparsha
(Swelling) (Local rise of asahanata
Temperature) (Tenderness)
1 Temporomandibular

2 Shoulder

123
 3 Elbow

4 Wrist and hand

5 Hip

6 Knee

7 Ankle and foot

Spine:

Feature to be observed *Mention the abnormality Inference

observed
Deformity *(Kyphosis/
Scoliosis/ Lordosis/
Steppingin spine; Loss
of normal curvatures at
different levels)
Gibbus

Cervical spine:

Feature to be *Mention the abnormality Inference

observed/ observed
Tests
Tenderness

Foramina compression
test
Lhermitte's sign
(Lhermitte’s
phenomenon)
Range of movements

Lumbar spine:

Feature to be *Mention the abnormality Inference

observed/ observed
Tests
Tenderness

Range of movements

124
 SLR test (Sakthnaha
kshepamnigraha):
Positive/ Negative
If SLR Test is Positive
Mention Range
Bragard’s test Lasegue’s
sign
Femoral nerve root
compression test:
(Sakthnahakshepam
nigraha): Positive/
Negative

Knee joint:

Feature to be *Mention the abnormality Inference

observed/Tests observed
Grind test

Patellar tap test

Baker’s cyst

Crepitus

Summarise your observations:

11. Investigations (Available reports and suggested

investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

125
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava

126
 Srotas:
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Joint
examinations

127
 SERIAL NO: 6 CLINICAL NO: C 6.11
Activity Name: Musculoskeletal System Examination

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

128
7. Kala (Seasonal):

8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:
Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:
Pallor: Icterus: Cyanosis:
Oedema (Shotha): Lymphadenopathy:
Height: meter/cm; Weight: Kg; Musculo-Skeletal
Examination
General Built (Akruiti): Body Mass Index:
Nutrient deficiency:

129
Darshnendriyataha pareeksha – Inspection

Gati pareeksha – Gait:

Gait – Affected/ Not Affected; If affected mention the type

Mention type of gait observed Inference

Antalgic gait
Trendelenburg gait
Any other

Sl Joints Inspection
No Sandhi Sandhi Sandhi karma Sandhi
Shotha vaikalyata
(Swelling) vaivarnya/ (Prasaarana (Deformity)
Raga akuncana)
(Redness)
1 Temporomandibular

2 Shoulder

3 Elbow

4 Wrist and hand

5 Hip

6 Knee joint

7 Ankle and foot

Sparshanendriyataha pareeksha – Palpation (Mention locationand side of examination

wherever applicable):

Sl Joints Palpation
No Sandhi Shotha Sandhi ushnata Sandhi sparsha
(Swelling) (Local rise of asahanata
Temperature) (Tenderness)
1 Temporomandibular

2 Shoulder

3 Elbow

130
 4 Wrist and hand

5 Hip

6 Knee

7 Ankle and foot

Spine:

Feature to be observed *Mention the abnormality Inference

observed
Deformity *(Kyphosis/
Scoliosis/ Lordosis/
Steppingin spine; Loss
of normal curvatures at
different levels)
Gibbus

Cervical spine:

Feature to be *Mention the abnormality Inference

observed/ observed
Tests
Tenderness

Foramina compression
test
Lhermitte's sign
(Lhermitte’s
phenomenon)
Range of movements

Lumbar spine:

Feature to be *Mention the abnormality Inference

observed/ observed
Tests
Tenderness

Range of movements
SLR test (Sakthnaha
kshepamnigraha):
Positive/ Negative

131
 If SLR Test is Positive
Mention Range
Bragard’s test Lasegue’s
sign
Femoral nerve root
compression test:
(Sakthnahakshepam
nigraha): Positive/
Negative

Knee joint:

Feature to be *Mention the abnormality Inference

observed/Tests observed
Grind test

Patellar tap test

Baker’s cyst

Crepitus

Summarise your observations:

11. Investigations (Available reports and suggested

investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

132
14.Samprapti ghataka (Samprapti ghataka of the
patient based on history taking and examination):

Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:
 Primary srotas

133
 Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda

Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

Joint
examinations

134
 SERIAL NO: 6 CLINICAL NO: C 6.10
Activity Name: Integumentary System Examination

Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):

135
8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:

Pulse:

Nakha pareeksha:

Blood Pressure:

Jihwa pareeksha (Tongue examination):

Jugular Venous Pressure (JVP): Present/Absent:

Pallor: Icterus: Cyanosis:

Oedema (Shotha): Lymphadenopathy:

Height: meter/cm; Weight: Kg; Body Mass Index:

General Built (Akruiti):

Nutrient deficiency:

136
Tvak pareeksha - Assessment of skin:
Inspection:

*Type of skin 1Colour and Size 1Configuration Arrangement Distribution

lesion pigmentation and symmetry of lesion over the
(Primary) of lesion of lesion body
surface

Vaivarnya –
Macule/ Patch
Sookshma
pidaka -
Papule
Udvrtta pidaka
- Plaque
Granthi -
Nodule
Varathi dashta
samsthana
shotha -Wheal
Sphota -
Vesicle
Vishphota –
Bullae
Putimamsa
pidaka -
Pustule
*Type of skin lesion Colour and Size Shape and Distribution over
(Secondary) pigmentation symmetry the body surface
Grushta Vrana - Erosion
Vrana - Ulcer
Daari - Fissure
Sthira cipitika - Crust
Shakala - Scale
Charmakhya –
Lichenification and
Hyperkeratinisation
Kshaya - Atrophy
Rajyo ati kandu -
Excoriation
Vruna vastu – Scar
Neelika, Mashaka – Nevus

137
 Pidaka – Comedone
Bahya Krimi pidaka -
Burrow of scabies
Sirajala – Telangiectasia
Any other

Palpation/ sensation/ deformities/ odour:

Type of skin *Palpation *Sensory *Deformity *Odour/ Srava/

lesion (Texture/ Symptoms Krimi
temperature) (Tvak
swapa/
daha)

Special tests:

Special tests Observation Inference

Candle grease sign
Auspitz’s sign
Koebner’s phenomenon
Blanch test
Nikolsky’s sign
Any other observations

Nakha pareeksha Nail:

*Features to beexamined Observation Inference

Colour
Shape
Any lesion
Nail bed: tenderness – Present/ Absent
Swelling Present/ Absent
Redness Present/ Absent

138
Kesha pareeksha - Assessment of hair:

*Features to be examined Observation Inference

Quantity
Distribution
Texture
Colour
Tick Appropriate:

Onset of Khalitya: Kalaja / Akalaja

Onset of Palitya: Kalaja / Akalaja

Summarise your observations:

11. Investigations (Available reports and suggested
investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

14.Samprapti ghataka (Samprapti ghataka of the

patient based on history taking and examination):
139
Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

140
Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda
Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

skin images; Dermatology inflammatory skin; skin lesions

141
 SERIAL NO: 6 CLINICAL NO: C 6.12
Activity Name: Integumentary System Examination
Patient information:

Age: Sex: M/ F/Others Marital status:

Education: Occupation: Religion:
Socio-economic status: Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Place of residence:

1. Pradhana Vedana with Kala prakarsha (Chief complaints with duration:)

Sr. No. Chief Complains Duration

2. Vedana sammuchraya (History of present illness :)

3. Chikitsa Vruttanta (Treatment history):

4. Kula vruttanta (Family history) Along with pedigree chart:

5. Samajika Vruttanta (Social history):

6. Desha (Environmental history):

7. Kala (Seasonal):

142
8. Occupational history:

9. Vaiyaktika Vruttanta (Personal history):

a. Ahara,

b. Agni,

c. Koshta,

d. Mala – Pureesha/ Bowel)

e. Mutra pravrutti

f. Nidra,

g. Vyasana

h. Vegadharana:

10. Obstetric and Gyanac History:

11. General Examination:

General Condition: Sangya jnana (Consciousness):

Temp.: R/R Heart rate:

Pulse:
Nakha pareeksha:
Blood Pressure:
Jihwa pareeksha (Tongue examination):
Jugular Venous Pressure (JVP): Present/Absent:

Pallor: Icterus: Cyanosis:

Oedema (Shotha): Lymphadenopathy:

Height: meter/cm; Weight: Kg; Body Mass Index:

General Built (Akruiti):

Nutrient deficiency:

143
Tvak pareeksha - Assessment of skin:
Inspection:

*Type of skin 1Colour and Size 1Configuration Arrangement Distribution

lesion pigmentation and symmetry of lesion over the
(Primary) of lesion of lesion body
surface

