COLLEGE
NAZARATHPET, CHENNAI - 600 123.
scsv*
KAYACHIKITSA - CASE SHEET
S.N0 : SEX: B.No
NAME : AGE : D.O.A
ADDRESS : OCCUPATION D.O.D
RELIGION: SOCIO-ECONOMICSTATUS
MENSTRUAL HISTORY
PROVISIONALDIAGNOSIS: FINAL DIAGNOSIS :
1. CHIEF COMPLAINT WITH DURATION :
•bood clSaqoboe-a A-afibCd
g mordk3
2. ASSOCIATED COMPLAINTS
crecdtoo -hu
3. HISTORY OF PRESENTILLNESS :
no*LBnq -bu-nrrcLgb)OJ '¯Tbeæe
LUCU , , peda-) de-ma G beel.J
a L.a•dJän I-jhQ .hcauå *Yue
buy DPO
4. HISTORY PASTILLNESS :
5. FAMILY HISTORY :
speTc
6. PERSONAL HISTORY :
a. DIET : b. SLEEP : cQu-Q9b •Roane,"
c. HABIT d. URINE 3 X) *roe; Q day)
e. BOWEL :
7. PANCIIAINDRIYA :
a. DARSHANA : d. GANDHA:
b. SPARSIIANA
c. SIIRAVANA:
8. ANGAPRATYANGA PAREEKSEIA :
a. ΚΟ%ΙΤΑ:
b. SHAKHA :
9. ΜΑΝΑΗ PAREEKSHA:
10.GNANENDRIYA PAREEKSHA:
Ι Ι. DASAVIDHA PAREEKSHA(AATURA Ι)ΕΗΑ BALA NIRNAYAM) :
α.ΡΙΙΑΚΙΙΙΤΙ:
-
WATA
ΡΙΤΤΑ -
U<APHA -
b.VlKRUTl :
• VATAJ Dosk-4
PITTAJA
• SANNIPATAJA
SANNIPATAJA
c.SARA :
,$4VAKSARA
• RAKTASARA
• MAMSASARA
• MEDOSARA 3ήη
• ASTHISARA qqi
• MAJIASARA
• SUKRASARA
• SATWASARA
d. SAMHANANAM
PRAVARA-
(Fa:)
MADYAMA-
AVARA -
e. PRAMANAM
PRAVARA
SAVARA 12
f. SATMYAM:
EKARASA
• VYAN41SHRA qqq
g. SATVAM :
PRAVARA qa--â•g 3mqr
• MADYAMAqqq
•..x' HEENA
h. AHARA SAHKTI :
PRAVARA
MADYAMA
ı. VYAYAMASHAKTHI :
PRAVARA
MADYAMA
AVARA
j.VAYO NIRNAYAM :
BALYAM
YOUVANAM
VARDAKYAM
• VATA
PITTA
KAPHA
SANNIPATA
b. MOOTRAM : (Macroscopic & Microscopic Examination)
fin
MATRA- 4
VARNA- eolOUL
PARADAR SHAKARA-
GANDHA
VISHISTA GURUTVAM
PRAKSHEPA DRAVYA
PRATIKRIYA
c. MALAM : (Macroscopic & Microscopic Examination)
1. MATRA large in Kantity / less in quantity
2. FREQUENCY once in a day / twice in a day / once in two days
3. SANGHATANAM loose in covrstency / semi - solid / hard
4. VARNA normal(yefow) / mixed with blood / black / brown
pale coloured
5. GANDHA normal odour / abnormal
6. KRIMI biting of teeth / anal itching / stomach pain
7. OTHERS associated with mucus / flatulence / pain
D. JIHWA :
VARNA normal / pale / beafy red / with ulcerations / Geographic
PAPILLAE
COATING present / absent
SURFACE soft
e SPARSHA:
f. SHABDA:
g. DRIK :
h. AKRUTI :
PRAVARA
MADYAMA
VAVARA
13. SROTO PAREEKSHA :
W PRANAVAHA
b. UDAKAVAHA
VANNAVAHA
d. MOOTRAVAHA
VPUREESHAVAHA
f. SWEDOVAHA
g. MANOVAHA
h. SAMNJAVAHA ORIENTED / NON-ORIENTED
SEMI - CONSCIOUS / CONSCIOUS / STUPOR
COMA/ CONFUSED / DROWSY
DHATU VAHAVRIDHIKSHAYA SROTODUSHTI LAKSHANA
a. RASAVAHA :
• VRDHI
v•-KSHAYA ;-a-rpa:
b. RAKTAVAHA :
• VRDHI
.4<SHAYA
c. MAMSAVAHA :
• VRDHI
• KSHAYA
d. MEDOVAHA :
VRDHI
• KSHAYA
e. ASTHIVAHA :
• VRDHI
• KSHAYA
f. MAJJAVAHA :
• VRDHI
KSHAYA
g. SUKRAVAHA :
VRDHI
• KSHAYA
14.VIKRUTI PAREEKSHA :
a. DOSHATAHA
-- a-æf
b. DO OSHYATAHA Ē )
c. PRAKRITITAHA a-ra
d. DESHATAHA
e. KALATAHA
f. HETUTAHA
g. LINGATAHA ,
15. ROGA BALA NIRNAYAM :
a. Curable / Incurable / Preventable
b. Prognosis - Gödd / Bad / Condition Explained
16. ROGA MARGA NIRNAYAM :
va<BAHYA
b. MADHYAMA -
Il
VABHYANTARA - Il
a-fi)
17. UPASHAYA-ANUPASHAYA : (Relieving / Aggravating factor)
18. SWATANTRA-PARATANTRA VYADHI : (Primary Secondary Disease)
19. VINISCHITA VYADHI : (Final Diagnosis)
20. UPADRAVANI : (Complications)
21. ARISHTALINGANI : (Bad Prognostic Criterias)
_22.PROGNOSIS : (Sadhya Sadhyatwa)
CHIKITSA
Treatment)
1. CHIKITSA SOOTRAM : (Line of
IV 1 9 ..æ
21
ear19)
sAMSODANA CHIKITSA : (Purifactory Process)
J. PURVA KARMA
b. PRADHAVA KARMA :
c. PASCHAT KARMA :
3. SAMSHAMANA CIKITSA : (Palliative care)
a. OUSHADAM :
I —O —)•C A IF )
chua-na
c) JFrquya.ffa-kA Iou
b. : Trawl) J
c. VIHARAM•
d. Do's / Don's (Pathyapathya)
4. ANUBHOOTA YOGAS :
5. RESULT:
6. PRECAUTIONS TO BE TAKEN IN FUTURE •
gråa-kt lood ) .cuJGC%
Signature of the Student Signature of the Lecturer
