WHO Scoring of Ayurveda Symptoms

WHO – DFC sponsored Project on
DEVELOPING GUIDELINES FOR CLINICAL

RESEARCH METHODOLOGY IN AYURVEDA
PRINCIPAL INVESTIGATOR
PROF. M. S. BAGHEL
INVESTIGATOR
DR. RAJAGOPALA S
INSTITUTE FOR POSTGRADUATE TEACHING &

RESEARCH IN AYURVEDA
GUJARAT AYURVED UNIVERSITY
JAMNAGAR – 361 008
INDIA
2011
1
PREFACE
Traditional medicine in general is the sum total of the knowledge, skills and
practices based on the theories, beliefs and experiences indigenous to different
cultures, whether explicable or not, used in the maintenance of health, as well as
in the prevention, diagnosis, improvement or treatment of physical and mental
illnesses [3]. The theories and concepts of prevention, diagnosis, improvement and
treatment of illness in traditional medicine historically rely on a holistic approach
towards the sick individual, and disturbances are treated on the physical,
emotional, mental, spiritual and environmental levels simultaneously. As a result,
most systems of traditional medicine may use herbal medicines or traditional
procedure-based therapies along with certain behavioural rules promoting healthy
diets and habits. Holism is a key element of all systems of traditional medicine.
Ayurveda, the indigenous medicine to India involves all the above said facts. In
addition to the physical and mental health component, it adds the spiritual and
social health also in to account and give a complete definition to health which of
course a unique to itself.
Research is a process that converts data into information, information to

knowledge and knowledge to wisdom and practice. Ayurveda, the ancient life care
wisdom of Indian subcontinent is an apt example for this; the vast observations
(research of that ancient time) of the Seers of the yore were converted into a huge
repository of information and knowledge which is in practice till today without any
alterations in its original thoughts and principles. Ayurveda is not an experimental
based medical system, but experience based medical system being practiced since
centuries with a profound literary heritage. Research should be a balanced
approach, comprehensive and having equal emphasize on literature, experimental
and clinical fields. It is a continuous process and should be able to put its impact
on the fields of academics, pharmacy and practice. The ancient research
methodology and the present day modern research methodology are totally different
in their path, though the end point is same i.e. benefit to patient.
Present day Ayurvedic researches are failing in this aspect as they are unable to
disseminate the knowledge gained from the exercises. Ayurvedic research of the
last 50 years has not changed the practice of Ayurveda neither text books were
enriched with these new researches. Prof. RH Sigh has made the same observation
“Ongoing research is proceeding in such a way that it is of more value to modern
medicine than Ayurved. It doesn’t strengthen Ayurveda and Ayurvedic practice,
Ayurvedic research outcomes have not trickled down to professional use; neither do
they benefit Ayurveda students or practitioners” [1]
The current methodologies of research being applied in Ayurveda should be

analyzed critically. Starting from Col. Chopra to many of his disciples have worked
extensively on herbal pharmacology, but except for Reserpine, not much quotable
evolved. CDRI (1965-1975) made attempts to screen more than 2000 medicinal
plants for their biological activities and this decade long arduous, expensive study
could hardly produce any results. Renowned pharmacologist Ranita Aiman, a
2
disciple of Col. Chopra while delivering the Chopra memorial oration [2] at AIIMS
(1978) accepted this fact and suggested that perhaps the fundamental principles of
Ayurveda have their significant role in defining the pharmacological activity of
plants, and called Ayurveda as “sleeping beauty” and expected that some day it will
awake which is still elusive.
The drug researches conducted in the field of Ayurveda for the last six decades
have not enriched the Ayurvedic understanding or Ayurvedic concepts though
these researches have created a better understanding of Ayurveda by the modern
medical fraternity. The researches on herbal pharmacology have led confirmation of
few concepts like reverse pharmacology, use of whole crude drugs in place of
isolation of fractions for clinical trails etc. These leads have changed the mindset of
researchers in herbal medicine. In last decade, too much of interest has been
generated in medical world regarding Ayurveda and other traditional medicines.
However, these all efforts have led to the enrichment of the knowledge of the
modern medicine and inclusion of some Ayurvedic herbs in to the Modern Materia
Medica (IP/BP).
During the last couple of decades, knowledge and use of Ayurveda medicine has
expanded globally and has gained popularity. It has not only continued to be used
for primary health care in India, but has also been used in countries where
conventional medicine is predominant. With this expansion of the use of Ayurveda
medicine worldwide, safety and efficacy as well as quality control of medicines and
procedure-based therapies have become important concerns for both health
authorities and the public. There are no international standards and appropriate
methods for evaluating traditional medicine. The challenge now is to ensure that
traditional medicine is used properly and to determine how research and
evaluation of traditional medicine should be carried out.
The quantity and quality of the safety and efficacy data on traditional medicine are
far from sufficient to meet the criteria needed to support its use worldwide. The
reasons for the lack of research data are due not only to health care policies, but
also to a lack of adequate or accepted research methodology for evaluating
traditional medicine. It should also be noted that there are heaps of published and
unpublished data on research in traditional medicine, but further research in
safety and efficacy should be promoted, and the quality of the research should be
improved. The methodologies for research and evaluation of traditional medicine
should guarantee the safety and efficacy of herbal medicines and traditional
procedure- based therapies and also they should not become obstacles to the
application and development of traditional medicine following its holistic principles.
Thus, the efficacy of traditional medicine has to be evaluated in an integrated
manner.
Since last few years it has been felt that there is a great need for a separate
research methodology for Ayurveda particularly for the clinical research. WHO has
made an attempt in this regard for Traditional medicines in 2000 [3] (WHO/TRM
guidelines). The guidelines focus on the current major debates on safety and
efficacy of traditional medicine, and are intended to raise and answer some
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challenging questions concerning the evidence base. The guidelines present some
national regulations for the evaluation of herbal medicine, and also recommend
new approaches for carrying out clinical research. The quality of life (QOL) manual
was developed by the WHO Program on Mental Health, and may also be used to
evaluate the results of clinical research in traditional medicine [3]. This document
has strongly recommended the exhaustive training of man power of Ayurvedic
institutions for research methodology. But the system has failed in production of
true Ayurvedic researchers owing to the facts narrated above i.e. lack of a clear
understanding of modern research methodology as well as its non-suitability for
Ayurveda and other Traditional systems of Medicines. Because of this various
researchers in the country started to feel that conventional clinical trial regimen is
not fit for Ayurveda. Dr. Ram Manohar [4] has opined that Ayurveda is based on
5000 years of clinical practice hence in place of conventional EBM (Evidence Based
Medicine) clinical trials, practice based clinical trials should be organized for
Ayurveda.
This is my strong view that the regime of EBM clinical trial with its evidence based
hierarchy is not fit for Ayurvedic clinical trials, limitation of EBM clinical trial
regimens limit the use of Prakriti, Dosha Anubandha-Anubandhyatwa, Arambhaka
and Anugami Dosha Vikalpa, Swanidana Prakopa Avaranajanya Prakopa, Prakriti
Sava Samaveta – Vikritivishamasaveta, Amavastha, Pakvavastha, etc. which leads
to variation of dose, dosage, form, Aushadhasevana kala, Anupana - sahapanaa,
Pathya-apathya, therapeutics like Panchakarma and Kriyakalpa procedures to be
adopted etc., hence if desired results of actual clinical practices are to be recorded,
the protocols should be prepared on these lines supported by EBM suitable for the
purpose. Ayurveda requires research in the areas of Ayurvedic diagnostic principles
taking into consideration of Dosha, Dushya, Agni, Ama, etc. units of Samprapti , so
that the Ayurvedic diagnosis can be made more pinpointed leading to more effective
treatment strategies. Ayurveda is a pure science based on strict logical explanation,
which are called Darshana. In last 2000 years, very less conceptual development in
Ayurveda is evident however whatever has been added is less explained or obscure.
Due to socio-political reasons, redaction (Pratisamskara) of Ayurvedic Samhitas
could not be done in last 2000 years which was mandatory every 1000 years. This
means that the present Samhitas are lagging behind to present the knowledge.
Many of the diagnostic tools have been missed in between and new principles like
Avarana added later on are remained unexplained.
Need of Ayurveda clinical trials is for revalidation of facts enumerated in

Ayurvedic classics leading to the explanation of fundamental principles, to find out
better treatment modalities for the existing diseases and for newer diseases, to
standardize the treatment procedures scientifically and to establish dose, duration,
indication and side effect profile of any given drug. Hence, if Ayurveda have to
provide much needed support to the modern medicine in the management of the
diseases it requires more tedious research in the areas of fundamental principles
and diagnostic tools in place of drugs. For this purpose the conventional modern
research methodology is not suitable and there is a need for a paradigm shift in the
research methodology of Ayurveda.
4
Dr. Nandini Kumar [5] has also opined that there is need to stem the misuse of
Indian traditional knowledge and there is dire need to gear up ourselves to show
the science carried out in Ayurvedic way but also use modern science to produce
interpretative evidence. Though ICMR advocates that protocols for Ayurvedic
researches had been prepared in consultation with ayurvedists however it does not
fulfill the actual need of strengthening Ayurveda.
Dr. Valiathan and his team, Dr. Ashok Vaidya and his team have started ‘Science
Initiatives in Ayurveda’, in order to explore Ayurvedic fundamentals like Prakriti in
the parlance of Genomics etc., for the welfare of the Humanity which is most
welcome. Genetic and epigenetic responses are being understood by some
scientists in the light of Prakriti, Oja, Bala and Rasayana. This is the beginning of
the study and will not go fat, if all the fundamental principles of Ayurveda are not
taken into consideration while initiating these projects.
Ayurveda looks like a mesmerizing ‘sleeping beauty’ for the modern medical
scientists, this illusion is due to the failures of modern medicine in curing
metabolic disorders, autoimmune disorders and cancer etc., however Ayurveda has
much more to offer than Oja, Bala and Prakriti. There are many fundamental
principles in Ayurveda which can be helpful in understanding the maladies in
modern medicine. But more than these there are many more fundamental
principles described in Ayurveda in brief and they are still not understood properly
by ayurvedists themselves. So while talking to holistic approach of Ayurveda, the
principles of Ayurveda should be applied in toto.
Looking into all these facts, years long effort on developing a pure ayurvedic patient
screening proforma was prepared, and with the help of learned Ayurveda scientists
/ educationists it was revised, later a proposal was sent to WHO Country Office
India for conduct of a national workshop on this topic, it was with the timely
support received from WHO, we could organize a national workshop in November
2009, srotas wise symptoms were graded for clinical evaluation, considering some
major diseases of particular srotas also into account. But these are in Sanskrit
language and solely can be understood by a person who is well versed in Ayurveda
terminologies and concepts. The finalized drafts were again scrutinized in an expert
meet held in March 2011, and a draft document is prepared, now it is in your
hands. This documents are again not final, it requires field trails, the lacunae are
to be identified and possibly after a couple of years of field trails we could be in a
position to call it standard.
The purpose of the guidelines are - These guidelines have been developed to
improve the situation described above, and to promote the proper use and
development of Ayurveda particularly to have a standard clinical research pattern
all over. It also aim to develop specific guidelines for clinical research for Indian
system of medicines i.e. Ayurveda, and also to develop a specific assessment
criteria based on disease and QOL parameters as explained by Charaka viz.
Agnibala, Dehabala, Chetasa Bala. The second aim is to prepare standard scoring
pattern for classical Ayurvedic symptom / signs to give more objectivity to
subjective sign and symptoms so that uniformity and reproducibility of data is
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made easy, and to improve the quality and value of research in Ayurveda and this
in turn will provide appropriate evaluation methods to facilitate the development of
regulation mechanism in Ayurveda research.
It is my strong believe that the outcome of this format will positively contribute for
better understanding of the pathogenesis concepts of Ayurveda in terms of Dosha,
Dhatu, Srotas, Guna, etc. and finally will help in strengthening Ayurveda. Now it is
high time that we should take cognizance that whether the use of conventional
research methodology for Ayurveda research or to use a separate methodology
developed incorporating leads from conventional methods and Ayurvedic principles
in a symbiotic manner. I wish this effort will be a starting point in this direction
and in the days ahead, we will be in a position to have a strong base of research
methodology and clinical research in Ayurveda.
- Prof. MS Baghel
Director, IPGT&RA
Principal Investigator
Reference:
1. Singh RH, Exploring issues in the developemt of Ayurvedic research methodology,
journal of ayurveadn integrative medicine, Vo 1, issue 2, April 2010, PP 91 – 95
2. Aiman Ranita, Indian indigenous drugs – retrospect – prospect,
Ind.J.Pharmac.,11(1)i-12 (1979).
3. WHO/TRM Guidelines, 2000 Downloaded from
www.sho.int/entity/hiv/amds/WHOTCM2005.1_OMS.pdf on 24.06.2006, New
Delhi.
4. Ram Manohar P, Evidence base for Traditional Medicine through practice based
research, International Conclave on Traditional Medicine, 16 -17, Nov 2006, New
Delhi.
5. Dr. Nandini K Kumar, personal communication dated 01Nov 2009
6. Dr. Valiathan, Ayurvedic Biology
7. Journal experimental biology, 1968-1975.
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Acknowledgements:
At the outset of accomplishment of this mammoth task, we would like to convey our heartfelt
thanks to the WHO Country Office for India, New Delhi for the sanction, support and providing the
technical support whenever required. We pay our sincere thanks to Dr. D. C. Katoch, Ex. National
Consultant (Traditional Medicines & Homeopathy), WHO Country Office for India, New Delhi for his
keen interest in the task and also for providing necessary technical inputs, it was his guidelines which
made this project in the present shape.
We also remember with great respect those personalities who inspired, initiated and helped in
successful completion of this task, the first being Prof. M. S. Baghel, Director, IPGT&RA, Gujarat
Ayurved University, Jamnagar and also the chief investigator of this project, without whose
guidance, and support it would not have been possible to complete this work. It was his thoughts
materialized in the form of this work. He is also acknowledged for providing the Clinical Research
Format which he developed with his vast field experience for the general cause of ayurvedic clinical
research.
We also would like to acknowledge with respect the experts participated in the national workshop
conducted in November 2009 and gave their valuable inputs, Prof. R.H. Singh, Dr. Nandini Kumar,
Dr. Dilip Gadgil, Dr. M.M. Padhi, and Dr. Vasanth Patil requires a special mention. We are equally
thankful to the experts who have participated in the expert meet held in March 2011 viz. Prof. C. P.
Shukla, Prof. Gurdip Singh, Dr. S. H. Acharya, Prof. GS Acharya and Dr. Rammanohar who have
contributed by way of scrutinizing the text prepared. Teaching faculty members of IPGT&RA also
deserves a special mention in this acknowledgement for their timely help, technical inputs and pains
and efforts taken to make the project complete. We also remember with gratitude and pay our
sincere thanks to all those who have responded to our mails and letters and provided the technical
inputs which were helpful in preparation of this manuscript. Without the help of our Post Graduate
and Ph. D. Scholars it would not have been possible to reach to this stage in the project, their help
and contribution received at every stage of the work is acknowledged with thanks.
Secretarial assistances received from the different offices of IPGT&RA are also acknowledged at this
juncture. Finally we pay our sincere appreciation and thanks to all those individuals who have helped
in this project directly or indirectly to make it complete.
Dr. Rajagopala S
Project Co-investigator
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Index
Sl. No. Title Page No.
1 A Guideline to User’s Of This Manual
1.1 Example 1: Tamaka Shvasa
1.2 Example 2: Amavata
1.3 Example 3: Amlapitta
1.4 Agni Bala Index
2 Manual Part 1:
2.1 General Screening Proforma – CRF 1
2.2 Assessment of Prakriti
2.3 Assessment of Sharirika Prakruti Features Of Somatic
Constitution (Self Answering Questionnaire)
3 Manual Part 2
3.1 Gradation Of Symptoms: Pranavaha Srotas
3.2 Gradation of Symptoms: Udakavaha Srotas
3.3 Gradation of Symptoms: Annavaha Srotas
3.4 Grading of Amlapitta Symptoms
3.5 Gradation of Symptoms: Rasavaha Srotas
3.6 Gradation Of Symptoms: Raktavaha Srotas
3.7 Gradation of Symptoms of Eka Kustha – Psoriasis
3.8 Gradation of Symptoms: Mamsavaha Srotas
3.9 Gradation of Symptoms: Medovaha Srotas
3.10 Criteria for Assessment of Results For Madhumeha
3.11 Criteria for Assessment of Sthaulya
3.12 Gradation Of Symptoms: Asthivaha Srotas
3.13 Scoring Pattern For Osteoporosis
3.14 Gradation Of Symptoms: Majjavaha Srotas
3.15 Gradation Of Symptoms: Shukravaha Srotas
3.16 Gradation Of Symptoms: Mutravaha Srotas
3.17 Gradation Of Symptoms: Purishavaha Srotas
3.18 Gradation Of Symptoms: Swedavaha Srotas
3.19 Gradation Of Symptoms: Artavavaha Srotas
3.20 Manasa pariksha bhava (mental factor examination)
3.21 Manasa vibhrama pariksha
3.22 Some general symptoms
3.23 Signs and symptoms of AMA in general
3.24 Agnibala assessment
3.25 Dehabala assessment
3.26 Satvabala assessment
4 Glossary of Ayurvedic terms
5 Brief report of expert meet
6 Brief technical report of national workshop
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A GUIDELINE TO USER’S OF THIS MANUAL
• This clinical research format is meant for clinical research personnel who have prior
exposure to Ayurveda and Ayurvedic terminologies.
• This guideline is presented in three parts, first part deals with general instructions and
some examples for calculation of overall effect of therapy and Agnibala of the patients.
The second part in CRF – 1 which is for patient data recording, a preliminary screening
Proforma and the third part comprises of the gradation of symptoms. The gradation of
symptoms are presented in two forms, viz. one general symptoms seen in Srotas and
second is with symptoms specific diseases corresponding to the Srotas.
• CRF – 1 [Clinical Research Format – 1] comprises of assessment of Roga bala Deha
bala Agni bala and Satva bala of the patients as per the description given in Charaka
Samhita (Ref. Charaka Samhita, Vimana Sthana Chapter 4).
• The specific disease related symptom presentation should be appended with CRF – 1 i.e.
questions specific to the diseases according to the Roga and its variants such as Dosha
etc.
• Roga Bala Pariksha is done in three headings viz. Kapha Varga, Pitta Varga and Vata
Varga. In each category it is further divided into Dosha Pariksha, Srotas involvement and
other systemic examination findings and supportive modern investigations if any
pertaining to these Srotases.
• Systemic examinations of the modern clinical methods are included within the Srotases
concerned, and so no separate systemic examination may be required.
• For each symptom of the Srotas involved suitable scoring pattern or gradation to be
adopted.
• Some symptoms are seen repeated in many places, such symptoms are kept under
‘General symptomatology’ heading; they are to be applied in required Srotas and diseases
by the research scholar. Similarly more one type of gradation may be applied to one
symptom from different angle of evaluation; they are also kept side by side in the text.
• Agni Bala: A Agni Bala Index (ABI) calculation is given in this which is basically for
Snehapana. But the same may be used in other research works too, wherever Agnibala is
in question.
• With regards to Quality of Life (QOL) parameters, the established WHO’s QOL
parameters may be used in research works of Ayurveda.
• Wherever parameter is expressed in terms of numbers i.e. Numerical Data / Quantitative
Data (e.g. Mutra Madhurya or glycosurea is expressed in terms of percentage; body
9
temperature in terms of degree centigrade or Fahrenheit), there is no need of any
gradation, the number itself is to be considered as grade; increase or decrease (as the case
may be) in the number is improvement in the grade of the symptom.
• A ‘Prakriti Self Analysis Questionnaire’ and ‘Prakriti Analysis Proforma’ (to be
performed by the observer) are given as Annexure, which may be used by research
scholars to assess the Doshic Prakriti of the patients.
• With regards to Good Clinical Practice (GCP), the guidelines issued by Dept. of AYUSH
for Ayurveda, Unani, Siddha system of medicines is to be followed.
• The ICMR “Ethical Guidelines for Biomedical Research in Human Participants” also
to be followed in all clinical research projects wherever applicable.
• The WHO guidelines for TRM give basic information regarding conduct of clinical
research in traditional systems of medicines; the applicable parts may be utilized in
Ayurveda clinical research too.
• Ethical clearance from the Institutional Ethics Committee or appropriate body is
mandatory for all clinical research projects.
• The plan of research should include specific inclusion & exclusion criteria, good and
appropriate (blinding – single/double/triple, black box, pilot study, single case study etc.)
study design and the outcome should be evaluated by applying suitable statistical
methods. The sample size to be calculated by applying appropriate sample size
calculation method as put forth by WHO, ICMR and such other research agencies. For
evaluation of the outcome specifically for the Srotas the given gradation of symptoms
may be used.
• Research personnel are advised to note that where ever short forms are used, it is to be
clearly defined.
• A unique arbitrary scoring method has been developed for evaluation of total outcome of
the clinical research. This arbitrary scoring method may be adapted to each clinical
research where in the total score would be 100; it is divided in four sectors relating to
Rogabala, Dehabala, Agnibala and Chetas / Satvabala, by giving due consideration and
weightage to Rogabala. The quality of life outcomes are measured using Dehabala,
Agnibala and Chetas / Satvabala. The disease in which Roga is strong in comparison to
other, then Rogabala will get maximum weightage, disease in which Satvabala /
Chetasbala is weak and needs maximum improvement, there it will get more weightage
in this scoring method, however the maximum being 100.
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• The research team should decide the arbitrary scoring division in the beginning itself
before starting the clinical research work, with a suitable hypothesis so that at the end
outcome may be measured.
• All the accepted grading systems of modern medicine to be adopted as such without any
alterations in appropriate symptoms or signs.
• The technical words of Ayurveda are given in Sanskrit language in the whole of the text
and glossary (meaning near to the Sanskrit word) for the same is also provided.
Overall assessment of therapy:

An arbitrary scoring can be framed by the research team depending upon the disease on
which the study is planned and also on the expected outcome. While framing this, the
division should be made in such a way that the more severe complaint where the result is
highly expected should be given higher preference and the chronic and less important
complaint should be given minimum importance. Deha Bala, Agnibala and Satvabala should
be given proportionate significance in the 100 marks scoring pattern.
The gradation or score given here are representative scores depending upon the severity of
individual symptom and its importance in the particular disease, this gradation may not match
with that given in the third part of the manual. Research scholars are at their liberty to make
suitable adjustments in the scoring pattern to suit to the disease and the role and importance
of that particular symptom in the given disease. Sometimes the scoring may have to be done
in decreasing or negative order in order to get the correct reading, and at some places scoring
either side may also be required (e.g. -1, 0, +1 etc.), this again depends upon the disease and
symptom in question.
The scoring pattern (clinical symptom gradation) used here may vary with that given in the
next section of this manual, suitable modification in the scoring pattern to be made by the
research scholar, which is dependent upon the research question or disease and anticipated
outcome. It is the liberty of the research scholar to do necessary modifications without
altering the basic structure of the arbitrary scoring pattern and care to be taken that it should
not cross 100 in total, within this how much importance to be given to Rogabala, Agnibala,
Dehabala and Chetasabala is purely dependent upon the disease and the immediate result
anticipated by a particular treatment protocol. For e.g. in Tamaka Shwasa, Roga bala is given
more importance and percentage whereas in a disease of psychiatric origin Chetasabala will
be given more importance and percentage of points. Few examples are given below:
EXAMPLE 1: TAMAKA SHVASA:
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Total 100 score has been divided in following- Rogabala, Dehabala, Agnibala and
Chetasabala as -
Rogabala 60
Agnibala 20
Dehabala 10
Chetasabala 10
ROGA BALA (60)

Rogabala has been given 60 score out of 100 for degree of disease activity and symptoms.
This score has been further subdivided as following.
Shvasa Kashtata - 25
Dyspnoea 5 Duration 4
Intensity 4 Presence of Pranavaha Sroto Dusti Lakshana 4
Frequency 4 Asino Labhate Saukhyam 4
Kaasa - 10
Kaasa 4 Kaasatah Sanniruddhyate 2
Kaphanishtivanama 2 Shleshma Vimokshante Saukhyama 2
Associated Symptoms - 10
Peenasa 2 Parshvashula 2
Kanthodhvansana 2 Ushnabhinandati 2
Trita / Vishushkasyata 2
Wheeze -5
A.E.C -5
PEFR -5
AGNIBALA (20)
It has been further divided into as follows;
Abhyavaharanashakti 6 Jaranashakti 6
Ruchi hi Aaaharakale 4 Vata Mutra Purisha Retasam Mukti 4
DEHABALA (10)
It has been further divided into as follows;
Balavriddhi 4 Swara Varna Yoga 4 Sharira Upachaya 2
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SATVABALA (10)
It has been further divided as follows;
Nidra Labhoyathakalam 4
Sukhena Cha Pratibodhanam 2
Vaikarikanam Cha Swapnanam Adarshanam 2
Mano Buddhi Indriya Avyappatti 2
OVERALL ASSESSMENT OF THERAPY:

On the basis of percentage relief in sign, symptoms and investigation reports further scores
have been allotted e.g. If Jarana Shakti was having 60% Relief then this has been given 3.6%
score from the total 6 scores given to Jaranashakti.
Total Score obtained in Rogabala, Dehabala, Chetasabala & Agnibala assessed in terms of
No improvement - 0
Mild improvement - 0-25
Improved - 26-50
Marked improvement - 51-75
Complete remission - 76-100
To establish the results statistically each sign & symptom may be given a specific score:
1) Frequency of Shvasa Vega:
0 - No attack during last 1 month
1 - Frequency of attack once in a month
2 - Frequency of attacks once in two weeks
3 - Frequency of attacks once in a week
4 - Frequency of attacks twice in a week
5 - Frequency of attacks once or more than once in a day.
2) Duration of attack
0 - No episode of attack
1 - Attack lasting for duration of 1/2 - 1 hr.
2 - Attack lasting for duration of 1 - 6 hr.
3 - Attack lasting for duration of 6 - 12 hr.
4 - Attack lasting for duration of 12 hr.
5 - Attack lasting for duration of more than 12 hours.
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3) Intensity of attack:
0 - Asymptomatic and normal lung function between exacerbations.
1 - Intermittent symptoms < once a week. Brief exacerbation (from a few hours to
few days), night time symptoms < 2 times a month.
2 - Symptoms > once a week but < once per day, exacerbation affect activity &
sleep, night time asthma symptoms > twice a month.
3 - Symptoms daily exacerbations affecting activity and sleep, night time asthma
symptoms > 1 times a week.
4 - Continuous symptoms, frequent exacerbations, frequent night time asthma
symptoms& physical activity limited by asthma symptoms.
4) Shvasakrichhrata :
0 - No sign of Shvasakrichhrata
1 - Mild intercostal retraction, Nasal alae flurring & can speak complete sentences
during dyspnoea.
2 - Intercostal retraction, sterrnocleidomastoid muscle use & speaks in phrases or
partial sentences during dyspnoea.
3 - Tracheosternal retraction, Intercostal retraction, sternocleidomastoid use & speak
in single words during dyspnoea.
4 - Nasal alae flurring & cannot able to speak during dyspnoea.
5 - All accessory muscles are working & not able to speak, expresses by body
language.
5) Asino labhate Saukhyam :
0 - Relief on lying position
1 - Temporarily feels better in sitting posture
2 - Sitting posture gives relief.
3 - Spontaneous sitting posture, can't sleep.
6) Presence of Pranavaha Sroto dushti lakshana :
Absent - 0
Less than 25% - 1
Between 25 - 50% - 2
Between 50 - 75% - 3
More than 75% - 4
7) Kaasa:
0 - No cough
1 - Cough dry without pain / wet with easy expectoration.
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2 - Dry cough with pain &expectoration with slight difficulty.
3 - Dry cough with severe pain stabbing, cutting / feeling of restlessness because of
difficulty in expectoration.
4 - Frequent coughing due to which patient becomes unconscious / Fainting.
8) Kapha Nistivanam :
0 - No Kaphanishtivanam
1 - Kapha nistivanam only in the early morning
2 - Kapha nistivanam 2 - 3 times daily
3 - Always Kapha nistivanam.
9) Kaasatah Sannirudhyate:
0 - No such feeling
1 - Occasional Kasatah Sannirudhyate
2 - Very often Kasatah Sannirudhyate
3 - Always Kasatah Sannirudhyate
10) Shleshma Vimokshante Muhurtam Sukham:
0 - No such feeling
1 - S.V.M. Sukham during attack
2 - Very often S.V.M. sukham
3 - Always S.V.M. sukham
11) Wheezing:
0 - No wheezing
1 - Wheezing only at early morning; doesn’t require any medicine
2 - Wheezing at early morning; requires medicine
3 - Wheezing at early morning & occasionally during day time.
4 - Wheezing throughout the day & requires medicine
5 - Wheezing throughout the day & not responding to any medicine, requires
hospitalization.
12) Ronchi / Crepts:
0 - Absent on normal breathing but few ronchi on forced breathing.
1 - Few scattered bilateral ronchi on normal deep breathing.
2 - Ronchi in between grade 1 & 3 on normal deep breathing.
3 - Innumerable high pitched bilateral ronchi on normal deep breathing.
13) Peenasa:
0 - No Peenasa
1 - Peenasa during attack & subside 1-2 days after attack
15
2 - Peenasa during attack & persists for a week after attack
3 - Peenasa very often without attack
4 - Peenasa always persisting
14) Urahshula / Parshvashula:
0 - No Urahshula
1 - Urahshula along with the attack
2 - Very often Urahshula even without attack but relieved by local Snehana &
Swedana
3 - Very often Urahshula without attack & not relieved by local Snehana &
Swedana
4 - Always Urahshula
15) Kanthoddhvansanam (Irritation in throat)
0 - No Kanthoddhvansanam
1 - Occasional Kanthoddhvansanam
2 - Very often Kanthoddhvansanam
3 - Always Kanthoddhvansanam
16) Trit (Trishna) / Vishushkasyata:
0 - No Trit / Vishushkasyata
1 - Occasional Trit / Vishushkasyata
2 - Very often Trit / Vishushkasyata
3 - Always Trit / Vishushkasyata
17) Ushnabhinandati:
0 - No particular
1 - Likes if available
2 - Always prefer
3 - Can't take cold things
AGNI BALA:
18) Jaranashakti:
Scoring according to Jeerna Aahara lakshana present after 6-8 hrs after taking food
They are Utsah, Laghuta , Udgarshuddhi , Kshut ,Trishna pravritti Yathochit malotsarga.
0 - presence of five symptoms
1 - Presence of four symptoms
2 - Presence of three symptoms
3 - Presence of two symptoms
4 - Presence of one symptom
5 - Absence of all the symptoms
16
19) Abhyavaharan Shakti :
0 - Taking food in good quantity twice / thrice
1 - Taking food in normal quantity twice a day
2 - Taking food in moderate quantity twice a day
3 - Taking food in less quantity twice a day
4 - Person taking food in less quantity once in a day
5 - Person not at all taking food.
20) Ruchi :
0 - Equally willing towards all the Bhojya padartha
1 - Willing towards some specific Aahara / Rasavisesha
2 - Willing toward only one among Katu/Amla/Madhura food stuffs.
3 - Willing towards only most liking foods not to the other.
4 - Unwilling for food but could take the meal
5 - Totally unwilling for meal.
21) Vaata Mutra Purisha Retasam Mukti :
0 - Occurs easily in normal routine times
1 - Difficulty in defecation but Malapravritti daily with discomfort in abdomen.
2 - Can't pass stool daily & feeling heaviness in abdomen.
3 - Passes stool after 2-3 days having gaseous distension
4- Passes stool after 3-4 days with Grathita, Sakasta Malapravritti & having gaseous
distention with Udgarapravritti.
DEHA BALA:
22) Balavriddhi:
0 - No weakness
1 - Slight weakness
2 - Feeling of weakness but ability to work unaffected
3 - Ability to work affected
4 - Can't do any type of work
23) Swara Varna Yoga :
Texture, Lusture & voice :
2 - Patient looks gloomy
1 - Lethargic & tired
0 - Patient looks cheerful
17
24) Sharira Upachaya
0 - No change
1 - Increases weight by 2kg
2 - Increases weight by more than 2kg
SATVABALA:
25) Nidra Labho Yathakalam :
0 - Sound sleep
1 - Sleep gets disturbed in the early morning
2 - Sleeps with disturbed interval & remains unsatisfied with sleep
3 - Disturbed sleep in night tries to compensate in day
4 - No sleep in day / night
26) Sukhena - Cha - Pratibodhanam:
0 - Total relief & feeling of well being at physical & mental level
1 - Improved in physical comfort level
2 - Improved in physical & mental level
3 - Not feeling well & not interested in any work
27) Vaikarikanama - Cha - Swapnanam Adarshanam:
0 - Absent
1 - Occasionally
2 - Daily
28) Mano Buddhi - Indriya Avyapatti:
0 - Enthusiastic, Vigorous, having concentration & interest in routine work
1 - Less enthusiastic & not concentrating but interested in routine work
2 - Less enthusiastic & not interested in routine work
3 - Loss of enthusiasm, concentration & vigor.
Criteria of Assessment:
Symptomatic relief obtained by the treatment given was assessed B.T. (Before Treatment)
and A.T. (After Treatment) with following criteria; they were graded on the basis of scoring
pattern.
1. Frequency of Swasa Vega
0 - No Attack.
1 - 2-3 Times in 3 Week.
18
2. Duration of Attack
0 - No episode of attack
1 - Attack lasting for duration of 10 min.
3. No. of emergency med. Taken/ wk.
0 - not needed.
1 - 2-3 doses occasionally in a Week.
2 - 2-3 doses occasionally in Alternate days.
3 - 2-3 doses regularly.
4. Presence of Pranavaha Srotodusti Lakshana
(Dyspnoea / Freq. Exp. / Very restricted Exp. / Prolonged Exp./ With Loud sound painful /
Difficulty in speaking / Sweating )
0 - Absent.
1 - Any 1or 2
2 - Any 2 or 3
3 - More than 4.
5. Asino Labhate Saukhyam (relieved with sitting position)
0 - No effect.
1 - Temporarily feels better.
2 - Sitting posture gives relief, patient can sleep.
3 - Spontaneous sitting posture / can’t Sleep.
6. Kasa (coughing)
0 - Absent.
1 - Cough with expectoration with slight difficulty
2 - Cough with pain difficulty in expectoration, patient can tolerable.
3 - Freq. coughing with more difficulty in expectoration, patient can’t tolerate.
7. Kapha nisthwana (Sputum)
0 - Absent.
1 - Only in morning.
2 - 4-5 times / day.
3 - Continuously.
8. Kasatah sannirudhyata (feeling of unconsciousness in effort to expel out the sputum)
0 - Absent.
1 - During Attack
19
2 - Without attack at any time.
3 - Always.
9. Shleshma vimokshante sukhum (Get relief after expel out the sputum)
0 - Absent.
1 - During Attack
2 - Without attack at any time.
3 - Always
10. Peenasa (Coryza)
0 - Absent.
1 - During attack & subside 1-2 days after attack
2 - During attack & persists for a wk. after attack
3 - Very often without attack
11. Parshvasula (Pain in thoracic region)
0 - No Shula
1 - Along with Attack / Cough
2 - Very often without attack, relived by Snehana / Swedana
3 - Very often even without attack, not relived by Snehana / Swedana
4 - Always.
12. Kanthodhvansanam (Throat irritation)
0 - No
1 - intermittent without cough.
2 - During cough.
3 - without cough.
13. Trita
0 - Normal feeling.
1 - Increased by 4-5 times / day.
2 - Increased by 6-8 times / day.
3 - More than 8 times.
14. Usnabhinandati (Liking for hot food & drink)
0 - No such feeling.
1 - Generally avoid Cold thinks.
2 - Prefer hot drinks.
3 - Always take hot food & drinks.
15. Wheeze
0 - No wheezing
1 - Few wheezing
2 - Few scattered unilateral.
3 - Few scattered bilateral.
20
EXAMPLE 2: AMAVATA
The improvement in the patients were assessed on the basis of Roga Bala, Agni Bala, Deha
Bala and Chetasa Bala which were scored as follows:
60 - Rogabala
20 - Agnibala
10 - Dehabala
10 - Chetasabala
These points are discussed in detail as follows:
• ROGABALA
Rogabala has been given 60 score out of 100 for degree of disease activity and symptoms of
Amavata. It has been further divided into (30+30):
I. 30 score to –
Degree of disease activity to be assessed on the basis of American Rheumatism
Association criteria (modified)
Grade 0 1 2 3
1) Fatigue Not there Work full Patient must Fatigued at
time despite interrupt work rest
fatigue to rest
2) Grip strength 200 mmHg or 198 to 118 to 70 Under
more 120mmHg mmHg 70mmHg
3) Spread of joints Not there 0 to 50 51 to 100 Over 100
4) Westergren ESR (in 0 to 20 21 to 50 50 to 100 Above 100
1st hour)
5) Haemoglobin (gm%) 12.5 or more 12.4 to 11 10.9 to 9.5 <9.5
6) General function All activity Most activity Few activity Little self
without but with cares for self care mainly
difficulty difficulty on chair &
bed
7) Patients estimate Fine Almost well Pretty good Pretty bad
8) Physicians estimate Inactive Minimally Moderately Severely
active active active
Apart from these criteria of ARA (1987) two other criteria were added here.
9) Foot pressure 36-40 kg 31-35 kg 26-30 kg <20 kg
10) Walking time (for 15–20 sec. 21-30 sec. 31-40 sec. >40 sec.
25 feet)
21
II.30 score - Assessed on the basis of the symptoms of Amavata which has been further
subdivided as : (14+10+6)
A. 14 score – To cessation of cardinal symptoms like
a) Sandhishoola (Pain in joints) Score
No pain 0
Mild pain 1
Moderate pain, but no difficulty in moving 2
Slight difficulty in moving due to pain 3
Much difficulty in moving the bodily parts 4
b) Sandhishotha (Swelling in joints)
No swelling 0
Slight swelling 1
Moderate swelling 2
Severe swelling 3
c) Sparshasahyata (Tenderness in joints)
No tenderness 0
Subjective experience of tenderness 1
Wincing of face on pressure 2
Wincing of face and withdrawal of the
affected part on pressure 3
Resist to touch 4
d) Sandhigraha (Stiffness in joints)
No Stiffness or Stiffness lasting for 5 mins. 0
5 min to 2 hrs 1
2 to 8 hrs 2
More than 8 hrs 3
B. 10 score to – Associated symptoms like
a) Jwara, Alasya, Gaurava, Asyavairasya, Daurbalya, Akarmanyata, Utsahahani,
Angamarda, Daha, Trishna were scored as mentioned below –
Symptoms observed before treatment 10
Some relief after treatment 05
Complete relief after treatment 00
No improvement after treatment 10
22
C. 6 score to – Physiological normalcy which was further divided into
a) Vata (i.e. relief in Anaha, Kukshishoola, Kukshikathinya, Antrakujan) 2
b) Mutra (i.e. relief in Bahumutrata) 2
c) Purisha (i.e. relief in Vibandha) 2
Each of above three can be scored as -
- Symptoms observed before treatment 2
- Some relief after treatment 1
- Complete relief after treatment 0
- No improvement after treatment 2
• AGNI BALA
It has been given 20 score out of 100 which has been further divided into (4+8+8).
A. 4 score - To Ruchihi ahara kale (Taste and appetite)
B. 8 score to Abhyavaharanabhilasha (Revival and improvement in hunger)
C. 8 score to Ahara Kala Samyagajaranam (Digestion of ingested food within time) – If
proper at the end of digestion will give Jirna Ahara Lakshana – they are
1) Utsaha
2) Laghuta
3) Udgar Shuddhi
4) Shutta Trishna Pravriti
5) Yathochhita Malotsarga
Scoring according to Jirna Ahara Lakshana
Presence of all (five) symptoms after 6 hrs - 0
Pravara
Presence of four symptoms after 6 hrs - 2
Presence of three symptoms after 6 hrs - 4
Madhyama
Presence of two symptoms after 6 hrs - 6
Presence of one symptom after 6 hours - 8 Avara
• DEHABALA
Dehabala has been further divided into: (3+3+3)
A. 3 score to – Swara Varna Yoga (Revitalization of speech and luster)
B. 3 score to – Sharira Upachaya (increase in body mass/weight & gain in muscle wasting)
C. 3 score to – Balavriddhi (increase in body strength)
• CHETASA BALA
Chetasa bala has been given 12 score which was further divided as : (2+2+3+3)
A. 2 score to – Nidralabho yathakalam (Sleep in proper time and cessation in symptom
Nidra-viparyaya).
23
B. 2 score to – Vaikarika Swapnanama Adarshanam (No pathological dreams)
C. 3 score to – Mana Buddhi Indriya Avyapatti (Proper and unaltered functioning of mind,
intellect and sense organs)
D. 3 score to – Sukhen Cha Pratibodhanam (Feeling of well being)
II. OVERALL ASSESSMENT OF THERAPY
Overall assessment of all the therapies will be done according to calculated score in terms
of:
Complete remission : 0 – 25 score in assessment criteria
Major improvement : 26 – 50 score in assessment criteria
Minor Improvement : 51 - 75 score in assessment criteria
Unchanged : 76-100 score in assessment criteria
EXAMPLE 3: AMLAPITTA
Total 100 score has been divided in following Rogabala, Dehabala, Agnibala and Chetasbala
as follows -
Rogabala 50
Agnibala 25
Deha + Chetasbala 25
Rogabala (50): Rogabala has been given 50 score out of 100, for degree of disease activity
and symptoms. This score has been further subdivided as follows –
Daha -6 Amlodgara -6 Shula -6
Chhardi -5 Adhmana -5 Angasada -5
Gaurava -5 Tama -4 Bhrama - 4 Kampa - 4
Agnibala (25): It has been further divided into as follows.
Aruchi -5 Abhyavaharana Shakti- 7
Avipaka- 7 Purisha Utsarga -6
Dehabala and Chetasbala (25): Looking to the less availability of the symptoms of
Dehabala and Chetasabala both have been grouped in one and 25 score has been further
subdivided as follows -
Shrama -5 Chittodvega- 4 Nidra- 5
Klama- 3 Swapna- 3 feeling of well being -5
There was no any gain or loss of weight before and after the treatment for which Shrama was
only symptoms reported by the patients under the category of Dehabala.
24
Assessment of total effect of therapies: The overall assessment was calculated on the basis
of average improvement in the percentage relief of Rogabala, Agnibala, Deha and
Chetasabala score.
1. Complete remission – 100%
2. Marked improvement – 76% to 99%
3. Improvement – 51% to 75%
4. Mild improvement – 26% to 50%
5. Unchanged – Below 25%
Scoring pattern may be adopted to assess the relief in each symptom as follows-
Rogabala
Daha
• No Daha 0
• Daha in any one area of Udara, Ura, Kukshi/ occasionally for more than half an hour.1
• Daha in any 2 area/ occurs daily for half hour to one hour 2
• Daha occurs daily in more than two area for one hour or more and relieves after
digestion of food or vomiting. 3
• Daha involving most of the areas patient may not sleep at night and does not relieve by
any measure. 4
• Severe degree of Daha involving the whole body like hands, feet or Sarvanga and does
not relieves by any measure. 5
Amlodgara
• No Amlodgara at all 0
• Occasionally during day or night for less than half hour after meals. 1
• Amlodgara occurs daily for two to three times for ½ - 1 hrs. and relieved by sweets,
water and antacids 2
• Amlodgara after every intake of meal any food substance for half to one hour, and
relieved by digestion of food or vomiting 3
• Amlodgara for more than one hour not relieved by any measure 4
• Amlodgara disturbing the patient’s even small amount of fluid regurgitate to patients
mouth (Dantaharsha) 5
Shula
• No pain 0
• Mild/ occasional pain which need not any medication 1
• Pain (abdomen) for less than half an hour and relieved after intake of sweets cold drinks
food antacid milk etc. 2
25
• Abdominal pain due to ingestion of food and relieves after digestion of food or by
vomiting. 3
• Severe unbearable pain which does not subside by any measure and the patient awake
in the night 4
• Unbearable pain associated with frequent vomiting and hematemesis 5
Chhardi/ Hrillasa/ Asyapraseka
• No vomiting at all 0
• Frequency of salivation on every day (Asyapraseka) 1
• Feels sense of nauseating and vomits occasionally (Hrillasa) 2
• Frequency of vomiting is two to three times or more per weeks and comes
whenever Daha or pain is aggravated 3
• Frequency of vomiting is daily 4
• Frequency of vomiting after every meal or even without meals 5
Adhmana
• No Adhmana 0
• Occasionally feelings of distension of abdomen 1
• Daily after intake of food up to 1 hour with mild distension of abdomen 2
• Distension of abdomen up to 1 -3 hours after intake of food 3
• Moderate distension of abdomen up to 6 hours after intake of food 4
• Severe distension of abdomen up to more than 6 hrs after intake of food 5
Tama
• No feeling of Tama 0
• Occasional feeling of Tama 1
• Feeling of Tama < 2-3 times a day 2
• Feeling of Tama 3-6 times a day 3
• Many times a day with problem in maintaining posture, tries to sit 4
Bhrama
• No Reeling of head/ Bhrama 0
• Sometimes feeling of reeling head/ Bhrama 1
• Feeling of reeling head/ Bhrama < 3 times a day 2
• Feeling of reeling head/ Bhrama > 3 times a day 3
• Frequently feeling of reeling head change of posture causes the severe problem 4
26
Kampa
• No presence of Kampa 0
• Occasionally present 1
• Mildly present one times feeble 2
• Moderately present i.e. visible disturbs holding light weight articles like news paper 3
• Severely present not able to do routine work like buttoning, eating etc. 4
Angasada/Gaurava
• No heaviness 0
• Occasionally feeling of heaviness for sometimes in hands and feet 1
• Feeling of heaviness for sometimes in hands and feet not affecting activities of daily
living 2
• Daily feeling of heaviness over body, which leads to Akarmanyata 3
• Most part of the body for long duration 4
• All body for most part of the day 5
Klama
• No Klama 0
• Occasionally feeling of lassitude without Shrama and remains for sometimes and
vanishes 1
• Lassitude without Shrama daily for sometimes 2
• Lassitude without Shrama daily for long duration 3
• Always feels tired and have no enthusiasms 4
Nidra
Paittika
• Even the patient may not sleep in night due to irritation in abdomen 5
• Patient can sleep < 3 hrs with severe irritation in abdomen 4
• Patient can sleep < 3 hrs with moderate irritation in abdomen 3
• Patients can sleep up to 3 – 6 hrs with mild irritation in abdomen 2
• Patient can sleep up to more than 6 hrs without any irritation 1
Kaphaja
• Normal / sound sleep 0
• Patient sleep up to 6 hrs without any disturbance 1
• Sleep deeply up to 8 hrs 2
• Sleeps up to 10 hrs 3
• Sleeps up to > 12 hrs 4
• Even patient may sleep during day time 5
27
Feeling of well being
• Feeling very well 0
• Occasionally feels discomfort 1
• Feels discomfort mildly and not able to concentrate to his work 2
• Feels discomfort moderately and feels depressed 3
• Feels discomfort severely and remains gloomy most of the time 4
• No feeling of well being at all 5
Agnibala
Avipaka
• No Avipaka 0
• Indigestion / prolongation of food digestion period occasionally related to heavy meals 1
• Avipaka occurs daily after each meals takes four to six hours for Udgara shuddhi etc.
lakshana 2
• Daily after each meals / seldom feels hunger but eats the food 3
• Eats only once in a day and does not have hunger by evening 4
• Never gets hungry always heaviness in abdomen followed by vomiting etc. Lakshan 5
Aruchi
• Willing towards all Bhojya Padarth 0
• Unwilling towards some specific Ahara but less than normal 1
• Unwilling towards some specific Rasa i.e. Katu/ Amla/ Madhura food 2
• Unwilling for food but could take the meal 3
• Unwilling toward unliking foods but not to the other 4
• Totally unwilling for meal 5
Abhyavaharana Shakti
• Taking of food in good quantity twice/ trice 0
• Taking food in normal quantity twice a day 1
• Taking food in moderate quantity twice a day 2
• Taking food in less quantity twice a day 3
• Person taking food in less quantity one in a day 4
• Person not at all taking food 5
Purisha Utsarga
• Occurs easily in routine times 0
• Sometimes feeling difficulty in defaecation 1
28
• Difficulty in defaecation but Mala Pravriti daily with discomfort in abdomen 2
• Can’t pass stool daily and feeling heaviness in abdomen 3
• Passes stool after 2 – 3 days having gaseous distension 4
• Passes stool after 3 -4 days with Grathita, Sakasta Mala Pravritti
and having gaseous distension with Udgara Pravritti 5
DEHABALA & CHETAS BALA
Shrama
• No Shrama 0
• 10% feels tired with some amount of work which was tolerable previously 1
• 20% early Shrama with some amount of physical activity 2
• Reduction of up to 50% in physical activity tolerance 3
• Patient get exhausted with minimal physical daily routine work 4
Chittodvega
• No 0
• Associated with less psychic involvement 1
• Associated with moderate psychic involvement 2
• Associated with sever psychic involvement 3
• Associated with psychic involvement as well as somatic involvement 4
Swapna
• No 0
• Occasionally not disturbing sleep 1
• Occasionally, disturbing sleep 2
• Regularly dreams not disturbing sleep 3
• Frequent dreams with severe disturbing of sleep 4
AGNI BALA INDEX:

Assessment for Agni:
Agni is assessed based on three factors viz Jarana Shakti (Digestion power). Ruchi (Appetite)
and Abhyavaharana shakti (Hunger).
(A)Evaluation of Jarana shakti (Digestion power)
If digestion process is proper, then at the end of digestion, it should give rise to Jeerna Ahara
Lakshana which includes Utsaha (enthusiasm), Laghuta (lightness in the abdomen & body),
Udgara Suddhi (clear belching), Ksudha (hunger), Trisha Pravrtti (thirst) and Yathocita
Malotsarga i.e. proper excretion of excretory material like flatus, urine and feces. According
29
to Ayurveda a normal diet in persons with normal Agni should be digested within 6 hours
though it is individual specific. The Signs of appropriate quantity of food are no
obstruction in heart, no pain in sides(Flanks) no excessive heaviness in abdomen, saturation
of sense organs, cessation of hunger and hunger, ease in standing, sitting, lying down,
movement &movement, easily digestion of food before next food timings (Morning-
evening), promotion and development of strength, complexion and body mass. The scoring
may be given to each of above symptom for assessment of Jarana Shakti.
A -Scoring according to Jeerna Ahãra Laksana
Note: this scoring is applicable for an individual who ingests normal required quantity of
food in appropriate timings food intake (Aharakala).
Score
1. Absence of all the symptoms 0 Avara
2. Presence of one symptom 1 )
3. Presence of two symptoms 2 Madhyama
4. Presence of three symptoms 3 )
5. Presence of four Symptoms 4 Pravara
6. Presence of All the five symptoms 5 )
B) Assessment of Abhyavaharan Shakti

1. The person not at all taking food 0 Avara
2. Person taking food in less quantity once in a day 1
3. Taking food in less quantity twice a day 2 Madhyama
4. Taking food in Moderate quantity twice a day 3
5. Taking food in normal quantity twice a day 4 Pravara
6. Taking food in excessive quantity twice or thrice 5
C) Evaluation for Ruchi
1. Totally unwilling for meal 0

2. Unwilling for food, but could take the meal 1
3. Willing towards only most liking food, and not to other 2
4. Willing towards only one among Katu/AmlalMadhura food stuffs 3
5. Willing towards some specific Ahãra or Rasa Vishesa. 4
6. Equal willing towards all the Bhojya Padartha. 5
Another method of evaluation of Jarana Shakti and Abhyavaharana Shakti is rather a vague
method of Avara (Poor), Madhyama (moderate) and Pravara (Good).
Kshudha Pravritti – Increase in appetite and an individual feels to take food when Kshudha –
hunger is there. Each type of diet has its own time for digestion which is called as Pachana
Kala and when Agnibala is increased Pachana Kala reduces. Thus Pachana kala and
quantity of diet play very important role in deciding the Agnibala. As Agnibala increases, the
Pacana Kala should decrease, even in the same quantity of diet, otherwise when the quantity
is increased, the duration for its digestion should also increase in the same proportion.
30
This can be tested effectively in a therapeutic procedure called Snehapana wherein a
specific quantity of medicated or plain Ghee is administered and for Sneha, ‘Abbyavaharana
Index’ may be graduated as follows -
A.I. = Test dose (T.D.)

(Abhyavaharana Index) Given dose / day (G.D.)
So for the first day if 30ml is the dose given then AI= 30/30 = 1 i.e. T.D. = G.D.
So If A.I. is more than 1, then it is pointed towards Agnimandya; and if A.I. is less than
1, then it shows an improvement of Abhyavaharana Shakti.
With the help of this Abhyavaharania shakti, one can calculate Agnibala. To set
Agnihala, we have to consider the second factor, i.e. Kala - the time required to digest the
given dose of Sneha. By multiplying the A.I. with time (t) required for digestion, we can get
Agnibala index (A.B.I.)
A.B.I. =T.D. /G,D. X time (t) =A.I. X t.
If the A.B.I. remains less than that of the calculation with the time required to digest
the test dose and accordingly increase every day, then we can say that Agnibala is
increased.
Eg. 30 ml is the Test Dose [T.D.] and it is digested in 3 hrs. then AI = 30/30 = 1
A.B. I. - 1 X 3 = 3.
If 300 ml. dose is digested in 7 hrs. in same person in a later day then
A.B.I. = 30 I 300 X 7 = 0.7 [T.D. = 30 ml, G.D = 300 ml. t = 7 hr.]
The initial A.B.I. was 3, which was reduced to 0.7 in the same person after some days;
as per simple mathematical calculation the person should take 30 hrs. to digest 300 ml but as
the Agnibala is increased, the time taken for digestion reduced to 7 hours.
Thus it is concluded that Lesser the A.B.I., more will be the Agnivriddhi. So A.B.I.
may be taken as a standard scoring pattern for Ksudhapravritti, with appropriate quantitative
measures, ABI calculation may be taken as a tool for assessment of Agni.
31
Manual part 1: CRF - 1
GENERAL SCREENING PROFORMA – CRF 1
Sl. No.: Registration No.: Date:
Name : Vaya _____Years _____ Months ____ Days
Address Sex - Male / Female
Religion : H / M/ S / Ch / J / B / Other Desha Jangal/ Anoopa/ Sadharana

Jataha Samvriddha Vyadhita
Marital Status : UM/ M / D / W O.P.D. / I.P.D. No. :

Education : UE / E /P / M / HS / G /PG /_____ Ward/ Bed No.:
Occupation : Date of Registration. :
Socio-eco. Status : BPL /P / M / R/V R Date of Completion:
Income per annum: Diagnosis
PRADHAANA VEDANAA (Chief Complaints with duration)

(In chronological order)
CHIEF COMPLAINTS DURATION
1)
2)
3)
4)
5)
VEDANA SAMUCCHRAYA: (History of Present Illness with duration)

(In chronological order)
UPASAYA:
Ahara:
Vihara:
Aushadha:
ANUPASHAYA:
Ahara:
Vihara:
Aushadha:
POORVA VYAADHI VRITTA: (History of Past Illness)
VAIYAKTIKA ITIVRITTA: (Personal History) BT AT

1. AAHAARA:
Type of Diet: Vegetarian / Mix/Non- Veg
Dominance of Rasa (taste) in Diet: M / A / L / Kt / T / Ks
32
Dominant Guna in Diet: G /L / St / U / Sn / R
Dietary habits: Samasana / Adhyasana / Vishamaasana
Regular / Irregular
Other Habits: Tea / Coffee / Cold drinks / others
Quantity per day:
2. VYASANA (Addiction): Tobacco (Smoking / Chewing) / Alcohol / Drug abuse / Other

Quantity per day:
3. VIHAARA:
Danta dhavana: Daily once / twice / after every meal
Datun / Tooth paste / Tooth powder / Danta Manjana Churna
Vyaayaama: Regularly / Irregularly / No / Less / Proper / Excess
Vishraama (Rest): ______hrs. / day; ______hrs. / night
Abhyanga: Regularly / Irregularly / No / Less / Proper / Excess
Snaana: Daily / Irregular; Hot Water / Warm water / Tape
water
4. NIDRAA: Samyaka / Asamyaka; Alpa / Prabhuta / Khandita
_____hrs. /day _____hrs. / night
Swapna Darshana: Yes / No; If Yes, Vaikarika / Avaikarika / __________
5. KOSHTHA - BOWEL:
Santushta / Asantushta; Saama / Niraama
Kathina / well formed / Drava / Sakashtam / Vivarna / Alpa/Muhurmuhuh
Frequency: ______time / day Colour: Odour:
Vatapravrutti: Yes / No; Durgandha: Yes / No
Koshtha: Mridu / Madhya / Krura
6. MOOTRA PRAVRITTI- MICTURITION:

Mootra Pravritti: Samyaka / Krucchra / Vaivarnya / Daaha / Alpa / Prabhuta
frequency : ______times / day ______times / night
7. ARTAVA PRAVRITTI - MENSTRUAL HISTORY:

Regular / Irregular; ________ days cycle; Pain: Nil / Mild / Moderate / Severe;
Flow details: ______ Pads / day, _________ flow days
Use of contraceptives: Yes / No if yes specify:_______________
Menarche Age: Menopause Age:
8. PRASAVA - OBSTRETIC HISTORY:

No. of Delivery / Abortion / Miscarriage G P A L D
9. AGNI: Sama / Vishama / Manda / Ati agni

Ruchi: Yes / No
Jarana shakti:
AATURABALA (DEHA BALA) PARIKSHAA:
1)Prakriti:
Shaarira: V / P / K / VP /VK / PK / VPK
Maanashika: S / R /T
2)Saara: P/M/A
Dhatu Assessment BT Assessment AT
33
3)Samhanana: P/M/A
4)Pramaana : Height___ Weight_____ kg
5)Satva: P/M/A
6)Satva(Emot. make-up): Prakrita /Utsahita/Udrikta/Khinna/Avasadita/Bhavanatmaka
7)Saatmya: P/M/A
8)Vyaayaama Shakti: P/M/A
Note:
• Prakriti analysis may be done by using separate proforma attached
• Satva may be evaluated based on tolerance for sufferings (or pain tolerance)
• Vyaayaama Shakti may be evaluated by Tread Mill Test (TMT)
FAMILY HISTORY OF DISEASES HAVING GENETIC PREDISPOSITION:
FAMILY PEDIGREE:
HISTORY OF AUPASARGIKA ROGA:
HETU (NIDAANATAH) PARIKSHA:

NIDANA DOSHA DOOSHYA / SROTO AGNI KHA- VAIGUNYAKARA
PRAKOPAKA DUSHTIKARA MANDYAKARA
Ahara
Vihara
Manasika
Vyadhi
Vishesha
History of vegadharana/Vegodeerana:
Vega: Vegadharana since (duration) :
Vega: Vedodheerana since (duration):
Iatrogenic causes (if any):
ADR as cause (if any):

Note: Consider Kaala, Asaatmyendriyaartha Samyoga, Prajnaparadha while taking noting
down causative factors of the disease:
ROGA BALA PARIKSHAA:
KAPHAVARGA PARIKSHAA:
KAPHA DOSHA PARIKSHA
PAREEKSHA VRIDDHI / PRAKOPA KSHAYA
BHAAVA
Darshana Sweta- Twachaa, Mala- Mootra Rukshyataa / Sandhi Shaithilya
Sandhi Vishlesa / Swaasa / Kaasa
Utsedha / Sneha Upachaya / Lalasrava
Sparshana Shaitya / Sthairya /Snigdha / Kleda
Prashna Gourava / Avasaada / Tandraa / Aalasya, Trushnaa / Nidraa Naasha / Dourbalya /
Agnisaada / Praseka / Sandhivishlesha Antardaaha / Hriddrava / Bhrama /
Kandu / Sthairya / Upalepa / Kleebata / Aamaashayetara Shlema-aasaya
Utsaha Shunyataa / Shirasasa cha Sunyataa
34
RASA & RASAVAHA SROTASA PARIKSHAA:
PAREEKSHYA BHAAVA VATA PITTA KAPHA
Darshana Krishnaangataa / Sveda / Paandutwa / Vaivarnya /Pandu /
Rukshata / Sosha Akale-Vali-Palita /Shvetataa
Sparshana Loss of sensation Jwara Shaitya

Prashna Angamarda / Klaibya / Tama Alpa Kandu / Mukha
Asyavairasya / virasataa / Gurutaa /
Arasajnataa / Tandraa Aalasya /
Angamarda / Hrit- Utklesha / Hrillaasa
Kampa / Hrit Drava / /Aruchi / Praseka /
Hritpidaa / Hritsunyataa Vamana / Anna Dvesha
/ Trishnaa/Hritghattana/ /Agni Mandya/
Sabdaasahishnutaa / Asraddhaa / Aruchi /
Hritshoola / Sramah Hrillaasa /Srotorodha/
Saada/Hridayotkleda
Nadi – Pulse
Blood Pressure
Temperature
Biochemical Concerned / related biochemical investigations
investigations
Examination of cardio-
vascular system:
Hridaya
Dhamani
Twak
Lasika Granthi
Rasa –Rakta
Samvahana
ECG, X- Ray, USG,
Doppler studies for
circulation status, ECHO
studies etc.
Maintain before (BT), during (DT) and after treatment (AT) reading chart in all subjective and
objective parameters.
Upadhatu Pareeksha:
Stanya:
Stana:
MAMSA & MAMSAVAHA SROTASA PARIKSHAA:

PAREEKSHYA VATA PITTA KAPHA
BHAAVA
Darshana Suskataa -(Sphik- Putimaamsa / Alaji Vriddhi – Sphik- Ganda-
Ganda-Ostha-Upastha- Ostha- Upastha-Uru-
Uru- Vaksha –Kakshaa- Baahu-Janghaa /
Pindika- Udara-Grivaa Adhimaamsa /
Arbuda,Upachaya
Sparshana Roukshya /
Dhamani Shaithilya
35
Prashna Toda /Gaatra / Sadana Guru Gaatrataa
Khamala
Kandara and Vasa
Avayava Pareeksha
Snayu, Kandara,
Peshi, Twak
investigations
USG, X’ ray, MRI etc.
Upadhatu Pareeksha:
MEDA & MEDOVAHA SROTAS PARIKSHAA:

BHAAVA
Darshana Atidirgha / Atihraswa Alomaa, Sveda Snigdhaangataa / Udara
/ Atilomaa / Vriddhi / Paarshwa
Atikrishna Vriddhi / Atigoura /
Atisthoola / Jatili
Bhaavakeseshu /
Chhidreshu Upadeham /
Gaatre Pippilikaa Saranam
/ Mutre Pippilikaa
Saranam
Sparshana Plihaa Vriddhi
Prashna Kara - Paada Suptataa Dourgandhya / Daaha Kaasa / Swaasa /
/ Anga Suptataa / Mukhasosha / Maadhuryamaasye /
Taalusosha / Aalasya / Malakaaye
Kanthasosha / Mutradosha / Nidraa /
Pipaashaa / Paridaaha Tandraa, Ayasa
/ Vishragandha
Lipid profile
BMI / Body Wt.
Vapavahana, Ganda,
Sphika, Kati, Vrikka,
ECG, X- Ray, USG
investigations
Upadhatu Pareeksha:
MAJJA & MAJAAVAHA SROTAS PARIKSHAA:

BHAAVA
Darshana Parvasu Sthoola mulaani
Arunsi Janma /
Netraabhisyanda
Sparshana Asthi Soushiryataa
Prashna Parvaruk / Alpa Murchchhaa / Sarvaanga Gourava /
Sukrataa / Parva Tamodarshana / Netra Gourava
Bheda / Asthi Nistoda Bhrama
/ Asthi Sunyataa /
36
Asthi Dourvalya /
Asthi Laaghava /
Pratata Vaata Rogani
Twak Sneha
Bone Marrow
Sandhi, Pleeha
ECG, X- Ray, USG,
MRI
investigations
Upadhatu Pareeksha:
SHUKRA & SUKRAVAHA SROTASA PARIKSHAA:

BHAAVA
Darshana Virupam Puyashukra Paandutwam /
Sukrameha
Sparshna
Prashna Klaibya / Aharshanam /
Roginam Alpaayu /
Dourbalya / Mukhasosha /
Sadana / Shrama / Sukra
Avisarga
STANA&STANYA
PARIKSHA
ARTAVA & ARTAVA
VAHA SROTO-
PARIKSHA
Semen Examination
Vrishana / Shephas
Testicular biopsy
investigations
ECG, X- Ray, USG,
MRI
Upadhatu Pareeksha:
OJAS:
VATA PITTA KAPHA
Ojo Visramsa Srama / Sandhi Gatra Sadana
Vislesha
Ojo Vyapat Stabdhata Guru–Gatrata, Tandra,
Nidra
Ojakshaya Mamsa etc.
Dhatuksaya / Moha /
Pralapa, Agyna
Upadhatu Pareeksha:
37
UDAKAVAHA SROTASA PARIKSHAA:
BHAAVA
Darshana Jihwaa-Taalu- Oustha-
Prashna Kantha- Kloma - Shosha Ati Trishnaa
Sparshana
Talu, Jihva, Netra,
Twak
Upadhatu Pareeksha:
PRAANAVAHA SROTASA PARIKSHAA:

BHAAVA
Darshana Uchchhwaasa-Atisristam, Uchchhwaasam-,
Kupitam, Abhikshnam, Alpamalpam,
Sparshana
Prashna Sashabdam, Sashoolam Atibaddham
Shvasa Parikshana
Stheevana Pariksha
Respiratory System Breath Sounds: Normal, Diminished
Type: Vesicular, Bronchial, Vesicular with prolonged expiration
Extra Sounds
Pulmonary Function
tests
GYANENDRIYA
PARIKSHA
Karna-
Nasa-
Netra-
Jihva-
ECG, X- Ray, USG,
MRI
investigations
Upadhatu Pareeksha:
PITTA VARGA PARIKSHAA:
PIITA DOSHA PARIKSHA:

VRIDDHI / PRAKOPA KSHAYA
Darshana Pitaavabhaasataa / Pita – (Vid-Mutra-Netra- Twak) / Nisprabhataa
Murchchhaa
Paaka / Sweda / Kleda / Kotha / Sraava / Raaga /
Murchchhaa
Sparshana Samtaapa Mandoshmataa
Oushnya,
38
Prashna Sitakaamitwa / Alpanidrataa / Valahaani / Indriyadourvalya Mandaagni
Daaha / Kandu / Vishra Gandha / Sadana / Mada /
Katukaasyataa / Amlaasyataa
RAKTAVAHA SROTAS PARIKSHAA:

BHAAVA
Darshana Raktakshaya / Rukshata / Raktapitta / Upakusha / Kotha / Pidaka /
Gulma / Vatashonita / Asyapaka / Raktanetrata / Kustha / Kustha /
Vaivarnya / Ati-daurbalya / Raktamandal / Masaka / Arbuda
Kampa / Charmadala / Mukhapaka /Visarpa / Pidakaa / Dadru /
Pramilaka / Kampa / Vidradhi / Raktameha /
Mlaana / Twag Roukshya Vaivarnya /
Sweda / Indralupta /
Raktaanga
Sparshana Sira-shaithilya / Twak Siraapurnatwam, Sira-Poornatva
Paarushya Santaapa
Prashna Amlashishira-prarthana / Raktapitta / Murcchaa / Agnimandya /
Swarakshaya, Mada Pootighrana / Gurugatrata / Aruchi
Asyagandhita / Pradara / /
Pipasa / Annapanasya Klama / Lavanasyata
Vida / Sweda / Sharira- /
Daurgandhya / Jvara Kandu
Haematology T.L.C.
D.L.C.
T R.B.C.
Hb% / E.S.R.
BT / CT / PT
Yakrita, Pleeha, Sira
USG / MRI /
LFT
investigations
Upadhatu Pareeksha:
SWEDAVAHA SROTAS PARIKSHAA:

BHAAVA
Darshana Aswedana / Swedanaasa / Atiswedana
Romachyuti / Twak Sphutana
Sparshana Paarushya / Sparsha Slakshnangataa
Vaigunya
Prashna Paridaaha / Twak- Lomaharsha / Kandu
Dourgandhya
Twak / Roma
Upadhatu Pareeksha:
39
ANNAVAHA SROTASA PARIKSHAA:
BHAAVA
Darshana Aadhmaana
Sparshana
Prashna Shooloa / Ati-Udgara Pipaasaa / Amla- Anannaabhilashanam /
Katu-Udgara Arochakam / Avipaaka /
Annadwesha / Chhardi /
Madhura Udgara
Ruchi Arasagyata Amla/Tikta Asyata Aruchi/Madhurasyata
Abhyavaharana Vishama Kshudha Atikshudha Anannabhilasha
Shakti
Jarana Shakti Vishama Vidaha Ajeerna
Examination of GIT,
Gall Bladder
X-Ray / USG
investigations
Agni Pareeksha: P/M/A
AGNI PAREEKSHA PRAKRITITAH VIKRITITAH

Ruchi
Jarana Shakti
MOOTRA & MOOTRAVAHA SROTAS PARIKSHAA:

BHAAVA
Darshana Aadhmaana /
Mutravaivarnya
Sparshana
Prashna Alpa Pravritti / Sashula Sadaha - Atisrista Bahala Mutra /
Pravritti / Prakupita / Pravritti Atibaddha Pravritti /
Bastitoda / Alpamutrataa / Kandu
Mutrakrichchhrata /
Pipaasaa
Mootra Pariksha
Examination of
Urinary Tract
X Ray, USG,
RFT
investigations
VAATA VARGA PARIKSHAA:
VATA STHANA PARIKSHA:

VRIDDHI / PRAKOPA KSHAYA
Darshana Kaarshya / Krishnataa / Gaadha Varchastwam / Alpa Chestataa / Alpa
Anaaha Vaaktwam / Mudha Sajnataa
40
Khanja / Pangu / Kubjatwa / / Uchchhwaasa-Niswaasa
Angasosha / Mandataa
Aakshepa
Sparshana Twak Paarushya / Gaatrasuptataa
Prashna Vaakpaarushyam / Gaatrasphurana / Ushna Kaamitaa Apraharsha / Utsaaha Haani /
/ Nidraa Naasa / Alpavalatwa / Sakritgraha /Indriya Manda Pravritti-Sweda-
Bhramsha / Dainya Praalaapa / Gaadha Varchastwam Mutra-Purisha
Sankocha / Parvastambha / Asthibheda / Parvabheda
/ Anidrataa / Naasha-Garbha-Sukra-Raja/
Spandanam- Hundana-Sira / (Naasaa-Akshi-Jatru-
Grivaa)-Bheda+Toda / Arti / Moha / Aayaasa /
Manovyaaharsana / Indriya Upahanana / Bhaya /
Shoka / Graha-(Paani, -Pristha-Sira) / Pralaapa /
Lomaharsha
ASTHI & ASTHIVAHA SROTAS PARIKSHAA:

BHAAVA
Darshana Dantabhanga / Nakhabhanga Vivarnataa / Dosha in
/ Roukshya / Patana-(Kesa- Kesa-Loma-Nakha-
Smashru-Loma) Shmashru
Sparshana
Prashna Asthitoda / Shrama
Examination of
Bones, Nails, Hairs
and examination of
Parathyroid gland
X Ray, USG, Bone
scan
investigations
S. calcium,
Thyroid hormone
Upadhatu Pareeksha:
PURISHAVAHA SROTAS PARIKSHAA:

BHAAVA
Darshana Roukshya
Sparshana
Prashna Aatopa / Adhovata Sanga Gourava
/Adhovata Ati Pravritti /
Kukhishoola / Sakrit Vedanaa
/ Hritpidaa / Paarswapidaa /
Sasabda Vaatasya
Urdhwagamana /
Aadhmaana / Aantrapidana /
Kukshinamana / Vaayoh
Tiryagurdhya Gamana
41
Stool Examination
Examination of Large
Intestine, Ractum,
Anus,
X Ray, USG, P/R
SANGYAVAHA, MANOVAHA, CHETANA VAHI SROTASA:

PAREEKSHYA BHAAVA- DARSHANA, SPARSHANA VATA PITTA KAPHA
PRASHNA (ANUMANA)
Karmendriya Pariksha
Manas Karma Pariksha
Buddhi Pariksha
Nervous System Examination, CNS, Motor &
Sensory
EEG, MRI, Nerve conduction Test etc.
SAAMA / NIRAAMA PARIKSHA:

Vata Pitta Kapha
Sama Dosha Lakshana
Nirama Dosha Lakshana
Rasa Rakta Mamsa Meda Asthi Majja Shukra
Saama Dushya lakshana
Niraama Dushya
Lakshana
Mala Mutra Sweda Other khamala
Saama Mala Lakshana
Niraama mala Lakshana
ROGA PARIKSHA:
1) DOSHA:-
i) Prithaka (with sub types):
VATA PITTA KAPHA
PR/ UD/ SM /VN/ AP PC/ RJ/ BH/ SD/ AL KL/ AV/ BD/ TR/ SH
ii) Sansarga: Vata-Pitta/Vata-Kapha/Pitta-Kapha
iii) Sannipata : Vata-Pitta- Kapha
iv) Avarana :
2) DOOSHYA:-
Dhatu:- Rasa / Rakta / Mansa / Meda / Asthi / Majja / Shukra
Upadhatu:- Stanya / Raja / Kandara / Sira / Dhamani / Twacha / Snayu
Mala:- Poorisha / Mootra / Sweda / Kapha nishteevana / Pitta / Khamala /
Kesha / Nakha / Akshisneha / Loma / Shmashru
3) SROTASA & SROTODUSHTI TYPE:
4) AGNI: Sama / Vishama / Tikshna / Manda
5) ADHISHTHANA: Ama / Pakwa..............................
6) VYAKTISTHANA: .........................................
7) KRIYAKALA: ...............................
8) ROGAMARGA: Koshtha / Shakha / Marma ...............
9) VYADHI SWARUPA: Chirakaari / Aasukaari
42
NIDAANA:
POORVARUPA:
ROOPA:
UPASHAYA:
ANUPASHAYA:
SAMPRAAPTI:
VYAVACHCHEDAKA NIDANA –
ROGAVINISCHAYA: Diagnosis:
SAADHYAASAADHYATAA: Saadhya / Krichchhrasaadhya / Yaapya / Pratyaakheya
AYUSHAHA PRAMANA PARIKSHAA
VYADHI AVASTHA:
UPADRAVA:
ARISHTA LAKSHANAS (if any)
MANAGEMENT / INTERVENTION
CHIKITSA SOOTRA (Line of treatment)
(A) Drug
(B) Dose and Anupana
(C) Aushadha sevana kala
(D) Pathya
(E) Apathya
(F) Treatment duration
Chikitsa upakrama
PANCHAKARMA:
A) POORVA KARMA:
(A) Rukshana
(B) Deepana / Pachana
(C) Abhyantara Snehapana (According to Koshtha) Sneha Yoga:
st nd rd
1 day ……………... / 2 day ……………… / 3 day ………………
4th day………………. / 5th day ……………… / 6th day ………………. 7th Day………….
(D) Swedana (duration) Sweda prakara:
B) PRADHANA KARMA Name of the Karma:

Drug
Dose
Schedule:
Outcome:
C) PASCHATA KARMA (SAMSARJANA KARMA)

Rasa samsarjana _ Peyaadi Krama / Tarpanaadi Krama
Eka-annakala / Dwi-annakala / Tri-annakala
After Pariharakala Shamana Yoga to be applied (for ____ duration).

Dose and Anupana
43
CRITERIA OF ASSESMENT –
ROGA BALA
Signs & Symptoms BT 1st 2nd 3rd AT
AGNI BALA
BT 1st 2nd 3rd AT
Jaranshakti
Abhyavaharanashakti
Ruchi hi aaharakale
Vata mutra purisha retsam mukti
DEHA BALA
BT 1st 2nd 3rd AT
Balavriddhi
Sharira upachaya
Swara varna yoga
SATVA BALA
BT 1st 2nd 3rd AT
Nindra labhoyathakalam
Sukhena cha pratibodhnam
Vaikarikanam cha
swapnanamadarshanam
Mano budhi indriya avyapatti
Note: Prakriti format & Questionnaire to be attached with general screening proforma.
44
Assessment of Prakriti
(to be filled by the research personnel)
Date: Sl. No.
Personal details:
Name: _____________________ ________________ _____________ Marital Status: Married /
single
Sex: Male / Female Age: _______ years Date of Brith: ____ / ___/ _____
Education: __________________ Blood Group: _______ ( ) ve
Occupation: ___________________ Monthly Income: (Rs)__________
Address:
Height: (in cm): ______________ Weight (in Kg)_________
Prakriti findings:
Sr. Subject / Questions Answers – Please tick wherever appropriate
No.
1 Body build Lean Medium Well – built
2 Skin Dryness More moles or Smooth, moist
freckles
3 Hairs Rough Scanty, gray, Plenteous, curly
balding
4 Complexion Dull, darkish Fair, ruddy Whitish (Pale)
5 Tendons & Veins Prominent Normal Well covered
6 Body movements Rapid & unsteady Normal Less
7 Gait Rapid & unsteady Normal Steady & firm
8 Physical exertion Poor endurance Medium Good endurance
9 Resistance to disease Poor Medium Good
10 Hunger /a Appetite Variable Strong, sharp Constant, less
11 Quantity of food Variable Large Small
12 Habit of taking food Fast Frequent Slow
13 Thirst Normal Abundantly Less
14 Perspiration Not specific Profuse, bad smell Constant, less
15 Memory Short-tem Average Long term
16 Sleep Scanty, disrupted Little but sound Abundant, heavy
17 Intolerance to Cold Hot Not specific
18 Initiation to start any Very quickly Medium speed Slowly
work
19 Receptive power Very quickly Average Slowly
20 Response / becoming Very quickly Quick Slowly
excited
21 Speech Quick, talkative, Argumentative, Slow definite, not
45
inconsistent convincing talkative
22 Competitive capacity Don’t like Excellent Handle competitive
competitive competitor stress easily
pressure
23 Mood Change quickly Change slowly Steady, unchangeable
Total V= P= K=
Percentage
Prakriti
ASSESSMENT OF SHARIRIKA PRAKRUTI
FEATURES OF SOMATIC CONSTITUTION (self answering questionnaire)

VATA PITTA KAPHA
1. Your body Lean Moderate Slight obese
constituency is
2. Your complexion is Dark and brown Reddish or Fair and bright.
fair
3. Your skin is Rough and Dry Oily and hot Oily and cold
4. Your veins are More prominent Less prominent Not visible
5. Your eyes are Small, and darkish Medium and brown Big, attractive and
6. Your nails are Thin, Rough Thin, Soft Thick, Smooth
7. Your hair is Rough, dry and less Soft, oily and Black, thick and
Premature graying strong
8. Your Eye brows are Thin, irregular Thin Thick and regular
9. Your forehead is Narrow Medium Broad
10. Your appetite is Variable and scanty Good and excessive Constant and less
11. Quantity of food Variable More Less