Vaivarnya –
Macule/ Patch
Sookshma
pidaka -
Papule
Udvrtta pidaka
- Plaque
Granthi -
Nodule
Varathi dashta
samsthana
shotha -Wheal
Sphota -
Vesicle
Vishphota –
Bullae
Putimamsa
pidaka -
Pustule
*Type of skin lesion Colour and Size Shape and Distribution over
(Secondary) pigmentation symmetry the body surface
Grushta Vrana - Erosion
Vrana - Ulcer
Daari - Fissure
Sthira cipitika - Crust
Shakala - Scale
Charmakhya –
Lichenification and
Hyperkeratinisation
Kshaya - Atrophy
Rajyo ati kandu -
Excoriation
Vruna vastu – Scar
Neelika, Mashaka – Nevus

144
 Pidaka – Comedone
Bahya Krimi pidaka -
Burrow of scabies
Sirajala – Telangiectasia
Any other

Palpation/ sensation/ deformities/ odour:

Type of skin *Palpation *Sensory *Deformity *Odour/ Srava/

lesion (Texture/ Symptoms Krimi
temperature) (Tvak
swapa/
daha)

Special tests:

Special tests Observation Inference

Candle grease sign
Auspitz’s sign
Koebner’s phenomenon
Blanch test
Nikolsky’s sign
Any other observations

Nakha pareeksha Nail:

*Features to beexamined Observation Inference

Colour
Shape
Any lesion
Nail bed: tenderness – Present/ Absent
Swelling Present/ Absent
Redness Present/ Absent

145
Kesha pareeksha - Assessment of hair:

*Features to be examined Observation Inference

Quantity
Distribution
Texture
Colour
Tick Appropriate:

Onset of Khalitya: Kalaja / Akalaja

Onset of Palitya: Kalaja / Akalaja

Summarise your observations:

11. Investigations (Available reports and suggested
investigations):

12.Differential diagnosis/ Sapekshanidana:

13.Vyadhi vinischaya (Diagnosis):

14.Samprapti ghataka (Samprapti ghataka of the

patient based on history taking and examination):
146
Dosha: Shareerika

Vriddhi / Kshaya

Samsarga / Sannipata: Sama samsarga / sannipata Or

Vishama samsarga / sannipata/ Anubandha / Anubandhya-

Dosha bheda
 Gati: Urdhva / Adha / Tiryak; Shakha

/Koshta / Marma asthi sandhi Dosha:

Manasika

 Raja / Tama

Dushya: Write Vriddhi/

shaya/

Dushti of Dhatu
 Upadhatu
 Mala
 Manas
 Indriya
 Avayava
 Srotas:
 Primary srotas
Secondary srotas

Sroto dushti lakshana:

Primary sroto dushti
Secondary sroto dushti

147
Agni: Koshtagni: Sama / ishama/ /Teekshna / Manda
Dhatwagni: Sama / Manda
Bhutagni: Sama / Manda
Ama: Koshtastha ama / Dhatugata ama /

Malarupi ama / Dosharupi ama Udbhava

sthana: Amashaya / Pakvashaya

Vyakta sthana: Sarva dehika / Sthanika

Bahya rogamarga / Madhyama rogamarga / Abhyantara rogamarga

Sadhyasadhyata (with rationality)

Student’s signature Teacher’s signature

skin images; Dermatology inflammatory skin; skin lesions

148
 SERIAL NO. 10 CLINICAL NO. 10.1

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-

Ahara (Dietary History):

Breakfast Lunch Dinner

149
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
150
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-

151
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

152
 SERIAL NO. 10 CLINICAL NO. 10.2

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-

Vayaktika Vruttanta (Personal history):-

153
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
154
 Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-
155
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

156
 SERIAL NO. 10 CLINICAL NO. 10.3

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-

157
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
158
 Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-
159
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

160
 SERIAL NO. 10 CLINICAL NO. 10.4

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-

161
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
162
 Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-
163
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

164
 SERIAL NO. 10 CLINICAL NO. 10.5

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-

165
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
166
 Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-
167
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

168
 SERIAL NO. 10 CLINICAL NO. 10. 6

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-

169
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
170
 Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-
171
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

172
 SERIAL NO. 10 CLINICAL NO. 10.7

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-

173
Ahara (Dietary History):
Breakfast Lunch Dinner
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
174
 Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-
175
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

176
 SERIAL NO. 10 CLINICAL NO. 10.8

Age :- OPD/IPD No. :-

Gender :- Caste / Religion:-
Occupation:- Residence:-
Date of examination:- Diagnosis:-

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):-

Vedanasammuchraya (History of present illness) :-

Poorvavyadhi Vruttanta (History of Past illness) :-

Chikitsa Vruttanta (Treatment history):-

Kula Vruttanta (Family History):-

1) Pitrakula:-
2) Matrakula:-
3) Swakula:-
Vayaktika Vruttanta (Personal history):-

