DEPARTMENT OF POST GRADUATE

STUDIES IN PANCHAKARMA
2007 - 2010

Basti & Nasya

Practical Work Record

S.D.M COLLEGE OF AYURVEDA

KUTHPADY, UDUPI-574118
 S.D.M COLLEGE OF AYURVEDA
KUTHPADY,UDUPI-574118

CERTIFICATE

This is to certify that the following is the record of practical work

carried out by P.G Scholar Dr.Sandeep K C of final year M.D
(Ayu) in Panchakarma.

Registration No:- 07AP204

Year of Examination:- 2010

Examination Center:-

Signature of the staff Signature of the H.O.D

DEPARTMENT OF POST GRADUATE STUDIES IN

PANCHAKARMA
 INDEX
Sl
No NAME OF PATIENT PROCEDURE PAGE NO.

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11

12

13

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16

17

18

19

20
 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 BASTI PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
TREATMENT:

OBSERVATIONS
DOSE: NIRUHA:
ANUVASANA:

TIME OF ADMINISTRATION

TIME OF EXPULSION

RETENTION TIME

NUMBER OF EVACUATIONS

SAMYAKA NIRUDA LAKSHNAS:

OBSERVATIONS DAY 2 DAY 4 DAY 6

MALASHODHANA

MUTRASHODHANA

ADHOVAYUNIRGAMANA

RUCHI

AGNIDEEPTI

ASHAYA LAGHUTA

ROGOPASHANTI

PRAKRITISTA

BALA

SAMAYAKA ANUVASITA LAKSHANAS:

OBSERVATIONS Day Day Day Day Day

1 3 5 7 8
SHAKRUT SHODANA

DHATU PRASADA

INDRIYA PRAASADA

SWAPNA

SHAREERA LAGAVA

BALA JANANA

MUTRASHODANA

ADHOVAYU NIRGAMANA
NIRUHA ATIYOGA LAKSHANAS:-

ANUVASANA ATIYOGA LAKSHANAS:-

NIRUHA AYOGA LAKSHANAS:-

ANUVASANA AYOGA LAKSHANA:-

PASHCHAT KARMA:

ANY OTHER FEATURES:

SIGNATURE OF SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

 NASYA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:

KOUTUMBIKA VRITTANTA:
VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :

G.U.S.:
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATION-

SAMYAK SHIROVIRECHAN LAKSHANA:

OBSERVATIONS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

SHIRO LAGHAVATA

SUKHA SWAPNA

INDRIYA, MANAHA
SHUDHI

SROTO VISHUDDHI

VIKAROPASHAMANA

SHIRO VIRECHANA AYOGA LAKSHANA:

SHIRO VIRECHANA ATIYOGA LAKSHANA:

PASCHATH KARMA:
PRECAUTIONS:

OVERALL OBSERVATION OF THE PROCEDURE:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF THE STAFF SIGNATURE OF THE H.O.D

DEPARTMENT OF POST GRADUATE
STUDIES IN PANCHAKARMA
2007 - 2010

Raktamokshana & Physiotherapy

Practical Work Record

S.D.M COLLEGE OF AYURVEDA

KUTHPADY, UDUPI-574118
 S.D.M COLLEGE OF AYURVEDA
KUTHPADY,UDUPI-574118

CERTIFICATE

This is to certify that the following is the record of practical work

carried out by P.G Scholar Dr.Sandeep K C of final year M.D
(Ayu) in Panchakarma.

Registration No:- 07AP204

Year of Examination:- 2010

Examination Center:-

Signature of the staff Signature of the H.O.D

DEPARTMENT OF POST GRADUATE STUDIES IN

PANCHAKARMA
 INDEX
Sl
No NAME OF PATIENT PROCEDURE PAGE NO.

