Name of College with LOGO
AYURVEDACHARYA (B.A.M.S.)
THIRD PROFESSIONAL B.A.M.S.
<< Subject Name >>
(SUBJECT CODE : AyUG- )
JOURNAL /ACTIVITY BOOK
Name of the student :
Institutional Roll No. :
Examination Reg. No. :
Academic Year :
(Name of the College)
(Affiliated to –National Commission for Indian System of Medicines, New Delhi &
Name of the University)
Name of the department
Batch- ___________
Certificate
This is to certify that, Mr. / Ms. ________________________________________, Enrolment
Number-________________ has satisfactorily completed the Practicals in (Subject Name
) prescribed by the (Name of University) as a part of the Third Professional B.A.M.S.
Course.
Examination Seat No.: _______________
Sign. of Teacher Sign. of H.O.D.
Date of Examination- _______________
Sign. Of Internal Examiner-______________
Sign. Of External Examiner-________________
JOURNAL /ACTIVITY BOOK
<< Subject name >>
(SUBJECT CODE : AyUG - )
Journal Cum Activity Book
DEPARTMENT OF
<< Name of Department >>
Name of the College
INDEX
Sr Topic Date Page
no no
1
2
3
4
Sl.No Minimum No of cases to be included as per the following guidelines
1. Netraroga Chikitsa Patrika- 15 Cases
2. Karnaroga Chikitsa Patrika- 05 Cases
3. Nasaroga Chikitsa Patrika- 05 cases
4. Mukharoga Chikitsa Patrika- 03 cases
5. Shiroroga Chikitsa Patrika- 02 cases
NETRA-ROGA CHIKITSA PATRIKA
Patient's Name :………………………Age/ …………. Date/ ……………………..
Sex/ ……OPD No. /IPD No. ………………………………………
Religion/ ………………Occupation: ……………..
D.O.A/………………………..D.O.D/……………………D.O.E/…………………
Education/ ………………..
Marital Status ……. Socio-economic Status-
Address/…………………………………………………………………………………
Provisional Diagnosis/ तात्कालिक लिदाि:……………………………………………………………..
CHIEF COMPLAINTS WITH DURATION/ प्रमुख वेदना -
ASSOCIATED COMPLAINTS/ अनुबंध वेदना -
HISTORY OF PRESENT ILLNESS/वर्तमान व्याधध वृत्तान्त -
PAST HISTORY/ पूवत व्याधध वृत्तान्त -
FAMILY HISTORY/ कुल वृत्तान्त -
PAST TREATMENT HISTORY/ पूवत धिधकत्सा इधर्हास -
PERSONAL HISTORY/ -
Frequent dietary items-/ आहार :
Addictions/ व्यसि :
Sleep/ लिद्रा :
Bowel Movement/ मि प्रवृलि:
Urinary Habits/ मूत्र प्रवृलि
EXAMINATION- 1. GENERAL EXAMINATION/ सामान्य परीक्षण -
िाड़ी – Pulse- B.P.
मि Temp.
मूत्र R.R.
लिह्वा Agni.