Ahara (Dietary History):

Breakfast Lunch Dinner

177
Dietary
components and
quantities

Other

6) Addiction- Duration:

Vihara History:
1) Vyayam(Exercise):- Regular/Irregular /Alpa/Prabhuta /None.
2) Abhyang :-
3) Snana(Bathing):- Regular / Irregular
4) Nidra(Sleep):- Proper / Improper: Alpa/Prabhuta / khandit
_______Hours /days. ____________Hours / nights
एवम् संस्थानम् एवं शब्दस्पशशरूपरसगन्धम:-
1) Dehoshma(Temprature):-
2) Nadi (Pulse):-
3) Shwasana (Respiratory Rate):-
4) Rakta daba (Blood pressure) :-
5) Mala:- Samhanan :-Kathin / Drava / Alpa samhat/ Muhur-muhu /
Sapravahana / Sashabda/ sashula.
Quantity :-________________ Vega/day:-_______________
6) Mutra :- Mutra Pravrutti :- Samyak / Kruchha / Vaivarnya / Daha /
Alpa /
Prabhuta.
Quantity :-___________Vega/day:-___________Vega/night:-__________
7) Jivha:-
8) Shabda(Karna) :-
9) Sparsha(Twak) :-
10) Druk (Netra) :-
11) Aakruti:- Dehabhar (Weight):-

Aatur Parikshan:-
1) Prakruti:
Sharir :- Vata / Pitta / Kapha / Vatapitta / Pittakapha / Kaphavata /
Tridosh.
Manas:- Sattvik / Rajas / Tamas
2) Sarata:-
3) Samhanana:- Prabhuta/Madhyam/Alpa
4) Satmyat:- Ahara:-
Vihara:-
Aushadhi:-
5) Satva:- Uttam / Madhyam / Hina.
178
6) Ahar Shakti:- Abhyavaran:-
Jarana:-
7) Vyayama Shakti:- Deshatah:-
Kalatah:-
Vayatah :-
Shadangani:-
Shira:-
Koshtha:-
Bahu:-
Charana:-

Vikrut Strotas Parikshana (Observations and Interpretations):-

Test Methods: - (Inspection, Palpation, Percussion, Auscultations)

Laboratory Test:-
Blood
Stools
Urine
X-ray
Others

एवं वृध्दिस्थानक्षयसमाध्ितम््ः -
Dushta Dosha:-
Dushya:-
Dhatu:-
Mala:-
Avayava:-
Indriya:-
Upadhatu:-
Adhishtaana:-

Vyadhi Bala:-
Vyadhi Hetu:-
Vyadhi Poorvarupa:-
Vyadhi Lakshan:-
Vyadhi Marga:-
Vyadhi Bala:-
Samprapti:-

179
Vyadhi Vinishchaya:-
Vyadhi Prakara:-
Udarka:-
Upadrava:-
Arishta:-
Sadhyasadhyatva:-
Vyadhi Sankara :-

Vyadhi Vyavachheda (Differential Diagnosis):-

Teacher’s Signature Student’s Signature

Date :- Date :-

180
181
 Maharashtra University of Health Sciences,
Nashik, Maharashtra

CLINICAL ACTIVITY BOOK

NAME OF THE INSTITUTE WITH LOGO

ROGA NIDAN EVAM VIKRITI VIGYAN

(AYURVEDA DIAGNOSTICS AND PATHOLOGY)

Name of the student:…………………………………………………………

Registration number:………………………………………………………..

Academic year:………………………………………………………………

182
 NAME OF THE INSTITUTE WITH LOGO

ROGA NIDAN EVAM VIKRITI VIGYAN

(AYURVEDA DIAGNOSTICS AND PATHOLOGY)
(Subject code: AyUG-RN)

University course code:

DEPARTMENT OF ROGA NIDAN EVAM VIKRITI VIGYAN

183
 (Name of the College)
(Approved by –National Commission for Indian System of Medicines, New Delhi &

(Name of University)

Certificate
This is to certify that, Mr.
/Ms.________________________________________

Enrollment Number- ____________________________ of

Batch___________has satisfactorily completed the course of Practical in
the ROGA NIDAN EVAM VIKRITI VIGYAN Subject prescribed by the
(Name of University)
as a part of the Second Professional B.A.M.S. Course.