12. Habit of taking food Fast Frequent Slow
13. The food you like Light, warm, sweet, Cold, sweet, bitter Hot, pungent,
sour and salt tastes and astringent taste bitter
and astringent
taste
14. Your thirst is Variable Excessive Scanty
15. You perspire (sweat) Less More Foul smelling
16. Your sleep is Scanty and Little but sound Deep
46
Disturbed
17. Do you get tensed Always Occasionally Never
during difficulties
18. You start the work Quickly After thinking After detailed
thinking
19. Grasping power Excellent Moderate Medium
20. Your memory Poor Excellent Good
21. Your anger For a short span For more time Less
22. You talk to the More As per need Less
unknown persons
23. You dream about Running, flying, Shining objects like River, greenery,
falling. lightening, fire and swimming.
violence
24. Physical activity of Very active Moderate As per Less active
your body is need
25. You speak Fast, talkative Clear cut Slow
26. Your mood Changes quickly Changes slowly Unchangeable
27. Your resistance to Poor Average Good
disease
28. Competitive capacity Don’t like Excellent competitor Handle stress
easily
29. Your financial status Poor, spends Moderate, spends Rich, money
is money quickly on luxuries saver, spends on
food
30. Do you feel In rainy season In summer season In winter season
discomfort while
working
TOTAL
PRAKRITI: Vata: ____ Pitta: _____ Kapha: _____

Dominant Dosha: Vata / Pitta/ Kapha
Recessive Dosha: Vata / Pitta / Kapha
Prakriti: Vata Pitta / Vata Kapha / Pitta Kapha / Tridoshaja / Eka doshaja [Vata / Pitta / Kapha]
47
MANUAL PART 2
GRADATION OF SYMPTOMS: PRANAVAHA SROTAS

Scoring of important symptoms of Tamaka Shwaasa:
Scoring has been made by the consideration of following points:

• Intensity of the symptom
• Frequency of the symptom
• Duration
• Effect ( life quality)
• Reliving factors.
Shwaas Vega: (Frequency of breathing difficulty attacks)
1 No Attack. 0
2 2-3 Times in 3 Week. 1
5 Persistant 4
Shwaas Vega: (breathing difficulty attacks - effecting the life quality)

1 Normal life / Good quality / can enjoy every thing 0
2 Dyspnoea after exertion only / can’t enjoy Shita / can’t go in Raja, 1
Dhuma Pravaata.
3 Dyspnoea without exertion but can do routine work 2
4 Needs rest or medication for routine work due to dyspnoea 3
5 Needs total rest and cant do routine work for dyspnoea. 4
Shwaas Vega: (breathing difficulty attacks - relieving factor)

1 Dyspnoea relives autometically 0
2 Dyspnoea relives with rest 1
3 Dyspnoea needs oral medications for reliving 2
4 Dyspnoea needs pump for reliving. 3
5 Dyspnoea needs injectable medication for reliving. 4
Sashabda Shwaasa: (Wheeze / additional sounds in breathing)

1 Normal breathing sounds heard 0
2 1
Wheezing heard only on localized part of chest with stethoscope at
time of attacks.
3 2
Wheezing heard on localized part of lung with stethoscope without
attacks.
4 Wheezing heard on whole lungs with stethoscope. 3
5 Wheezing heard even without stethoscope 4
48
Kaasa in Shwasa: (Intensity of cough in breathing difficulty attacks)
1 Coughing 0
2 Persistat cough with expectoration, relieving with expectoration 1
3 Persistant cough with occasional repetition with sputum 2
expectoration
4 Persistatn cough with fainting (darkness) 3
Nishthivana: (Sputam in breathing difficulty attacks)

1 No Nishthivan during Kaasa or Shwaasa 0
2 Tanu Svachchha Nirgandha Nishthivan (Thin colourless sputam 1
without any Smell)
3 Bahala Pittaabha Durgandhi Nishthivana. (Thick yellowish sputam 2
with foul Smell)
4 Sarakta Nishthivana. (Haemoptysis) 3
5 Bahala Harita Puyasaha Putigandhi Nishthivana. (Thick, green 4
sputam with Pus and foul smell)
Note: Nishthivana i.e. Sputum with Vata dosha predominancy will have watery in nature,
Pitta dosha dominance will have yellowish discolouration, and amount will be more and
thick in case of Kapha dosha predominancy.
Ronchi:
1 No ronchi even upon forced expiration 0
2 Ronchi present upon forced expiration but not audible upon deep 1
breathing
3 A few scattered ronchi audible upon normal deep breathing 2
4 Innumerable low pitched ronchi audible upon normal breathing 3
5 Innumerable high pitched ronchi audible upon normal breathing 4
Crepitations:
1 No crepts upon normal forced expiration 0
2 Crepts audible upon forced expiration but not upon deep breathing 1
3 Few scattered crepts audible upon normal deep breathing 2
4 Innumerable low internsity crepts audible upon normal breathing 3
5 Innumerable high intensity crepts audible upon normal breathing 4
Peak Expiratory Flow Rate (PEFR) – Numerical / quantitative data, grading as per reading
Table on diagnostic criteria: guidelines NAEPP or GINA guidelines may be adopted here.
Spirometry reading - Numerical / quantitative data, grading as per reading.
Breathe holding time (BHT) - Numerical / quantitative data, grading as per reading
Shwasa Roga - Duration of one breathing difficulty attack

1 No episode of attack 0
2 Attack lasting for duration of 10 min. 1
49
Intensity of attack (severity of Bronchial Asthma)

1 Asymptomatic and normal lung function between exacerbations. 0
2 Intermittent symptoms < 1 time a week. Brief exacerbation (from a 1
few hours to few days), night time symptoms < 2 times a month.
3 Symptoms > 1 time a week but < 1 time per day, exacerbation affect 2
activity & sleep, night time asthma symptoms > 2 times a month.
4 Symptoms daily exacerbations affecting activity and sleep, night 3
time asthma symptoms > 1 times a week.
5 Continuous symptoms, frequent exacerbations, frequent night time 4
asthma symptoms& physical activity limited by asthma symptoms.
Intensity of attack (severity of Bronchial Asthma affecting routine activities)

1 Asymptomatic and normal lung function 0
2 Attack of Shwasa disturbing normal sleep at early morning hours 1
3 Attack of Shwasa, disturbing normal sleep any time 2
4 Attack of Shwasa disturbing daily routine activity 3
5 Attack of Shwasa is continuous, physical activity gets disturbed 4
Need of emergency medicines / week.

1 No need. 0
2 2-3 doses occasionally in a Week. 1
3 2-3 doses occasionally in Alternate days. 2
4 2-3 doses regularly. 3
Intensity of Srotodushti
Presence of Pranavaha Srotodusti Lakshana (Dyspnoea / Freq. Exp./ Very restricted

Exp. / Prolonged Exp./ With Loud sound painful / Difficulty in speaking / Sweating )
1 Absent. 0
2 Any 1or 2 1
3 Any 2 or 3 2
4 More than 4. 3
Asino Labhate Saukhyam - Get relief with sitting posture

1 Dyspnoea on recumbent position 0
2 Con continue recumbent position but feels better on sitting 1
3 Not able to continue recumbency for long time 2
4 Canot assume recumbancy / can’t sleep 3
5 Dyspnoea in recumbent position / relief on sitting 4
50
Shvasakrichhrata – labored breathing
1 No sign of Shvasakrichhrata. 0
2 Mild intercostal retraction, Nasal alae flurring & can speak complete 1
sentences during dyspnoea (labored breathing)
3 Intercostal retraction, sternocleidomastoid muscle use & speaks in 2
phrases or partial sentences during dyspnoea.
4 Tracheosternal retraction, Intercostal retraction, sternocleidomastoid 3
use & speak in single words during dyspnoea.
5 Nasal alae flurring & cannot able to speak during dyspnoea. 4
6 All accessory muscles are working & cannot able to speak, express 5
by body language only.
Kasatah sannirudhyata - feeling of unconsciousness in effort to expel out the sputum

1 Absent. 0
2 Present during Attacks 1
Shleshma vimokshane sukhum - Get relief after expel out the sputum
1 Feeling comfortable after expulsion of sputum. 0
2 Not Feeling comfortable even after expulsion of sputum. 1
Peenasa - Coryza
1 Absent 0
2 Present 1
Parshvasula - Pain in thoracic region producing functional disturbance*

1 No shula 0
2 Along with Kasa - Cough 1
3 Very often without attack, relived by snehana / swedana 2
4 Very often even without attack, not relived by snehana / swedana 3
5 Always. 4
*Visual Analogue Scale may also be used here to assess the severity of pain
Kanthodhvansanam - Throat irritation

1 Absent 0
2 Present 1
Usnabhinandati - Liking for hot food & drinks

1 No such feeling. 0
2 Generally avoid Cold thinks. 1
3 Prefer hot drinks. 2
4 Always take hot food & drinks. 3
51
GRADATION OF SYMPTOMS: UDAKAVAHA SROTAS
Shosha – dryness of Jihva Talu Oshtha Kantha Kloma

1 Absence of Shosha 0
2 Shosha – one organ 1
3 Shosha two organs 2
4 Shosha in three organs 3
5 Shosha in all organs involved. 4
Mukha Shosha – dryness of mouth and oral cavity (in general)

1 Absent 0
2 Present 1
Note: Use Visual Analogue Scale to assess the severity of the complaint.
GRADATION OF SYMPTOMS: ANNAVAHA SROTAS

Gradation for Chhardi:
According or gradation of any symptom following criteria should be considered.
1. Frequency
2. Chronisity (Duration)
3. Intensity (on the basis of Dosha dominancy)
4. Progressiveness (Dhatu gatatva)
On the basis of frequency:

1 No vomiting 0
2 Getting comfort after single vomiting 1
3 1-3 vomiting per day 2
4 3 – 6 vomiting per day 3
5 > 6 vomiting per day 4
On the basis of duration: chronicity

1 Occasional 1
2 Vomiting since 12 hrs. 2
3 Vomiting for 12 – 24 hrs. 3
4 Vomiting duration is of 1 day to 1 week 4
5 Vomiting duration is of more than a week 5
According to contents expelled out with vomiting:

1 Unprocessed food in vomitus 1
2 Kapha expelled out with vomits 2
3 Pitta expelled out with vomits 3
4 Rakta expelled out with vomits 4
5 Purisha expelled out with vomits 5
52
On the basis of progressiveness (Dhatugata avastha)
1 Chhardi without involvement of any Dhatukshaya laxana 1
2 Chhardi with Rasa kshaya laxana 2
3 Chhardi with Rakta kshaya laxana 3
4 Chhardi followed by Sanjna nasha 4
Presence of Rasakshaya Lakshana (xxxxxxx)

1 Absent. 0
2 Any 1
3 Any 2 2
4 Any 3 3
5 More than 3 lakshana 4
Grading of Amlapitta symptoms:

Daha: (Burning sensation heart burn)
1 No daha 0
2 Daha in any one area of udara, ura, kukshi/ occasinally for more 1
than half an hour.
3 Daha in any 2 area/ occurs daily for half hour to one hour 2
4 Daha occurs daily in more than two area for one hour or more and 3
relieves after digestion of food or vomiting.
5 Daha involving most of the areas patient may not sleep at night and 4
does not relieve by any measure.
6 Severe degree of daha involving the whole body like hands, feet or 5
sarvanga and does not relieves by any measure.
Amlodgara (acid irructations)
1. No Amlodgara at all 0
2. Occasionally during day or night for less than half hour after 1
meals.
3. Amlodgara occurs daily for two to three times for ½ - 1 hrs. and 2
relieved by sweets, water and antacids
4. Amlodgara after every intake of meal any food substance for half 3
to one hour, and relieved by digestion of food or vomiting
5. Amlodgara for more than one hour not relieved by any measure 4
6. Amlodgara disturbing the patients even small amount of fluid 5
regurgitate to patients mouth (danta harsha)
53
Shula (Pain)
1. No pain 0
2. Mild/ occasional pain which need not any medication 1
3. Pain (abdomen) for less than half an hour and relieved after intake 2
of sweets cold drinks food antacid milk etc.
4. Abdominal pain due to ingestion of food and relieves after 3
digestion of food or by vomiting.
5. Severe unbearable pain which does not subside by any measure and 4
the patient awake in the night
6. Unbearable pain associated with frequent vomiting and 5
hamatemesis
Note: Visual Analogue Scale may be used to assess the severity
Chhardi/ Hrillasa/ Asyapraseka (vomiting /Water brush)
1. No vomiting at all 0
2. Frequency of salivation on every day (asyapraseka) 1
3. Feels sense of nauseating and vomits occasionally (Hrillas) 2
4. Frequency of vomiting is two to three times or more per weeks and comes 3
whenever Daha or pain in aggravated.
5. Frequency of vomiting is daily 4
6. Frequency of vomiting after every meal or even without meals. 5
Adhmana (distention of abdomen)

1 No Adhmana 0
2 Occasionally feelings of distension of abdomen 1
3 Daily after intake of food upto 1 hour with mild distension of abdomen 2
4 Distension of abdomen up to 1 -3 hours after intake of food 3
5 Moderate distension of abdomen up to 6 hours after intake of food 4
6 Severe distension of abdomen upto more than 6 hrs after intake of food 5
Tama:
1 No feeling of Tama 0
2 Occasional feeling of Tama 1
3 Feeling of Tama < 2-3 times a day 2
4 Feeling of Tama 3-6 times a day 3
5 Many times a day with problem in maintaining posture, tries to sit 4
54
Bhrama
1 No Reeling of head/ Bhrama 0
2 Sometimes feeling of reeling head/ Bhrama 1
3 Feeling of reeling head/ Bhrama < 3 times a day 2
4 Feeling of reeling head/ Bhrama > 3 times a day 3
5 Frequently feeling of reeling head change of posture causes the severe 4
problem
Kampa
1 No presence of Kampa 0
2 Occasionally present 1
3 Mildly present one times feeble 2
4 Moderately present i.e. visible disturbs holding light weight articles like 3
news paper
5 Severely present not able to do routine work like buttoning, eating etc. 4
Angasada/Gaurava
1 No heaviness 0
2 Occasionally feeling of heaviness for sometimes in hands and feet 1
3 Feeling of heaviness for sometimes in hands and feet not affecting activities 2
of daily living
4 Daily feeling of heaviness over body, which leads to Akarmanyata 3
5 Most part of the body for long duration 4
6 All body for most part of the day 5
Klama
1 No klama 0
2 Occasionally feeling of lassitude without Shrama and remains for 1
sometimes and vanishes
3 Lassitude without Shrama daily for sometimes 2
4 Lassitude without Shrama daily for long duration 3
5 Always feels tired and have no enthusiasms 4
Nidra
Paittika
1 Even the patient may not sleep in night due to irritation in abdomen 5
2 Patient can sleep < 3 hrs with severe irritation in abdomen 4
55
3 Patient can sleep < 3 hrs with moderate irritation in abdomen 3
4 Patients can sleep upto 3 – 6 hrs with mild irritation in abdomen 2
5 Patient can sleep upto more than 6 hrs without any irritation 1
Kaphaja
Normal / sound sleep 0
Patient sleep upto 6 hrs without any disturbance 1
Sleep deeply upto 8 hrs 2
Sleeps upto 10 hrs 3
Sleeps upto > 12 hrs 4
Even patient may sleep during day time 5
Feeling of well being

1 Feeling very well 0
2 Occasionally feels discomfort 1
3 Feels discomfort mildly and not able to concentrate to his work 2
4 Feels discomfort moderately and feels depressed 3
5 Feels discomfort severely and remains gloomy most of the time 4
6 No feeling of well being at all 5
Gradation of Hrillasa etc.