10

11

12

13

14

15

16

17

18

19

20
 RAKTAMOKSHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
Samprapti Ghataka:

Dosha:
Dushya:
Agni:
Ama:
Srotas:
Sroto Dusti Prakara:
Udbhava Sthana:
Sanchari Sthana:
Vyakta Sthana:
Adhistana:
Rogamarga:

Chikitsa Karma:

Requirements:

Poorvakarma:

Pradhana Karma:

Observation:
Samyaka Raktamokshana Lakshana
Atiyoga Raktamokshana Lakshana

Ayoga raktamokshana lakshsna

Paschath Karma:

Precautions:

Disscussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 RAKTAMOKSHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
Samprapti Ghataka:

Dosha:
Dushya:
Agni:
Ama:
Srotas:
Sroto Dusti Prakara:
Udbhava Sthana:
Sanchari Sthana:
Vyakta Sthana:
Adhistana:
Rogamarga:

Chikitsa Karma:

Requirements:

Poorvakarma:

Pradhana Karma:

Observation:
Samyaka Raktamokshana Lakshana
Atiyoga Raktamokshana Lakshana

Ayoga raktamokshana lakshsna

Paschath Karma:

Precautions:

Disscussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 RAKTAMOKSHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
Samprapti Ghataka:

Dosha:
Dushya:
Agni:
Ama:
Srotas:
Sroto Dusti Prakara:
Udbhava Sthana:
Sanchari Sthana:
Vyakta Sthana:
Adhistana:
Rogamarga:

Chikitsa Karma:

Requirements:

Poorvakarma:

Pradhana Karma:

Observation:
Samyaka Raktamokshana Lakshana
Atiyoga Raktamokshana Lakshana

Ayoga raktamokshana lakshsna

Paschath Karma:

Precautions:

Disscussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 RAKTAMOKSHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
Samprapti Ghataka:

Dosha:
Dushya:
Agni:
Ama:
Srotas:
Sroto Dusti Prakara:
Udbhava Sthana:
Sanchari Sthana:
Vyakta Sthana:
Adhistana:
Rogamarga:

Chikitsa Karma:

Requirements:

Poorvakarma:

Pradhana Karma:

Observation:
Samyaka Raktamokshana Lakshana
Atiyoga Raktamokshana Lakshana

Ayoga raktamokshana lakshsna

Paschath Karma:

Precautions:

Disscussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 RAKTAMOKSHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
Samprapti Ghataka:

Dosha:
Dushya:
Agni:
Ama:
Srotas:
Sroto Dusti Prakara:
Udbhava Sthana:
Sanchari Sthana:
Vyakta Sthana:
Adhistana:
Rogamarga:

Chikitsa Karma:

Requirements:

Poorvakarma:

Pradhana Karma:

Observation:
Samyaka Raktamokshana Lakshana
Atiyoga Raktamokshana Lakshana

Ayoga raktamokshana lakshsna

Paschath Karma:

Precautions:

Disscussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 RAKTAMOKSHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
Samprapti Ghataka:

Dosha:
Dushya:
Agni:
Ama:
Srotas:
Sroto Dusti Prakara:
Udbhava Sthana:
Sanchari Sthana:
Vyakta Sthana:
Adhistana:
Rogamarga:

Chikitsa Karma:

Requirements:

Poorvakarma:

Pradhana Karma:

Observation:
Samyaka Raktamokshana Lakshana
Atiyoga Raktamokshana Lakshana

Ayoga raktamokshana lakshsna

Paschath Karma:

Precautions:

Disscussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 PHYSIOTHERAPY PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

CHIEF COMPLAINTS: DURATION:

HISTORY OF PRESENT ILLNESS:

PERSONAL HISTORY:
GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG

PHYSIOTHERAPY MANAGEMENT:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

DEPARTMENT OF POST GRADUATE
STUDIES IN PANCHAKARMA
2007 - 2010

Snehana & Swedana

Practical Work Record

S.D.M COLLEGE OF AYURVEDA

KUTHPADY, UDUPI-574118
 S.D.M COLLEGE OF AYURVEDA
KUTHPADY,UDUPI-574118

CERTIFICATE

This is to certify that the following is the record of practical work

carried out by P.G Scholar Dr.Sandeep K C of final year M.D
(Ayu) in Panchakarma.

Registration No:- 07AP204

Year of Examination:- 2010

Examination Center:-

Signature of the staff Signature of the H.O.D

DEPARTMENT OF POST GRADUATE STUDIES IN

PANCHAKARMA
 INDEX
Sl
No NAME OF PATIENT PROCEDURE PAGE NO.