Examination Seat No.: Date of Examination-

Sign. Of Internal Sign. Of External

Examiner- Examiner-

Sign. of Teacher Sign. of H.O.D

184
 (Index of Activity Book)
7 DECODING INSIGHTS PATHOLOLGY
Name of the clinical Page Instructor
Sl. No Date Remarks
Activity No. Signature
C 7.1 Anaemia evaluation
Urinary Tract
C 7.2
Infectionevaluation
C 7.3 Hepatic evaluation
C 7.4 Renal evaluation

C 7.5 Thyroid evaluation

Diabetes Mellitus
C 7.6
evaluation
C 7.7 Stroke evaluation

C 7.8 Arthritis evaluation

C 7.9 Fever evaluation

Male infertility
C 7.10
evaluation
Helminthiasis
C 7.11
evaluation
Histopathology
Histopathology Specimens
8 RADIOGRAPHIC INSIGHTS

C 8.1 X-Ray reading (Basics –

Positioning, etc.)
C 8.2 X-Ray reading and interpretation
(Chest)
C 8.3 X-Ray reading and interpretation
(Bones and Joints)
9 ELECTRO CARDIO GRAPH

C 9.1 & 9.2 Basic ECG interpretation

Other
Role Play
Namaste-Portal
Visits: (Pathology)
Visits: (Radio-imaging)

Teacher’s signature

185
 7. DECODING INSIGHTS

C 7.1 Anaemia evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration) :

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness ) :

186
Initial Physical Examination:
• General appearance: ……………………………………………….
• Vital signs:
 Blood pressure …………. mmHg.
 pulse rate ………bpm.
 respiratory rate …………. Breaths per minute.
 temperature ………………°F (……°C).
• Cardiovascular examination:
 Heart sounds: Regular / Irregular
 Murmurs: Yes / No
 Palpitation: Yes / No
• Respiratory examination:
Breath sounds: Normal / Abnormal
• Abdominal examination:
Hepatosplenomegaly or masses: Yes / No
• Extremities:
Peripheral edema or clubbing: Yes / No

1. Complete Blood Count (CBC):

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

187
Interpretation:

 Red blood cells (RBCs):……………..

 Hemoglobin:…………………………
 Hematocrit:………………………
 mean corpuscular volume (MCV):…………………
 mean corpuscular hemoglobin (MCH): …………….
 Meancorpuscular hemoglobin concentration (MCHC):…………………
 Red cell distribution width (RDW):……………………….

Teacher’s signature

188
2. Peripheral Blood Smear:
Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

189
 Teacher’s signature

190
 7.DECODING INSIGHTS

C 7.2 UTI evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness ) :

191
Initial Physical Examination:
• General appearance: ……………………………………………….
• Vital signs:
 Blood pressure …………. mmHg.
 pulse rate ………bpm.
 respiratory rate …………. Breaths per minute.
 temperature ………………°F (……°C).
• Abdominal examination:
Tenderness in the lower abdomen : Mild / Moderate/ Sever
• Genitourinary examination:
 Abnormal findings: Yes / No
 Cervical discharge: Yes / No

1. Urinalysis:

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

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Interpretation:
Urine physical examination:
 Appearance:……………………………
 Color:……………………….
 Odor:…………………..
 Specific gravity:………….
Chemical examination :
 Urine-pH:………………….. Crystals
 Sugar:…………………………
 Albumin:………………………
 Bile pigment :…………………………..
 Bile salt:…………………………………
 Blood:………………………………………
 Ketone:………………………………
 Urobilinogen:………………………..
Microscopic Examination:
 Epithelial cells:………………… Microscopic
 WBCs:……………………..
 RBCs:……………………….
 Leukocytes:………………………
 Casts:……………………..
 Crystals:…………………………..
 Bacteria (suggesting a bacterial infection) :…………………………..

Teacher’s signature

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2. VDRL:
Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.3 Hepatic evaluation

Patient I nformation
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration) :

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness ) :

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Initial Physical Examination:
• General appearance: ……………………………………………….
• Vital signs:
 Blood pressure …………. mmHg.
 pulse rate ………bpm.
 respiratory rate …………. Breaths per minute.
 temperature ………………°F (……°C).
• Abdominal examination:
 Tenderness in the right upper quadrant: Yes / No
 Hepatomegaly (enlarged liver): Yes / No
 splenomegaly (enlarged spleen): Yes / No
• Skin examination:
 Spider angiomas (tiny blood vessels visible on the skin): Yes / No
 Palmar erythema (redness of the palms): Yes / No
 Jaundice: Yes / No

1. Liver Function Tests:

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

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Interpretation:

 AST :……..
 ALT:…………
 GGT:…………..
 Bilirubin levels:……………..
 Albumin levels:………………
 Prothrombin time:……………..
 Clotting time:……………………

Teacher’s signature

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2. Coagulation Profile:

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.4 Renal evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration) :

Sr. No. Chief Complains Duration

Vedana sammuchaya (History of present illness):

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Initial Physical Examination:
• General appearance: ……………………………………………….
• Vital signs:
 Blood pressure …………. mmHg.
 Pulse rate ………bpm.
 Respiratory rate …………. Breaths per minute.
 Temperature ………………°F (……°C).
• Abdominal examination:
 Bimanual palpation-
• Extremities examination:

1. Renal Function Tests: Serum creatinine, Blood urea nitrogen (BUN),

Serum uric acid

 Materials required:

 Indication:

 Type of investigation:

 Patient preparation:

 Sample collection:

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 Interpretation:

2. Urine albumin-to-creatinine ratio (ACR):

 Materials required:

 Indication:

 Type of investigation:

 Patient preparation:

 Sample collection:

 Interpretation:

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3. Electrolyte Levels: Serum Potassium, Serum Sodium, Serum Chloride

 Materials required:

 Indication:

 Type of investigation:

 Patient preparation:

 Sample collection:

 Interpretation:

4. Serum Calcium, Serum phosphate

 Materials required:

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 Indication:

 Type of investigation:

 Patient preparation:

 Sample collection:

 Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.5 Thyroid evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness):

Initial Physical Examination:

• General appearance: ……………………………………………….
• Vital signs:
 Blood pressure …………. mmHg.
 Pulse rate ………bpm.
 Respiratory rate …………. Breaths per minute.
 Temperature ………………°F (……°C).

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• Skin examination:
 Skin:
 Hair:
 Nails:
• Neurological examination:
 Reflexes:
 Speech:
 Mental process:

1. Thyroid Function Tests Thyroid-Stimulating Hormone (TSH) level, T3, T4, FT3, FT4:
Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.6 Diabetic evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchaya (History of present illness):

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Initial Physical Examination:
• General appearance: ……………………………………………….
• Vital signs:
 Blood pressure …………. mmHg.
 Pulse rate ………bpm.
 Respiratory rate …………. Breaths per minute.
 Temperature ………………°F (……°C).
• Skin examination: ……………..
• Neurological examination:…………….

1. Fasting Plasma Glucose (FPG) Tests:

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

2. Post-Prandial Plasma Glucose (PPPG) Test:

Materials required:

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 Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

3. Glycated Hemoglobin (HbA1C) test:

Materials required:

Indication:

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 Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

4. Oral Glucose Tolerance Test (OGTT):

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

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 Interpretation:

5. C – Peptide Level:
Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 6. DECODING INSIGHTS

C 7.7 Stroke evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchaya (History of present illness):

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Initial Physical Examination:
• General appearance: ………………………
• Vital signs:
 Blood pressure …………. mmHg.
 Pulse rate ………bpm.
 Respiratory rate …………. Breaths per minute.
 Temperature ………………°F (……°C).
• Neurological examination:…………….

7. Total Cholesterol, LDL Cholesterol, HDL Cholesterol, Triglycerides:

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.8 Arthritis evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchaya (History of present illness):

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Initial Physical Examination:
• General appearance: ………………
• Vital signs:
 Blood pressure …………. mmHg.
 Pulse rate ………bpm.
 Respiratory rate …………. Breaths per minute.
 Temperature ………………°F (……°C).
• Musculoskeletal examination: Swelling/Tenderness/Limited range of motions/Crepitus

8. Rheumatoid Factor (RM), C-reactive Protein (CRP)Level:

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.9 Fever evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchaya (History of present illness):

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Initial Physical Examination:
• General appearance: ……………………………
• Vital signs:
 Blood pressure …………. mmHg.
 Pulse rate ………bpm.
 Respiratory rate …………. Breaths per minute.
 Temperature ………………°F (……°C).
• Abdominal examination: Tenderness

9. Complete Blood Count (CBC): Platelet, Total Leucocyte Count,

Differential Leucocyte Count and Erythrocyte Sedimentation Rate
Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

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 10.Bleeding Time:
Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

11.Widal Test
Materials required:

Indication:

Type of investigation:

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 Patient preparation:

Sample collection:

Interpretation:

12. Malarial Parasite (Peripheral smear/ Card test):

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

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Interpretation:

13. Dengue NS 1- IgG, IgM (Card test):

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.10 Male Infertility evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchaya (History of present illness):

Initial Physical Examination:

• General appearance: ……………………………………………….
• Vital signs:
 Blood pressure …………. mmHg.
 Pulse rate ………bpm.