1 Absent. 0
2 Anannabhilasha 1
3 Aasyapraseka 2
4 Hrillasa 3
5 Chhardi 4
Gradation based on Dosha expelled in Chardi

1 Prabhoota matra Kapha
2 Varnayukta Pitta
3 Alpa matra Vata
Note: Nausea profile may be added here [Ref: Muth ER, Sterm RM, et al. Assessment of
psysomatic research 1999].
On the basis of above criteria final gradation of Chhardi can be made as given below:
GRADE - 1
Getting comfort after single vomiting -1
Vomiting since 12 hrs. -1
Kapha expelled out with vomits -1
Chhardi associated with kapha laxana -1
Chhardi without involvement of Dhatukshaya laxana - 1
56
GRADE – 2
1-3 vomiting per day -2
Vomiting for 12 – 24 hrs. -2
Pitta expelled out with vomits -2
Chhardi associated with Pitta laxana -2
Chhardi with Rasa kshaya laxana -2
GRADE – 3
3 – 6 vomiting per day -3
Vomiting duration is of 1 day to 1 week -3
Rakta expelled out with vomits -3
Chhardi associated with Vaayu laxana -3
Chhardi with Rakta kshaya laxana -3
GRADE – 4
> 6 vomiting per day -4
Vomiting duration is of more than a week -4
Purisha expelled out with vomits -4
Chhardi associated with Rakta / other disease laxana- 4
Chhardi followed by Sanjna nasha -4
NOTE: any two or more characteristics found, the same grade should be considered
GRADATION OF SYMPTOMS: RASAVAHA SROTAS

Sirā śaithilya (Loss of the usual prominence of the SIRĀ)
1. Present 0
2. Absent 1
AMLA ŚEETA PRĀRTHANĀ (Desire for sour and cold substance):

1. Absent 0
2. Present - Occasional 1
3. Present – always 2
ŚIRNĀLOMATA (HAIR FALL):

1 Absent 0
2 Present 1
TAMAHA-DARŚANA (FAINTING): black outs

1 Nil 0
2 Rare Tamaha Darśana for short duration 1
3 Rare Tamaha Darśana for short duration leads to Bhrama 2
4 Frequent Tamaha Darśana for short duration leads to Bhrama 3
5 Constant Tamah Darshan 4
57
HRIDAYA SPANDANĀDHIKYA (PALPITATION):
1 Absent 0
2 Present only during heavy exercise that subsides itself on rest 1
3 Present during the normal routine activities, but does not disturb 2
normal activities, subsides by rest
4 Present during the normal routine activities but doesn’t subside 3
on rest
5 Present in routine activities, distressful condition, present even in 4
resting condition
SHUNAKSHIKUTA SHOTHA – periorbital oedema – puffyness of eye socket

1 Absent 0
2 Present – eye socket only 1
3 Present – dependent parts 2
4 Present – all over body 3
5 Present, always and disturbing routine activities 4
PINDIKODWESHTANAM – cramps on legs

1 Absent 0
2 Present Occasional 1
3 Present frequent attacks 2
4 Present regular 3
KARNAKSHWEDA
1 Absent 0
2 Occasional & Tolerable 1
3 Occasional & Non Tolerable 2
4 Constant & Non Tolerable 3
GATRASHULA: visual Analogue Scale may be adopted here.
GRADATION OF SYMPTOMS: RAKTAVAHA SROTAS:

Twak rookshata – Dryness of skin
1 No line on scrubbing with nail 0
2 Faint line on scrubbing by nail 1
3 Linging & even words can be written by anil 2
4 Excessive rukshata leading to kandu 3
5 Rukshata leading to crack formation 4
Bahalatva – thickening of skin

1 No Bahalatva 0
2 Mild thickening 1
3 Moderate thickening 2
4 Very thick 3
5 Very thick with induration 4
58
Rakta Mandala – Erythema
1 Normal skin 0
2 Faint or near to normal 1
3 Blanching + red colour 2
4 No blanching + red colour 3
5 Red colour + subcutaneous 4
Ratavarna / Arunavarna – (Erythema)

1 No erythema 0
2 Faint 1
3 Light red 2
4 Moderate red 3
5 Bright red 4
Unnati - Elevation
1 No elevation 0
2 Elevation can not palpable 1
3 Elevation can be palpable 2
4 Apparently palpable (Approx. about mm) 3
5 Apparently palpable (Approx. more than 1 mm) 4
Aswedana – Anhydrosis
1 Sweating induced on walking 0
2 Sweating induced on brisk walking 1
3 Sweating induced on running 2
4 Sweating induced on walking up steps 3
SADAMGA INVOLVEMENT AND BODY SURFACE AREA [PASI]

Sl No. Anga- Body region Code Percent body
Sanskrit English surface
1 Shiras Head H 10 %
2 Antaradhi Trunk T 20 %
3 Urdhwashakha Upper limbs U 30 %
4 Adhahshakha Lower limbs L 40 %
SADAMGA INVOVLVEMENT AND EXTENT INDICATOR

Portion of body region affected Extent indicator
0–5% 0
5 – 25 % 1
25 – 45 % 2
45 – 55 % 3
55 – 75 % 4
75 – 95 % 5
95 – 100 % 6
Symptom Code Extent

Sanskrit English
59
Raktavarna Erythema E 0-4
Utsedha Infiltratin I 0-4
Matsyashakalopama Desquamation D 0-4
Aswedanam Anhydrosis A 0-4
Kandu (Kapha) Pruritus P 0-4
Dosa bala (Severity index)

= SUM ((Sadamga involvement and Body surface area -
percent BSA in body region) x [(extent U£ü uÉhÉï / AÂhÉ uÉhÉï - erythema in region) +
(extent EixÉåkÉ -infiltration in region) + (extent qÉixrÉvÉMüsÉÉåmÉqÉ desquamation in
region) + (Extent of AxuÉåS anhydrosis) + (Extent of MühQÒû pruritus)) x (extent of body
region affected)] =
Dosa bala (Severity index)
= ((0.1 * ((erythema head) + (infiltration head) + (desquamation head) (anhydrosis head) (pruritus
head)) x (extent of head affected)) + ((0.2 x ((erythema trunk) + (infiltration trunk) + (desquamation
trunk) (anhydrosis trunk)( pruritus trunk)) x (extent of trunk affected)) + ((0.3 x ((erythema upper
extremities) + (infiltration upper extremities) + (desquamation upper extremities) (anhydrosis upper
extremities)( pruritus upper extremities)) x (extent of upper extremities affected)) + ((0.4 x
((erythema lower extremities) + (infiltration lower extremities) + (desquamation lower extremities)(
anhydrosis lower extremities)( pruritus lower extremities)) x (extent of lower extremities affected))
Interpretation: • minimum score = 0 • maximum score = 120
[References: (1) Fredriksson T, Pettersson U. Severe psoriasis: Oral therapy with a new retinoid.
Dermatologica. 1978; 157: 238-244. (2) Marks R, Barton SP, et al. Assessment of disease progress in
psoriasis. Arch Dermatol.1989; 125: 235-240]
Guidelines for Research in Ekkushtha (Psoriasis) are as follows-

1) Psoriasis Area And Severity Index (PASI)
2) Scoring Pattern Of Some Symptoms Given By National Psoriasis Foundation
3) Scoring Pattern Made Specially ForThe Present Study which includes Deha, Agni
Chetasabala and Dehabala Pariksha.
4) Dermatology Life Quality Index
5) Psoriasis Disability Index
6) Photographs of Patients Taken Before and After Treatment.
GRADATION OF SYMTOMS OF EKA KUSTHA – PSORIASIS

Matsyashaklopamam (Scaling):
1 No scaling 0
2 Mild scaling by rubbing/by itching (scaling from some 1
lesionis)
3 Moderate scaling by rubbing/by itching (from all lesions) 2
4 Severe scaling by rubbing / by itching (from all lesions) 3
5 Scaling without rubbing / by itching (from all lesions) 4
Scaling – other scoring method

1 No scaling 0
2 Scaling off between 15 – 28 days 1
60
Aswedanam (Anhydrosis):
1 Normal 0
2 Improvement 1
3 Present in few lesions 2
4 Present in all lesions 3
5 Aswedanam in lesion and uninvolved skin 4
Mahavastu (Extent of lesion)

1 No lesions on Mahasthanam 0
2 Lesion on partial part of hand, leg, neck, scalp, hand, back. 1
3 Lesions on most part of hand, leg, neck, scalp, trunk, back. 2
4 Lesions on whole part of Mahasthanam (Vast area) 3
5 Lesions on whole body 4
Deep black reddish discoloration

1 Normal coloration 0
2 Near to normal which looks like normal color to distant 1
observer
3 Reddish coloration 2
4 Slight black reddish discoloration 3
5 Krsna arunavarna 4
Mandala (Circular skin lesion):

1 No Mandala 0
2 Few mandala and smaller than coin 1
3 Few mandala and big (larger) than coin 2
4 More mandala and smaller than coin 3
5 More mandala and bigger than coin 4
Another gradation for Mandala (Erythma) :

1 Normal skin 0
2 Faint or near to normal 1
3 Blanching + red colour 2
4 No blanching + red colour 3
5 Red colour + subcutaneous 4
Nakhdusti (Deformity of nails):
1 No Nail involvement 0
2 1-5 nail’s involvement of any extremities 1
3 5-10 nail’s involvement of any extremities 2
4 10-15 nail’s involvement of extremities 3
5 15-20 nail’s involvement 4
61
Another grade for Nakha dushti. Pitting in nail:
1 No Pitting 0
2 Pitting in 1 finger only 1
3 Pitting in few fingers 2
4 Uncountable pitting 3
5 Uncountable Pitting with nail pathology 4
Bahaltva: (thickening in skin lesion)

1 No bahaltva 0
2 0- Mild thickening 1
3 1- Moderate thickening 2
4 Very thick 3
5 2- Very thick with induration 4
Unnati : (Elevation in skin lesion)

1 No elevation 0
2 Slight elevation that cannot be felt 1
3 Elevation can be felt but depressed in middle 2
4 Elevation in all lesions but soft 3
5 Elevation in all lesions and hard 4
Scaling: The score was decided depending upon the duration of shedding of scales.
1 No Scaling 0
Joint involvement:
1 No arthritis 0
2 Slight pain 1
3 Pain present but do not hinder activity 2
4 Pain with deformity 3
Pain with deformity affecting activity & sleep 4
Candle grease sign:

1 Absent 0
2 Improvement 1
3 Present 2
Auspitz sign:
1 Absent 0
2 Improvement 1
3 Present 2
62
Koebner phenomena:
1 Absent 0
2 Improvement 1
3 Present 2
Criteria for assessment of involvement of body surface area

Scale Percentage
Posterior surface and anterior surface of head and neck 9
Anterior and posterior surface of forearms 18+18 =36
Anterior and posterior and surface of trunk 18
Anterior and posterior and surface of feet, legs and buttocks 18+18 =36
Perineum including anus and uro genetical 1
Criteria for the assessment of overall effect of the therapies:

1) Complete remission (R): 100% relief in the all signs and symptoms.
2) Marked improvement (MI): <100% to > 60% relief in the signs and symptoms
3) Moderate improvement (MOI): < 60% to > 20% relief in the signs and symptoms.
4) Unchanged: <20% relief in the signs and symptoms.
5) Deterioration: Increase in the progress of the disease with the appearance of new lesions
and severity of existing lesions was considered as deterioration.
GRADATION OF SYMPTOMS: MAMSAVAHA SROTAS
GALASHUNDIKA Grading of symptoms:

Dirgha shopha (dhmatabhstiprakasha – swelling resembling blown up bladder)
1 No Inflammation 0
2 Negligible inflammation visible redness of the area 1
3 Marked inflammation and redness noticeable in the area 2
4 Profuse inflammation and redness in surrounding area also 3
Measurement of muscle bulk

• By measuring the circumference, a numerical / quantitative data, grading may be done
accordingly.
Muscle hypotonia: 4 point grading may be adopted
1 Normal 0
2 Mild 1
3 Moderate 2
4 Severe 3
Muscle power grading:

1 No contraction 0
2 Flicker or trace of contraction 1
3 Active movement with gravity eliminated 2
4 Active movement against gravity 3
5 Active movement against gravity and moderate resistance 4
6 Active movement against gravity and full resistance (normal 5
power)
63
Overall assessment of mobility of the patient:
1 Walk independently 0
2 Walk with limping 1
3 Walk only with support 2
4 Can’t stand without support 3
5 Totally on bed 4
Mamsapradoshaja Vyadhi:
1 Absent 0
2 Present 1
GRADATION OF SYMPTOMS: MEDOVAHA SROTAS

CRITERIA FOR ASSESSEMENT OF RESULTS FOR MADHUMEHA
Avila Mutrata (Turbidity): News Paper Test 10 points
1. Crystal clear fluid 0
2. Faintly cloudy, smoky or hazy with slight turbidity. 1
3. Turbidity clearly visible but newsprint easily read 2
through test tube-
4. Newsprint not easily read through test tube 3
5. Newsprint can not be seen through test tube 4
Mutramadhurya (Glycosuria):
1. Absence of Glucose in urine 0
2. Traces of Glucose in urine 1
3. + Glucose in urine 2
4. ++ Glucose in urine 3
5. +++ Glucose in urine 4
6. ++++ Glucose in urine 5
Pipasa-Adhikya (Increased Thirst):

1. Feeling of thirst (7 – 9 times/24 hours) & relieved by drinking water 0
2. Feeling of moderate thirst (>9 - 11 times/24 hours) & relieved by drinking 1
water
3. Feeling of excess thirst (>11 – 13 times/24 hours) not relieved by drinking 2
water
4. Feeling of sever thirst (>13 times) not relieved by drinking water 3
Kshudha-Adhikya (Increased Appetite): (1 meal = about 350gm diet)

1. As usual / routine 0
2. Slightly increased (1 meal extra with routine diet) 1
3. Moderately increased (2 meals extra with routine diet) 2
4. Markedly increased (3 meals extra with routine diet) 3
64
Swedadhikya (Perspiration):
1. Sweating after heavy work and fast movement or in hot weather 0
2. Profuse sweating after moderate work and movement 1
3. Sweating after little work and movement (stepping ladder etc.) 2
4. Profuse sweating after little work and movement 3
5. Sweating even at rest or in cold weather 4
Angagandha (Bad odour):

1. No odour 0
2. Bad odour but not offensive 1
3. Storng odour but can be lessened by use of deodorants or perfumes 2
4. Very strong odour even after using fragrances (use of deodorants or 3
perfumes)
Nidradhikya (Increased Sleep):

1. Normal & sound sleep for 6 – 8 hrs. /24 hrs. with 0
feeling of lightness and relaxation in the body & mind
2. Sleep >8 -9 hrs. /24 hrs. with slight heaviness in the body. 1
3. Sleep >9 - 10 hrs. /24 hrs. with heaviness in the 2
body associated with Jrimbha.
4. Sleep >10 hrs. /24 hrs. with heaviness in the body associated with Jrimbha & 3
Tandra
Hasta-Pada-Tala Daha:
1. No Daha 0
2. Hasta -Pada-Tala Daha found occasionally, mild, bearable 1
3. Hasta -Pada-Tala Daha continuous but bearable & not severe 2
4. Hasta -Pada-Tala-Daha continuous and severe & unbearable 3
Kara-Pada Suptata:
1. No suptata 0
2. Kara-Pada Suptata incontinuous 1
3. Kara-Pada Suptata continuous but bearable & not severe 2
4. Kara-Pada Suptata continuous and severe & 3
Unbearable
Note: The Diabetic Nuropathy scale may also be used here
Prabhuta Mutrata (Polyuria)

A. Quantity of urine:
1. 1.5 to 2.00 liters / 24 hours 0
2. > 2.00 to 2.50 liters / 24 hours 1
3. > 2.50 to 3.00 liters / 24 hours 2
4. > 3.00 liters / 24 hours 3
65
Prabhuta Mutrata (Polyuria)
A. Frequency of Urine: A numerical / quantitative data
1. 3 – 5 times per day, no rarely at night 0
2. 6 – 8 times per day, 1 – 2 times per night 1
3. 9 – 11 times per day, 3 – 4 times per night 2
4. > 11 times per day, > 4 times per night 3
OTHER CRITERIA FOR ASSESSMENT OF MADHUMEHA