10

11

12

13

14

15

16

17

18

19

20
 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SNEHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK SNIGHDA LAKSHANA:

FEATURES OF SAMYAK 1 2 3 4 5 6 7
SNIGDHA LAKSHANA
VATA ANULOMANA
AGNI DIPTI
SNEHA UDVEGA
ASAMHATHA VARCHAS
ANGA LAGHAVA
GATRA SNIGDHATA
PURISHA SNIGDHATA
KLAMA
ADASTAD SNEHA
DARSHANA
GATRA MARDAVATHA
SHAITILYA

OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

SIGNATURE OF THE SCHOLAR

SIGNATURE OF STAFF SIGNATURE OF H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 SWEDANA PROCEDURE RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA :
RAJO PRAVRITTI :
RAJONIVRITTI :
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS :
DASHA VIDHA PARIKSHA:
PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S
SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA : BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ----- F
PULSE: ------/MINUTE
RESPIRATORY RATE: -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S:

R. S :

C. N. S :

P.A :
SAMPRAPTI GHATAKA:
DOSHA :
DUSHYA:
AGNI :
AMA :
SROTAS :
SROTO DUSTI PRAKARA:
UDBHAVA STHANA :
SANCHARI STHANA :
VYAKTA STHANA :
ADHISTANA :
ROGAMARGA :

CHIKITSA KARMA:

REQIUREMENTS & MEDICAMENTS :

POORVA KARMA :

PRADHANA KARMA :
OBSERVATIONS :

SAMYAK LAKSHANA ATHIYOGA LAKSHANA AYOGA LAKSHANA

SHEETHA VYUPARAMAE PITTA PRAKOPA UDVESHTANA
SHOOLA VYUPARAMAE MOORCHA DHARUNATHA
STHAMBA NIGRAHA SHAREERA SADHANA GURUTHVA
GAURAVA NIGRAHA TRUSHA STHABADA GATRATHA
MARDHAVATA DAHA MARUTHACHA PRASIDHI
SWEDA PRADURBAVA SVARA DAURBALYA
VYADHI HANI ANGA DAURBALYA
SHEETHARTHI SANDI PEEDA
SPOTOTHPATHI
RAKTHA PRAKOPA
BRANTHI
KLAMA
JWARA
SHAVA RAKTHA MANDALA
CHARDI

ANY OTHER FEATURES:

PASCHATH KARMA:

PRECAUTIONS:

DISCUSSION:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

DEPARTMENT OF POST GRADUATE
STUDIES IN PANCHAKARMA
2007 - 2010

Vamana & Virechana

Practical Work Record

S.D.M COLLEGE OF AYURVEDA

KUTHPADY, UDUPI-574118
 S.D.M COLLEGE OF AYURVEDA
KUTHPADY,UDUPI-574118

CERTIFICATE

This is to certify that the following is the record of practical work

carried out by P.G Scholar Dr.Sandeep K C of final year M.D
(Ayu) in Panchakarma.

Registration No:- 07AP204

Year of Examination:- 2010

Examination Center:-

Signature of the staff Signature of the H.O.D

DEPARTMENT OF POST GRADUATE STUDIES IN

PANCHAKARMA
 INDEX
Sl
No NAME OF PATIENT PROCEDURE PAGE NO.

10

11

12

13

14

15

16

17

18

19

20
 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VAMANA PRACTICAL RECORD

DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA

S.D.M COLLEGE OF AYURVEDA

Name:

Age: O.P.D. Number:

Sex: I.P.D. Number:

Religion: Bed Number

Education: DOA :

Marital status: DOD :

Socio-economic status: Diagnosis:

Occupation: Procedure:

Postal address:

Desha:

Vedana samuchaya: Duration:

Vedana vrittanta:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CMS
WEIGHT: --------KGS
TEMPERATURE: ------IN DEGREE FAHRENHEIT
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKAS:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:
PRADHANA KARMA

Time No Sharira
Liquid Qty In Colour Bp Pulse/
Of of Sambhandhi
Given Ml Mm hg Min
Admnstn Vegas Lakshana

Laingiki

Samyakyoga Laxana Atiyoga Laxana Ayoga Laxana

Kale pravruthi; Phenila vamana Vega apravarti

Yathakrama.kapha,pitta, Raktha,chandrikavata Kevala.oushada

vata doshaharan vamana pravruthi

Anathimahathi vyatha Athyanta rakthasrava Jwara

Swayam avasthana Trusna Hridaya asuddhii
Hridaya suddhi Moha Srotoasuddhii
Parsva suddhi Murcha Vegavibandhaa
Murdha suddhi Nidra haani Gurugatrat
Srotosuddhi Balahaani Spota
Indriya suddhi Hritapida Kota
Laghuta Kanta pida Kandu
Karshya Tamha;pravesa Kaphaprasekha
Dourbalya Brhama
Kantasuddhi Pittati yoga
Kapha samsravha Vata prakopa
Daha