शब्द Koshtha
क्षुधा :
स्पशश Prakriti
आकृलत Sara
2. SYSTEMIC EXAMINATION/सवाांग परीक्षण -
3. OCULAR EXAMINATION/नेत्र परीक्षण –
Head Posture/धिर: स्थिर्ी
Facial Symmetry/ मुख धिपार्श्त-सस्थिधर्
OD OS
Eye Brows/ भ्रू मंडल
Eye Lashes/ पक्ष्म मंडल
Eye Lids/ वर्त्त मंडल
Orbit/ अधक्षकूट
Conjunctiva/ नेत्र श्लेष्मावरण कला
Sclera/ िुक्ल मण्डल
कृष्णमंडल
Cornea/ कधणतका
Size
Shape
Curvature
Transparency
Vascularization
Sensation
Iris/ र्ारका
Color
Pattern
Synechiae
Pupil/ दृधिमंडल
Shape
Reflex
Size
Position
Margin
Lens/ दृधिमधण
Color
Transparency
Displacement
Anterior Chamber/ पूवत वेश्म
Depth
Content
Lacrimal apparatus/ अश्रुमागत
Lacrimal Puncta/ अश्रुवालहि़ी मुख
Lacrimal Sac/ अश्रुकोष
Examination of Junctional Area/ संधधपरीक्षण
Outer canthus/ अपाांगगत सांलध
Inner canthus/ कि़ीलिकागत सांलध
Eye–lid margin/ पक्ष्मवर्त्शगत सांलध
Fornix/ वर्त्शशुक्लगत सांलध
Limbus/ शुक्लकृष्णगतसांलध
VISUAL ACUITY TEST/ दितन िस्थि परीक्षण
Vision Right Left Both
Without Glasses- Distance
Pin Hole
Near
Pin Hole
With Glasses- Distance
Near
VISUAL FIELD/ दृलिक्षेत्र
COLOR VISION/ वर्श ज्ञाि–व्यवच्छे द
RETINA/ दृधिपटल परीक्षण
Direct Ophthalmoscopy right left
Media/ माध्यम
Optic Disc/ दृििाड़ी श़ीषश
CD Ratio
Macula Lutea/ प़ीत ल ांदु
Blood Vessels/ रक्त वालहन्या
General Fundus/ दृलिपटि
TONOMETRY/ नेत्र दाव परीक्षण
OTHER SPECIFIC EXAMINATIONS/ अन्यधविेष परीक्षण (OCT/FFA/ERG/EOG/SCAN
etc.)
LAB INVESTIGATIONS/ प्रयोगिाला जांि
NIDANA/ धनदान
POORVA ROOPA/ पूवतरूप
ROOPA/रूप
SAMPRAPTI/ सम्प्रास्थि
SAMPRAPTI GHATAKA/ सम्प्रास्थि घटक
DIFFERENTIAL DIAGNOSIS
COMPLICATIONS/ उपद्रव
DIAGNOSIS/ व्याधध धनधातरण
PROGNOSIS/ साध्य-असाध्यर्ा
TREATMENT/धिधकत्सा
• Treatment Principle/धिधकत्सा सूत्र
Oral Medications/ अभ्यन्तरयोग
SHAMANAUSHADIS PRAMANA ANUPANA DURATION
• Name of Kriya Kalpa/Anushastra Karma/Shastra Karma
पूवत कमत
प्रधानकमत
पश्चार्् कमत
SUITABLE-UNSUITABLE DIET-LIFESTYLE/ पथ्य-अपथ्य आहार- धवहार
FOLLOW UPS-
Date Clinical features Treatment
Sign of Teacher Name of Student.
--------------------------------------------------- X0X ----------------------------------------------------
KARNAROGA CHIKITSA PATRIKA
Patient's Name :………………………Age/ …………. Date/ ……………………..
Sex/ ……OPD No. /IPD No. ………………………………………
Religion/ ………………Occupation: ……………..
D.O.A/………………………..D.O.D/……………………D.O.E/…………………
Education/ ………………..Habitat ……………………….
Marital Status ……. Socio-economic Status-
Address/…………………………………………………………………………………
PROVISIONAL DIAGNOSIS/ र्ात्काधलक धनदान:……………………………………………………………..
CHIEF COMPLAINTS WITH DURATION/ प्रमुख वेदना -
ASSOCIATED COMPLAINTS/ अनुबंध वेदना -
HISTORY OF PRESENT ILLNESS/वर्तमान व्याधध वृत्तान्त -
PAST HISTORY/ पूवत व्याधध वृत्तान्त -
FAMILY HISTORY/ कुल वृत्तान्त -
PAST TREATMENT HISTORY/ पूवत धिधकत्सा इधर्हास -
PERSONAL HISTORY/ -
Frequent dietary items-/ आहार :
Addictions/ व्यसि :
Sleep/ लिद्रा :
Bowel Movement/ मि प्रवृलि:
Urinary Habits/ मूत्र प्रवृलि
EXAMINATION- 1. GENERAL EXAMINATION/ सामान्य परीक्षण -
िाड़ी – Pulse- B.P.
मि temp.
मूत्र R.R.
लिह्वा Agni.
