KAYACHIKITSA CERTIFICATE
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1 AYURVED COLLEGE AFFILIATED TO GUJARAT AYURVED UNIVERSITY JAMNAGAR KAYACHIKITSA CERTIFICATE This is to certify that 3 rd year B.A.M.S. student.. Roll no. has completed the practicals of Kayachikitsa under our supervision and has documented 20 case history forms herein. We hereby certify the authenticity of this record. Jamnagar Date: Teacher Kayachikitsa H.O.D. Kayachikitsa Page 1 of 17
2 INDEX Sr.No. Name of Patient Diagnosis Date of Admission Date of Discharge Student Signature H.O.D.Signature Page 2 of 17
3 Patient s Clinical Case history Sr.No.: Name: Age: Sex: Caste: Religion: O.P.D. No. : I.P.D. No.: Ward Bed No. : Address: Name and address of Relatives/Attendant: Occupation: Financial Status: Marital Status: D.O.A. : D.O.D. Result: Cured/Markedly improved/ Moderately improved/ Mild improved/ LAMA/Referred Chief Complaints (with duration): History of Present illness (Origin, duration and progress): Past History: 1) History of past illness - 2) Previous health status - Page 3 of 17
4 3) Treatment/Surgical history - Family History (If any specific related illness): Personal history: 1) Diet (Type and Quantity) Mixed/Veg - Details of dietary articles - Details of quantity of dietary articles - 2) Addiction- Tea / coffee/ tobacco chewing/ smoking/ alcohol/ other Quantity / day Duration Yrs. 3) Sleep 4) Dreams 5) Rest 6) Urination : Frequency ---per day, ---per night with associate complaints (if any) 7) Defecation: Frequency --- duration ---- with associate complaints (if any) 8) Flatus 9) Menstrual History 10) Obstetric History: Delivery- Abortion- Miscarriage- General Examination: Page 4 of 17
5 1) General Constitution: a] Constitution type (Built/Stature) b] Facial appearance 2) Vital Data Pulse: a] Rate/Minb] Rhythmc] Tensiond] Volumee] Arterial wall feelf] Doshika assessment- Respiration: a] Respiratory rate/min b] Type of Respiration Temperature: Blood pressure: Body weight: 3) Skin: 4) Oral cavity examination: 5) Lips: 6) Tongue: 7) Teeth and Gums: 8) Hair- 9) Scalp- 10)Body hairs- 11)Nails- 12) Agni: Page 5 of 17
6 13) Koshtha: Atura Bala Pariksha (Assessment of Patient strength) 1. Prakriti : Sharirika- Manasika- 2. Sara (Excellence Of tissues) Pravara / Madhyama / Avara 3. Samhanana (Physique)-Pravara / Madhyama / Avara 4. Pramana (Anthropological assessment) - Pravara / Madhyama / Avara 5. Satmya - Pravara / Madhyama / Avara 6. Satva (Mental status) : Pravara / Madhyama / Avara 7. Aahara Shakti (State of digestion): Abhyavaharana Shakti (Capacity for food Intake)- Jarana Shakti (Digestive capacity)- 8. Vyayama Shakti (Capacity to exercise) Pravara / Madhyama / Avara 9. Vaya (Age) Pravara / Madhyama / Avara Indriya Parikshana Examination of Sensory organs: 1. Ears (Vestibulocochlear Nerve examination) - 2. Skin (Superficial/Deep sensations) Touch - Pain - Temperature 3. Eyes (Ophthalmic Nerve examination) Visual acquity - Visual field - Color Vision Page 6 of 17
7 4. Nose (Olfactory Nerve examination) 5. Tongue (Glossopharyngeal Nerve examination) Srotasa Examination: 1) Pranavaha Srotasa (Root - Hridaya and Mahasrotasa) Examination of Respiratory system Upper Respiratory tract- 1. Nasal examination 2. Throat examination (Tonsils, Pharynx, Larynx, etc.) Examination of Lungs 1. Inspection: Shape of the chest- Equality of movement- Rate of Respiration- Type of Breathing- Any other evident findings- 2. Palpation: Equality of movement- Palpation of trachea- Tactile vocal fremitus (TVF)- 3. Percussion: Resonant/Tympanic/Hyper resonant/dull 4. Auscultation: 2) Udakvaha Srotasa (Root-Talu and Kloma) Palate examination- Page 7 of 17
8 Tracheopharyngeal examination- State of Hydration (Dehydration, Edema, etc.) 3) Annavaha Srotasa (G.I.T.) (Root-Aamashaya and Vamaparshwa) G.I.T Examination - 1. Inspection-Shape and contour of abdomen Umbilicus Movement of abdominal wall Any visible peristalsis Skin/Visible veins on abdomen Hernial sites 2. Palpation- 3. Percussion- 4. Auscultation- 4) Purishvaha Srotasa (Excretory system) (Root-Pakvashaya and Guda) Large intestine / Sigmoid Colon- Any visible peristalsis- - Peristaltic sounds- - Herniation- Rectum (P/R Examination) Stool examination- 5) Mutravaha Srotasa (Urinary system) (Root-Basti and Vankshana) Page 8 of 17