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:
Dhumapana {Haridra}---------------------

Samsarjana Krama

Precautions:

Overall Observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D

 VIRECHANA PRACTICAL RECORD
DEPARTMENT OF P.G STUDIES IN PANCHAKARAMA
S.D.M COLLEGE OF AYURVEDA

NAME:

AGE: O.P.D. NUMBER:

SEX: I.P.D. NUMBER:

RELIGION: BED NUMBER

EDUCATION: DOA:

MARITAL STATUS: DOD:

SOCIO-ECONOMIC STATUS: DIAGNOSIS:

OCCUPATION: PROCEDURE:

POSTAL ADDRESS:

DESHA:

VEDANA SAMUCHAYA: DURATION:

VEDANA VRITTANTA:

PURVA VYADHI VRITTANTA:

CHIKITSA VRITTANTA:
KOUTUMBIKA VRITTANTA:

VAIYAKTIKA VRITANTA:

RAJO PRAVRITTI VRITTANTA:

RAJO DARSHANA:
RAJO PRAVRITTI:
RAJONIVRITTI:
PRASAVA VRITTANTA: G / P / A / D / L
OTHER SYMPTOMS:

DASHA VIDHA PARIKSHA:

PRAKRITHI : V/ P/ K/ VP/ PK/ KV/ S

SATVA : P/M/A
SARA : P/M/A
SAMHANANA: P/M/A
PRAMANA : P/M/A
SATMYA : P / M / A.
AHARA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
JARANA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VYAYAMA SHAKTI: PURVA KALINA-------- P/ M/ A ADHYATANA: P/ M/ A
VAYA: BALA/MADHYAMA/ VRIDDHA

GENERAL EXAMINATION:

BUILT: WELL/ MODERATE/ POOR

NOURISHMENT: WELL/ MODERATE/ POOR
HEIGHT: -------CM
WEIGHT: --------KG
0
TEMPERATURE: ------ F
PULSE ------/MINUTE
RESPIRATORY RATE -------/MINUTE
BLOODPRESSURE ------MM OF HG
PALLOR: PRESENT/ ABSENT
ICTERUS: PRESENT/ ABSENT
LYMPHNODES: PALPABLE/ NON PALPABLE
NAIL CHANGES: CYANOSIS: PRESENT/ ABSENT
CLUBBING: PRESENT/ ABSENT

SYSTEMIC EXAMINATION:

C. V. S :

R. S:

C. N. S:

P.A:
SAMPRAPTI GHATAKA:

DOSHA:
DUSHYA:
AGNI:
AMA:
SROTAS:
SROTO DUSTI PRAKARA:
UDBHAVA STHANA:
SANCHARI STHANA:
VYAKTA STHANA:
ADHISTANA:
ROGAMARGA:

CHIKITSA KARMA:

PANCHAKARMA PROCEDURE:

REQUIREMENTS:

POORVAKARMA:

PRADHANA KARMA:
OBSERVATION:

Sl. Samyaga Yoga Heena Yoga Ati Yoga

1. Sroto Vishyudhi Kapha Prakopa Kaphakshaya
2. Indriya Prasad Pitta Prakopa Pittakshaya
3. Laghuta Vata Prakopa Raktakshay
4. Agni Vruddhi Agnimandya Vata Prakopa
5. Anamayatva Gaurava Supti
6. Vit, Pitta ,Kapha Pratishyaya Angamarda
Anilanam Kramena
Prapti
7. Vatanulomana Tandra Klama
8. Chardi Vepathu
9. Aruchi Nidra Abhava
10. Vataprathiloma Balaabhava
11. Hikka
12. Unmada

Anthiki

Vegiki
Input -- Out Put--
Maniki

Lyngiki

Observation
Paschath Karma:

Samsarjana Krama

Precautions:

Overall observation of the Procedure:

Discussion:

Signature of the Scholar

Signature of the Staff Signature of the H.O.D