शब्द koshtha
क्षुधा
स्पशश Prakriti
आकृलत Sara
EXAMINATION OF EAR RIGHT LEFT
1. PINNA
Microtia
Macrotia
Colour and Texture
Auricle
Tragus
Lobule
Posterior surface
Tenderness
Movement
2. EXTERNAL AUDITORY MEATUS
Content
Ulcer
Srava
Furunculosis
Otomycosis
Growth
Any other-
3. TYMPANIC MEMBRANE
Colour
Shape (convex/concave)
Perforation
Anatomical Landmarks
4. MIDDLE EAR
Facial nerve
Eustachian Tube
Mastoid
5. INNER EAR
4. TUNING FORK EXAMINATION
Rinnes Test
Webbers Test
ABC Test
Any other
5. OTHER EXAMINATION
Voice Test
Whisper Test
LAB INVESTIGATIONS/ प्रयोगिाला जांि
AUDIOMETRY
NASA PAREEKSHANA
MUKHA PAREEKSHANA
X-RAY
NIDANA/ धनदान
POORVA ROOPA/ पूवतरूप
ROOPA/रूप
SAMPRAPTI/ सम्प्रास्थि
SAMPRAPTI GHATAKA/ सम्प्रास्थि घटक
DIFFERENTIAL DIAGNOSIS
COMPLICATIONS/ उपद्रव
DIAGNOSIS/ व्याधध धनधातरण
PROGNOSIS/ साध्य-असाध्यर्ा
TREATMENT/धिधकत्सा
• Treatment Principle/धिधकत्सा सूत्र
Oral Medications/ अभ्यन्तरयोग
SHAMANAUSHADIS PRAMANA ANUPANA DURATION
• Name of Kriya Kalpa/Anushastra Karma/Shastra Karma
पूवत कमत
प्रधानकमत
पश्चार्् कमत
SUITABLE-UNSUITABLE DIET-LIFESTYLE/ पथ्य-अपथ्य आहार- धवहार
FOLLOW UPS-
Date Clinical features Treatment
Sign of Teacher Name of Student.
-----------------------------------------XOX----------------------------------------------------------------
NASAROGA CHIKITSA PATRIKA
Patient's Name :………………………Age/ …………. Date/ ……………………..
Sex/ ……OPD No. /IPD No. ………………………………………
Religion/ ………………Occupation: ……………..
D.O.A/………………………..D.O.D/……………………D.O.E/…………………
Education/ ………………..Habitat ……………………….
Marital Status ……. Socio-economic Status-
Address/…………………………………………………………………………………
PROVISIONAL DIAGNOSIS/ र्ात्काधलक धनदान:……………………………………………………………..
CHIEF COMPLAINTS WITH DURATION/ प्रमुख वेदना -
ASSOCIATED COMPLAINTS/ अनुबंध वेदना -
HISTORY OF PRESENT ILLNESS/वर्तमान व्याधध वृत्तान्त -
PAST HISTORY/ पूवत व्याधध वृत्तान्त -
FAMILY HISTORY/ कुल वृत्तान्त -
PAST TREATMENT HISTORY/ पूवत धिधकत्सा इधर्हास -
PERSONAL HISTORY/ -
Frequent dietary items-/ आहार :
Addictions/ व्यसि :
Sleep/ लिद्रा :
Bowel Movement/ मि प्रवृलि:
Urinary Habits/ मूत्र प्रवृलि
EXAMINATION- 1. GENERAL EXAMINATION/ सामान्य परीक्षण -
िाड़ी – Pulse- B.P.
मि temp.
मूत्र R.R.
लिह्वा Agni.