9 Kidney Palpation (Bimanual)- Bladder- Urethra- Urine examination- 6) Rasavaha Srotasa (Lymphatic system) (Root-Hridaya and Dasha dhamani) Circulatory system (Heart) Inspection- 1. Shape of precordium Normal/Bulging/Retraction 2. Apex beat- Palpation 1. Palpation of apex beat- 2. Palpation of Carotid artery- Auscultation - Heart sounds- - Murmurs- Lymph nodes (If enlarged) Stanya Aartava - 7) Raktavaha Srotasa (Hemopoetic system) (Root-Yakrit and Pleeha) Liver- Spleen- Gall bladder- Veins (Deep Vein thrombosis,varicosity,thrombophlebitis, etc.) Skin pigmentation / discoloration: 8) Mamsavaha Srotasa (Examination of Motor system of CNS) (Root-Snayu and Twak) Page 9 of 17
10 Power of muscles- Tone of Muscles- Hypertonia (Spasticity, Rigidity, etc.) - Hypotonia Coordination- Finger Nose finger test- - Heel Knee test- -Romberg s sign- Involuntary movements Convulsions/Tremors/Chorea/Fasciculation/Tics Nutrition of muscles Wasting/Pseudo hypertrophy/hypertrophy/atrophy Deep tendon reflexes Biceps - Triceps - Brachioradialis - Knee Jerk - Ankle Jerk/Clonus - Planter reflex 9) Medavaha Srotasa (Root-Vrikka and Vapavahana) Presenting symptoms and involvement of dosha-dushya / Symptoms of Atisthaulya State of Adiposity (Obesity/Emaciation) /Distribution of fat deposition 10) Swedavaha Srotasa (Epocrine/Sweat glands) (Root-Meda and Lomakupa) Skin Skin pores Sweating 11) Asthivaha Srotasa (Skeletal system) (Root- Meda and Jaghana) Page 10 of 17
11 Gait- Posture- Mobility- Deformity- Osteoporosis/Osteopenia/Osteomalacia Fractures- 12) Majjavaha Srotasa (Bone marrow) (Root-Asthi and Sandhi) Joint tenderness Swelling Joint Crepitus Range of movement 13) Shukra-Artavavaha Srotasa (Reproductory system) (Root-Shukra,Artava,Stanya) Examination of male genitalia (Penis,Scrotum,Testes,etc) - Semen analysis - Examination of female genitalia (Perineum, Vulva, Labia majora, etc.) - P/V examination - P/S examination - Breast examination 14) Manovaha Srotasa (Psychiatric assessment) Mana (Examination of Manasika bhavas like Thinking, knowledge, etc.) Page 11 of 17
12 Buddhi (Examination of intellectual faculties of mind like intelligence, memory, patience, etc.) Appearance and Behavior- Speech Mute/Flight of ideas/dysphasia/dysarthria Mood Euthymic/Depressed/Anxious/Irritable Thought content Abnormal beliefs (Delusions, Hallucinations, etc.) Assessment of Cognitive state Level of Consciousness Orientation Attention and Concentration Memory Intelligence Laboratory investigations: Stool Urine Sputum Vomitus Sweat Menstrual blood Others Quantity Consistency Odour Colour Sama/Nirama Other Laboratory findings and relevant investigations like X-ray, USG, etc.: Sufficient Extra space needed here Page 12 of 17
13 Sr.No. LakshanaSamuchchaya (Sign and Symptoms) Dosha Guna involved / Amshans ha Kalpana Dushya Srotasa Sama/ Nirama Differential Diagnosis: Concerned/Related Diseases- Provisional diagnosis- Final diagnosis- Nomenclature of Disease-Criteria for final diagnosis: Type/Subtype Stage of disease (Saama/Niraama/Acute/Chronic/Episodic) Nature of disease (Mild/Severe) Nidana Panchak :- 1. Nidana (Etiological factors):- 2. Samprapti (Pathogenesis):- General :- Specific :- Samprapti Ghatak (Constitution of Samprapti):- Dosha- Origin- Page 13 of 17
14 Dushya- Rogamarga- Srotasa- Place of manifestation of disease- Srotodushti Prakara- Stage of disease- Agnimandya- Doshika nature of the disease- Aama- Aggravating period of disease- Remission period of disease- 3. Purvaroopa (Premonitory sign and symptoms):- 4. Roopa (Cardinal sign and symptoms):- 5. Upashaya/Anupshaya (Aggravating and relieving factors) :- 6. Upadrava (Complications):- 7. Arishta:- 8. Sadhyaasadhyatva (Prognosis):- Treatment Protocol: Principle line of treatment Drug of choice Shadvidha Upakrama (Six modes of treatment) 1. Langhana (Therapeutic fasting) [ insert check box in front of each Karma as shown below] A] Shodhana (Biopurification) B] Shamana (Pacification) i) Vamana i) Deepana Page 14 of 17
15 ii) Virechana iii) Basti iv) Nasya ii) Pachana iii) Upawasa [Fasting] iv) Pipasa Nigraha [Restriction of fluids] v) Raktamokshana v) Vyayama [Exercise] vi) Aatapa Sevana [Exposure to sunlight] vii) Maruta Sevana [Exposure to fresh air] 2. Brimhana (Nourishing) 3. Rukshana (Drying) 4. Snehana (Oleation) 5. Swedana (Fomentation) 6. Stambhana(Styptic) Treatment given: Medicines Dosage Time of administration Anupana (Vehicle) Add sufficient space here Pathya-Apathya (Do s and Don ts) Pathya- Ahara(diet)- Vihara (activities)- Page 15 of 17
16 Apathya- Ahara(diet) Vihara(activities)- Follow up record: Date Symptoms Treatment Percentage improvement Page 16 of 17
17 Signature of student Signature of teacher Page 17 of 17
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