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  Respiratory rate …………. Breaths per minute.
 Temperature ………………°F (……°C).
• External Genital examination:

14.Semen Analysis: Assess the quantity, quality, and motility of sperm.

Parameters evaluated include sperm count, motility, morphology
(shape), and presence of any abnormalities or infections.

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

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 7.DECODING INSIGHTS

C 7.11 Helminthiasis evaluation

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration):

Sr. No. Chief Complains Duration

Vedana sammuchaya (History of present illness):

Initial Physical Examination:

• Abdominal examination: Tenderness

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 15.Stool Examination: (Colour, Consistency, Microscopy- Ova, cyst, pus
cells)

Materials required:

Indication:

Type of investigation:

Patient preparation:

Sample collection:

Interpretation:

Teacher’s signature

223
SERIAL NO: 8 CLINICAL NO: C 8.1

Activity Name : X-Ray reading (Basics – Positioning, etc.)

Activity Description: Evaluate chest X-Ray for positioning, rotation, and penetration.

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration) :

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness ) :

Materials and Equipment:

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Basics of X Ray:

Positioning:

Rotation:

Penetration:

Any other observations:

Write your inference on the given X-Ray:

Teacher’s signature

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SERIAL NO: 8 CLINICAL NO: C 8.2

Activity Name: X-Ray reading and interpretation (Chest).

Activity Description: Evaluate chest X-Ray for Airway and tracheobronchial tree, Bones and
Bony Structures, Cardiac Silhouette, Diaphragm, Effusions (Pleural), Fields (Lung Fields),
Gastric Bubble (Stomach), and Hilum. Write your comments on the given X-Ray.

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:
Pradhana Vedana with Kala prakarsha (Chief complaints with duration) :

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness ) :

Materials and Equipment:

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Chest X Ray:

Airway and Tracheobronchial tree:

Bones and Bony Structures:

Cardiac Silhouette:

Diaphragm:

Effusions (Pleural):

Fields (Lung Fields):

Gastric Bubble (Stomach):

Hilum:

Any other observations:

Write your inference on the given X-Ray::

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 Teacher’s signature
SERIAL NO: 8 CLINICAL NO: C 8.3

Activity Name : X-Ray reading and interpretation (Bones and Joints)

Activity Description: Evaluate X-Ray for various bone and joints. Write your comments on
the given X-Ray.

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration) :

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness ) :

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Materials and Equipment:

Bones and joints X Ray:

1.Study Details:

 Imaging Modality: X-ray -

 Body Part: (Specific bones or joints examined) -

 Radiographic Views: (Specific views obtained) -

 Technique: (Exposure details, if available) -

2.Findings:

 List and describe the relevant bones or joints examined -

 Provide a detailed description of the observed abnormalities, including fractures,

dislocations, joint space narrowing, bone density changes, or any other significant
findings -

 Include measurements or quantitative details, if applicable -

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3. Impression:

 Provide a concise summary of the overall findings -

 Mention any specific diagnosis, if possible -

 Indicate the significance or clinical relevance of the observed abnormalities -

 Recommend any additional imaging studies or consultations, if necessary -

4. Recommendations:

 Suggest any further diagnostic steps or follow-up examinations -

Teacher’s signature

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SERIAL NO: 9 CLINICAL NO: C 9.1 & 9.2

Activity Name : Basic ECG interpretation

Activity Description: Evaluate ECG for any abnormalities. Write your comments on the given
ECG.

Patient information
Patient Name:
Age: Occupation:
Education: Sex: M / F/Others
Socio-economic status: Marital status:
Place of residence: Religion:
Date of Consultation:
Out Patient Number: Date of Admission:
In Patient Number: Bed number:

Pradhana Vedana with Kala prakarsha (Chief complaints with duration) :

Sr. No. Chief Complains Duration

Vedana sammuchraya (History of present illness ) :

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Materials and Equipment:

ECG interpretation:

ECG reporting:

1. ECG Technical Details:

A. ECG lead configuration (standard or modified) - ...............................................................

B. Paper speed (25 mm/s or 50 mm/s) - ...................................................................................

C. Calibration (in millivolts per millimeter) - ..........................................................................

D. Any artifacts or technical issues encountered during the recording -................................

...............................................................................................................................................