शब्द koshtha
क्षुधा
स्पशश Prakriti
आकृलत Sara
EXAMINATION OF NOSE AND PARANASAL SINUSES
• EXAMINATION OF EXTERNAL NOSE
Shape and size –
Growths-
• ANTERIOR RHINOSCOPY
Nasavamsha (Septum)–
Right left
Space in Nasal cavities-
Turbinates –
Meatus-
Nasal mucosa –
• NASAGANDAKUTALALATASTHI (PARANASAL SINUSES)-
• SRAAVA– (quantity, colour, smell, consistency)
• POSTERIOR RHINOSCOPY
LAB INVESTIGATIONS/ प्रयोगिाला जांि
KARNA PAREEKSHANA
MUKHA PAREEKSHANA
X-RAY
NIDANA/ धनदान
POORVA ROOPA/ पूवतरूप
ROOPA/रूप
SAMPRAPTI/ सम्प्रास्थि
SAMPRAPTI GHATAKA/ सम्प्रास्थि घटक
DIFFERENTIAL DIAGNOSIS
COMPLICATIONS/ उपद्रव
DIAGNOSIS/ व्याधध धनधातरण
PROGNOSIS/ साध्य-असाध्यर्ा
TREATMENT/धिधकत्सा
• Treatment Principle/धिधकत्सा सूत्र
Oral Medications/ अभ्यन्तरयोग
SHAMANAUSHADIS PRAMANA ANUPANA DURATION
• Name of Kriya Kalpa/Anushastra Karma/Shastra Karma
पूवत कमत
प्रधानकमत
पश्चार्् कमत
SUITABLE-UNSUITABLE DIET-LIFESTYLE/ पथ्य-अपथ्य आहार- धवहार
FOLLOW UPS-
Date Clinical features Treatment
Sign of Teacher Name of Student.
-------------------------------------- XOX --------------------------------------------------------------------
MUKHAROGA CHIKITSA PATRIKA
Patient's Name :………………………Age/ …………. Date/ ……………………..
Sex/ ……OPD No. /IPD No. ………………………………………
Religion/ ………………Occupation: ……………..
D.O.A/………………………..D.O.D/……………………D.O.E/…………………
Education/ ………………..Habitat ……………………….
Marital Status ……. Socio-economic Status-
Address/…………………………………………………………………………………
PROVISIONAL DIAGNOSIS/ र्ात्काधलक धनदान:……………………………………………………………..
CHIEF COMPLAINTS WITH DURATION/ प्रमुख वेदना -
ASSOCIATED COMPLAINTS/ अनुबंध वेदना -
HISTORY OF PRESENT ILLNESS/वर्तमान व्याधध वृत्तान्त -
PAST HISTORY/ पूवत व्याधध वृत्तान्त -
FAMILY HISTORY/ कुल वृत्तान्त -
PAST TREATMENT HISTORY/ पूवत धिधकत्सा इधर्हास -
PERSONAL HISTORY/ -
Frequent dietary items-/ आहार :
Addictions/ व्यसि :
Sleep/ लिद्रा :
Bowel Movement/ मि प्रवृलि:
Urinary Habits/ मूत्र प्रवृलि
EXAMINATION- 1. GENERAL EXAMINATION/ सामान्य परीक्षण -
िाड़ी – Pulse- B.P.
मि temp.
मूत्र R.R.
Agni. koshtha
शब्द स्पशश
क्षुधा Prakriti
आकृलत Sara
EXAMINATION OF ORAL CAVITY
• Examination of Oashtha.
UPPER LIP
Shape Site Colour
Cracks
LOWER LIP
Shape Site Colour
Cracks
• Examination of Buccal Mucosa
• Examination of Talu (Soft/Hard Palate and Uvula)
• Examination of Dantamula
Varna
Srava
Sparsha
Shotha
• Examination of Danta
Arrangement DentalFormula
Asahatwa-Sensitivity RightLeft
12345678 12345678
Tenderness 1 2 3 4 5 6 7 8 1 2 3 4 5 6 78
Varna
Caries
Sharkara (tartar)
• Examination of Jivha Paediatric Formula
Dorsal surface Right Left
12345 12345
Lateral surface 12345 12345
Posterior surface
• Other Examination- Nasophrynx, Laryngopharynx
• Examination of Tonsils, Palatopharyngeal fold, Palatoglossal fold
• Examination of Larynx-
• Examination of Neck- (Glands, swellings, cricoid, thyroid cartilage, vessels)
LAB INVESTIGATIONS/ प्रयोगिाला जांि
X-RAY
NIDANA/ धनदान
POORVA ROOPA/ पूवतरूप
ROOPA/रूप
SAMPRAPTI/ सम्प्रास्थि
SAMPRAPTI GHATAKA/ सम्प्रास्थि घटक
DIFFERENTIAL DIAGNOSIS
COMPLICATIONS/ उपद्रव
DIAGNOSIS/ व्याधध धनधातरण
PROGNOSIS/ साध्य-असाध्यर्ा
TREATMENT/धिधकत्सा
• Treatment Principle/धिधकत्सा सूत्र
Oral Medications/ अभ्यन्तरयोग
SHAMANAUSHADIS PRAMANA ANUPANA DURATION
• Name of Kriya Kalpa/Anushastra Karma/Shastra Karma
पूवत कमत
प्रधानकमत
पश्चार्् कमत
SUITABLE-UNSUITABLE DIET-LIFESTYLE/ पथ्य-अपथ्य आहार- धवहार
FOLLOW UPS-
Date Clinical features Treatment
Sign of Teacher Name of Student.
-------------------------------------------------XOX-----------------------------------------------------
SHIROROGA CHIKITSA PATRIKA
Patient's Name :………………………Age/ …………. Date/ ……………………..
Sex/ ……OPD No. /IPD No. ………………………………………
Religion/ ………………Occupation: ……………..
D.O.A/………………………..D.O.D/……………………D.O.E/…………………
Education/ ………………..Habitat ……………………….
Marital Status ……. Socio-economic Status-
Address/…………………………………………………………………………………
PROVISIONAL DIAGNOSIS/ र्ात्काधलक धनदान:……………………………………………………………..
CHIEF COMPLAINTS WITH DURATION/ प्रमुख वेदना -
ASSOCIATED COMPLAINTS/ अनुबंध वेदना -
HISTORY OF PRESENT ILLNESS/वर्तमान व्याधध वृत्तान्त -
PAST HISTORY/ पूवत व्याधध वृत्तान्त -
FAMILY HISTORY/ कुल वृत्तान्त -
PAST TREATMENT HISTORY/ पूवत धिधकत्सा इधर्हास -
PERSONAL HISTORY/ -
Frequent dietary items-/ आहार :
Addictions/ व्यसि :
Sleep/ लिद्रा :
Bowel Movement/ मि प्रवृलि:
Urinary Habits/ मूत्र प्रवृलि
EXAMINATION- 1. GENERAL EXAMINATION/ सामान्य परीक्षण -
िाड़ी – Pulse- B.P.
मि temp.
मूत्र R.R.
लिह्वा Agni.
शब्द koshtha
क्षुधा
स्पशश Prakriti
आकृलत Sara
Examination Of Head
• Head Posture –
• Facial Asymmetry –
• Examination Of Scalp –
• Any other- (redness/throbbing/venous dilatation/ etc.)
LAB INVESTIGATIONS/ प्रयोगिाला जांि
KARNA PAREEKSHANA
NASA PAREEKSHANA
MUKHA PAREEKSHANA
X-RAY
NIDANA/ धनदान
POORVA ROOPA/ पूवतरूप
ROOPA/रूप
SAMPRAPTI/ सम्प्रास्थि
SAMPRAPTI GHATAKA/ सम्प्रास्थि घटक
DIFFERENTIAL DIAGNOSIS
COMPLICATIONS/ उपद्रव
DIAGNOSIS/ व्याधध धनधातरण
PROGNOSIS/ साध्य-असाध्यर्ा
TREATMENT/धिधकत्सा
• Treatment Principle/धिधकत्सा सूत्र
Oral Medications/ अभ्यन्तरयोग
SHAMANAUSHADIS PRAMANA ANUPANA DURATION
• Name of Kriya Kalpa/Anushastra Karma/Shastra Karma
पूवत कमत
प्रधानकमत
पश्चार्् कमत
SUITABLE-UNSUITABLE DIET-LIFESTYLE/ पथ्य-अपथ्य आहार- धवहार
FOLLOW UPS-
Date Clinical features Treatment
Sign of Teacher Name of Student.
--------------------------------------------- XOX ---------------------------------------------------------