2.Heart Rate and Rhythm:

A. Heart rate (calculated or measured) - ................................................................

B. Rhythm interpretation (sinus rhythm, atrial fibrillation, etc.) -..............................

...........................................................................................................................

C. Presence of any ectopic beats or arrhythmias - ................................................

3. P-Wave Analysis:

A. P-wave morphology (duration, amplitude, and shape) - ....................................................

...............................................................................................................................................
B. Presence of P-wave abnormalities (e.g., P-wave abnormalities indicating atrial
enlargement) - ......................................................................................................................

4. PR Interval:

A. PR interval duration - ..........................................................................................................

B. Assessment of atrioventricular conduction - ......................................................................

5. QRS Complex:

A. QRS complex duration - ......................................................................................................

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 B. Assessment of ventricular conduction and morphology - ..................................................

...............................................................................................................................................

6. ST Segment:

A. ST segment morphology (elevation, depression, or isoelectric) - ....................................

...............................................................................................................................................

B. Presence of ST segment abnormalities indicating myocardial ischemia or injury -

..............................................................................................................................................

...............................................................................................................................................

7. T-Wave Analysis:

A. T-wave morphology (symmetry, amplitude, and shape) - .................................................

...............................................................................................................................................

Presence of T-wave abnormalities (inversion, flattening, or peaked T-waves) -

..............................................................................................................................................

...............................................................................................................................................

8. QT Interval:

A. QT interval duration - ..........................................................................................................

B. Assessment of QT interval prolongation - ..........................................................................

9. Axis and Intervals:

A. Electrical axis of the heart (normal or deviated) - .............................................................

B. Measurement of other intervals (e.g., PR, QRS, QTc) - ....................................................

...............................................................................................................................................

10. Additional Findings:

A. Any additional findings, such as ventricular hypertrophy, chamber enlargement, or ST-T

wave abnormalities -........................................................................................................
..............................................................................................................................................

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 ...............................................................................................................................................

11. Additional Findings:

A. Interpretation and overall impression of the ECG -...........................................................

...............................................................................................................................................

...............................................................................................................................................

B. Differential diagnosis and possible clinical implications – ...............................................

...............................................................................................................................................

...............................................................................................................................................

...............................................................................................................................................

...............................................................................................................................................

12. Recommendations:

A. Suggested follow-up or additional investigations, if necessary - ....................................

..............................................................................................................................................

...............................................................................................................................................

..

Teacher’s signature

234
 Topic 10 10. Introduction to Histopathology
CO4, CO5, CO6 Order and interpret tests for Histopathology specimens
Topic 11 11. Study of Histopathology Specimens
CO4, CO5 Distinguish and describe prepared histopathology
(Provide normal and abnormal slides to distinguish while demonstrating and spotting)

1. Specimen Labelled as: Lung and trachea

Microscopy:

Interpretation:

2. Specimen Labelled as: Blood

Microscopy:

Interpretation:

3. Specimen Labelled as: Spleen and lymph

Microscopy:

Interpretation:

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 4. Specimen Labelled as: Heart and vessels:
Microscopy:

Interpretation:

5. Specimen Labelled as: Glands

Microscopy:

Interpretation:

6. Specimen Labelled as: Liver:

Microscopy:

Interpretation:

Sign. of Student Sign. of H.O.D./Teacher

236
 Role Play
 Each group must be formed with at least 10 students
 the name of the topic will be selected from number 10 from the activity log of the syllabus
 Perform documentation with a group photo

Name of Role Play:

Date and Time:

Sr. No. Name of Student Sr. No. Name of Student

1. 6
2. 7
3. 8
4. 9
5. 10
Write a Theme of Role play with Photographs:

Name & Sign. of Student Sign. of H.O.D./Teacher

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 Demonstrations- the operation of the
NAMASTE portal
(The student should observe and implement reporting technologies and
diagnosis from the NAMASTE portal and write a short report)
Name of Student:

NAMASTE portal
Date and Time Visited:

Write a summary of Contents Observed/Read:

Name & Sign. of Student Sign. of H.O.D./Teacher

Field visit (Laboratory)

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 (Observe the procedure and submit the report)
Name and Address of Pathology Laboratory:
Date and Time:

Observations of the Procedures:

Sign. of Student Sign. of H.O.D./Teacher

239
 Field visit (Radio-Imaging Centre)
(Observe the procedure and submit the report)
Name and Address of Radio-Imaging Centre:
Date and Time:

Observations of the Procedures:

Name & Sign. of Student Sign. of H.O.D./Teacher

240