After the completion of the treatment, the results were assessed by adopting the following
criteria :
Improvement in signs and symptoms of disease on the basis of the symptoms score.
F.B.S. and P.P.B.S. levels
Serum Cholesterol
Urine sugar
The patients tobe examined weekly and the changes observed in the signs and symptoms tobe
assessed by adopting suitable scoring method and the objective signs by using appropriate
clinical tools. The detail assessment of clinical signs & symptoms are discussed below:
Prabhuta Mutrata (Polyuria) Quantity of urine in liter A numerical / quantitative data
1 1.50 to 2.00 0
2 2.00 to 2.50 1
3 2.50 to 3.00 2
4 3.00 and onwards 3
Prabhuta Mutrata – Frequency of urine: A numerical / quantitative data

1 3 – 6 times per day, rarely at night 0
2 6 – 9 times per day, 0 – 2 times per night 1
3 9 – 12 times per day, 2 – 4 times per night 2
4 More than 12 times per day, more than 4 times per night 3
Pipasa (Polydypsia): A numerical / quantitative data

1 Feeling of thirst 7 – 9 times/24 hours, either/or Intake of water 0
5 – 7 times/24 hours with quantity 1.5 – 2.0 liter/24 hours
2 Feeling of thirst 9 - 11 times/24 hours, either/or Intake of water 1
7 - 9 times/24 hours with quantity 2.0 - 2.50 liter/24 hours
3 Feeling of thirst 11 – 13 times/24 hours, either/or Intake of 2
water 9 – 11 times/24 hours with quantity 2.50 -3.00 liter/24
hours
4 Feeling of thirst >13 times/24 hours, either/or Intake of water 3
>11 times/24 hours with quantity >3.00 liter/24 hours
Kshudha (Appetite)
1 Regular usual 0
2 Slightly increased (1 – 2 meals) 1
3 Moderately increased (3 – 4 meals ) 2
4 Markedly increased (5 – 6 meals) 3
66
Abhyavaharana Shakti (Hunger):
1 Person taking food in excessive quantity twice in a day 0
2 Person taking food in normal quantity twice in a day 1
3 Person taking food in moderate quantity twice in a day 2
4 Person taking food in less quantity twice in a day 3
5 Person taking food in less quantity once in a day 4
6 Person not at all taking food 5
Kara-Pada-Tala-Daha/Supti (Neuropathy)
1 No Daha 0
2 Kara-pada-tala-daha/Supti incontineous 1
3 Kara-pada-tala-daha/Supti continuous but not severe 2
4 Kara-pada-tala-daha/Supti continuous and severe 3
Avila Mutrata (Turbidity):

1 Crystal clear fluid 0
2 Faintly cloudy or smoky (turbidity barely visible) 1
3 Turbidity clearly present but newsprint easily read through test 2
tube
4 Newsprint not easily read through test tube 3
Newsprint cannot be seen through test tube 4
Urine turbidity test as mentioned in Mutravaha srotas may also be adapted here.
Mutramadhurya (Glycosuria): A numerical / quantitative data

1 Absence of Glucose in urine 0
2 <0.5% Glucose in urine 1
3 0.05 - 1.0% of Glucose in urine 2
4 1.0 – 2.0% of Glucose in urine 3
5 >2.0% Glucose in urine 4
Swedadhikya (Perspiration)
1 Sweating after heavy work and fast movement or in hot weather 0
2 Profuse sweating after moderate work and movement 1
3 Sweating after little work and movement (stepping ladder etc.) 2
4 Profuse sweating after little work and movement 3
5 Sweating even at rest or in cold weather 4
Shrama Swasa (Dyspnoea)

1 Dyspnoea after heavy work and walking 0
2 Dyspnoea after moderate work and walking 1
3 Dyspnoea after mild work 2
4 Dyspnoea even at resting condition 3
67
Nidradhikya (Sleep)
1 Normal sleep, 6 – 8 hours/24 hours 0
2 Sleep up to 8 hours/24 hours with Angagaurava 1
3 Sleep up to 8 hours/24 hours with Angagaurava and Jrimbha 2
4 Sleep up to 10 hours/24 hours with Tandra 3
5 Sleep up to >10 hours/24 hours with Tandra & Klama 4
Jarana Shakti (Digestion) - According to presence of Jirna Ahara Lakshana :

Udgarashuddhi, Utsaha, Yathochitta, Malotsarga, Laghuta, Kshudha, Trishna
1 Presence of all symptoms within 4 hours 0
2 Presence of all symptoms within after 4 hours 1
3 Presence of four or more symptoms after 4 hours 2
4 Presence of three or more symptoms after 5 hours 3
5 Presence of two or more symptoms after 6 hours 4
6 Anyone symptom presence after 6 hours 5
Purishabaddhata (Constipation)
1 Stool passes as per normal schedule 0
2 Passes stool with strain, sometimes takes purgative 1
3 Passes stool after more than 24 hours, frequently takes purgative 2
4 Passes stool after gap of one day, normal purgatives does not 3
work
Pindiko-udveshatan (Cramps)
1 No cramps 0
2 Cramps after walking more than 1 km. 1
3 Cramps after walking 2
4 Cramps after walking ½ km 3
5 Inability in walking even ½ km 4
Tanu madhuryata: Glycosuria – a numerical / quantitative data based on FBS / PPBS / RBS
readings , so grading may be done as on readings.
CRITERIA FOR ASSESSEMENT OF STHAULYA:

Cala Sphik - Udara - Stana:
1. Absence of Calatva 0
2. Little visible movement (in above areas) after rapid movement 1
3. Little visible movement (in above areas) after moderate movement 2
4. Movement (in the areas) after mild movement 3
5. Movement (in the areas) even after changing posture 4
68
Krichha Vyavayta (Loss of Libido): [Refer Shukravaha srotas also]
1. Normal performance without external stimulation 0
2. Decreased frequency with normal performance 1
3. Decrease frequency with insufficiency 2
4. Normal performance with external stimulation 3
5 No sexual stimulation at all 4
Angagandha (Bad Odour):

1. No odour 0
2. Bad odour but not offensive 1
3. Strong odour but can be lessened by use of deodorants or perfumes 2
4. Very strong odour even after using fragrances (use of deodorants or 3
perfumes)
Swedadhikya (Perspiration):
1. Sweating after heavy work and fast movement or in hot weather 0
2. Profuse sweating after moderate work and movement 1
3. Sweating after little work and movement(stepping ladder etc.) 2
4. Profuse sweating after little work and movement 3
5. Sweating even at rest or in cold weather 4
Kshudha-Adhikya (Increased Appetite): (1 meal = about 350gm diet)

1. As usual / routine 0
2. Slightly increased (1 meal extra with routine diet) 1
3. Moderately increased (2 meals extra with routine diet) 2
4. Markedly increased (3 meals extra with routine diet) 3
Pipasa-Adhikya (Increased Thirst):

1. Feeling of thirst (7 – 9 times/24 hours) & relieved by drinking water 0
2. Feeling of moderate thirst (>9 - 11 times/24 hours) & relieved by drinking 1
water
3. Feeling of excess thirst (>11 – 13 times/24 hours) not relieved by drinking 2
water
4. Feeling of sever thirst (>13 times) not relieved by drinking water 3
Kshudra Shwasa (Exertional Dyspnoea):

1. No Dyspnoea even after heavy work 0
2. Dyspnoea after moderate work but relieved later and tolerable; dyspnoea 1
by climbing upstairs of 10 steps & time taken will be more than 15 sec.
3. Dyspnoea after little work but relieved later and tolerable; dyspnoea by 2
climbing upstairs of 10 steps & time taken will be more than 25 sec.
4. Dyspnoea after little work but relieved later and not tolerable; dyspnoea 3
by climbing upstairs of 10 steps & time taken will be more than 35 sec.
5. Dyspnoea in resting condition 4
69
Nidradhikya (Increased Sleep):
1. Normal & sound sleep for 6 – 8 hrs./24 hrs. with 0
feeling of lightness and relaxation in the body & mind
2. Sleep >8 -9 hrs./24 hrs. with slight heaviness in the body. 1
3. Sleep >9- 10 hrs./24 hrs. with heaviness in the 2
body associated with Jrimbha
4. Sleep >10 hrs./24 hrs. with heaviness in the body associated with 3
Jrimbha & Tandra
GRADATION OF SYMPTOMS: ASTHIVAHA SROTAS

Adhidanta - supernumerary tooth
1 Absnet 0
2 Present 1
Adhidanta - supernumerary tooth

1 No adhidanta 0
2 Only one supernumerary tooth 1
3 Two supernumerary tooth 2
4 Three supernumerary tooth 3
5 More than three supernumerary tooth with facial deformity 4
Dantashoola/Dantabheda-
1 No pain 0
2 Mild pain with no associated complaints. 1
3 Discomforting pain aggravated during mastication. 2
4 Distressing pain associated with fever, edema etc. 3
5 Horrible pain. 4
Note: Visual Analogue Scale may be used to assess the severity of pain.
Danta vikara/pata (Dental deformity/fall):

1 Absnet 0
2 Present 1
Danta vikara/pata (Dental deformity/fall):

1 No dental deformity 0
2 Occasional dental pain with dental caries or loosening of at 1
least one tooth.
3 Dental pain that don’t responds to analgesics along with 2
caries/loosening / loss of 2-4 teeth.
4 Loosening / loss of 4-8 teeth. 3
5 Loosening / loss of more than 8 teeth. 4
70
Asthi shula/bheda (Pain in bones)
1 No piercing pain in bones. 0
2 Mild piercing pain in bones not affecting daily activities. 1
3 Occasional moderate piercing pain in bones not affecting daily 2
activities. Pain can be relieved by rest no need of medication.
4 Frequently severe piercing pain in bones affecting daily 3
activities. Patient needs medication.
5 Continuous severe piercing pain in bones with restricted 4
movements not relieved even by simple medications.
Vivarnata: Discolouration
1 Absnet 0
2 Present 1
Kesha vikara (Palitya):

1 No greying of hair 0
2 Very few grey hair 1
3 Partial greying of hair 2
4 Significant greying of hair 3
5 Generalized greying of hair 4
Kesha pata (Hair fall):

1 No hair fall 0
2 Hairs fall once in the morning while washing / combing. 1
3 Hairs fall on every time of combing. 2
4 Hairfall even without combing and raised hairline in frontal 3
region (mild baldness).
5 Visible or significant baldness in frontal or vertex region. 4
Other classification that can be adapted to assess hairfall in male and females:
Norwood class of assessing hair fall - Male
Ludwig scale for female pattern baldness – Female
Asthi kshaya lakshana:

Shrama (Tiredness):
1 No shrama (Tiredness). 0
2 Tiredness with excessive exertion. 1
3 Tiredness with moderate exertion. 2
4 Tiredness with mild exertion. 3
5 Tiredness with no exertion. 4
71
Sandhi Shaithilya: (Looseness/Weakness of Joints)
1 No feeling of looseness/weakness in joints 0
2 Mild feeling of looseness/weakness in joints. Patient can 1
stand/walk independently without difficulty.
3 Moderate feeling of looseness/weakness in joints. Patient can 2
stand/walk independently with difficulty.
4 Severe feeling of looseness/weakness. Patient can stand/walk 3
only with support (Crutches, cane or walkers).
5 Severe feeling of looseness/weakness. Patient unable to 4
stand/walk even with support (Crutches, cane or walkers).
Nakha Vikara- Nail deformity

1 No Nail deformity 0
2 Mild loss of natural texture & maliability of nails. 1
3 Moderate loss of texture & maliability of nails. 2
4 Visible brittleness of nails (which breaks easily). 3
Rukshata (Dryness)
1 No dryness. 0
2 Occasional dryness without winter season 1
3 Visible dryness, mild dull white streaks after scratching on the 2
skin which disappears after sometime.
4 Dryness/roughness, bright white streaks on the skin remaining 3
for a considerable time.
5 Dryness/roughness and criss-cross visible cracking of skin. 4
Mamsabhilasha (Desire of eating meat)

1 Absnet 0
2 Present, occasional 1
3 Present, intense 2
Asthi Sndhi baddhata (Stiffness in bones & Joints)

1 No stiffness. 0
2 Stiffness for few minutes relieved by mild movements. 1
3 Stiffness lasting for 1 to 2 hours but, routine works are not 2
disturbed.
4 Stiffness lasting for more than 2 hours mildly affecting the 3
daily routine.
5 Episodes of stiffness lasting for 2-6 hours. Daily routines are 4
hampered
Scoring pattern for Osteoporosis

Subjective criteria: Results of the treatment can be assessed on the basis of relief in
Asthikshayatmaka lakshana with the help of specific scoring pattern as below:
72
ASTHIVEDANA – pain in bones
1 None 0
2 Only on movement 1
3 Without movement at rest 2
4 Pain even at night 3
KATISHOOLA – back ache

1 No backache 0
2 Occasionally 1
3 Relieves by medicine 2
4 Dependent on painkiller 3
SANDHISHOOLA – pain in joints

1 No pain 0
2 Mild pain + no difficulty in walking 1
3 Slight difficulty in walking 2
4 Much difficulty in walking 3
KESHA PATAN: Hair fall

1 Absent 0
2 Hair fall on washing 1
3 Hair fall on combing 2
4 Hair fall on simple stretching 3
GRADATION OF SYMPTOMS: MAJJAVAHA SROTAS

Netra gaurava (Heaviness in the eye)
1 No feeling of heaviness in eye. 0
2 Occasional feeling of heaviness in eye 1
3 Frequent feeling of heaviness in the eye associated with 2
headache.
4 Feeling of heaviness in the eye throughout the day along with 3
headache and disturbed vision.
Pain in small joints (interphalengeal joints)

1 No pain 0
2 Mild pain involving only one joints 1
3 Discomforting pain in 2 joints. 2
4 Distressing pain in > 2 joints and hampering day to day 3
activities.
5 Horrible pain. 4
73
Murchha- (Fainting):
1 No murccha 0
2 Murccha only after exertion, lasting for few seconds 1
3 Murccha on exertion lasting for few minutes. 2
4 Murccha without any exertion lasting for few minutes. The 3
patient can stand or walk slowly.
5 Murccha without any exertion. The patient cannot stand, walk 4
or even can’t sit on the bed due to the fear of fainting. He/she
has to lie down.
Timir-darshanam
1 No tama 0
2 Occasional tama darshana for short duration 1
3 Occasional tama darshana for small duration leads to bhrama. 2
4 Frequent tama darshan for small duration leads to bhrama 3
5 Frequently tama-darshana for longer duration. 4
Arumshika
1 No Arumshika 0
2 Occasional abscess on the scalp with less pain. 1
3 Few abscesses on the scalp. 2
4 Many abscesses on the scalp associated with severe pain, 3
discharge, reduced hair density.
5 Generalized scalp abscesses on the scalp with severe pain, 4
discharge, reduced hair density associated with systemic
symptoms like fever etc.
Asthi shunyata / Asthi saushirya- Osteoporosis: Singh’s Index

1 All the normal trabecular groups are visible and the upper end of 6
the femur seems to be completely occupied by cancellous bone.
2 The structure of principal tensile and compressive trabeculae are 5
accentuated. Ward’s triangle appears prominent.
3 Principal tensile trabeculae are markedly reduced but can still be 4
traced from the lateral cortex to the upper part of the femoral
neck.
4 There is a break in the continuity of the principal tensile 3
trabeculae opposite the greater trochanter. This grade indicates
definite osteoporosis.
5 Only the principal compressive trabeculae stand out prominently; 2
the others have been more or less completely resorbed.
6 Even the principal compressive trabeculae are markedly reduced 1
in number and are no longer prominent.
(Singh.M; Nagrath.A.R. and Maini P.S. Changes in the trabecular pattern of the upper end of the
femur as an index to osteoporosis; Journal of bone and joint surgery, 52A,457-467, 1970)
74
Bone Mineral Density (B.M.D).
t-score (WHO criteria for assessing osteoporosis.)
1 Normal - t score > -1 0
2 Osteopenia - t score between -1 to -2.5. 1
3 Osteoporosis - t score < or = -2.5. 2
4 Severe osteoporosis - t score < -2.5 with one or more fragility 3
fractures.
(Pauline M. Chamaco, Paul D. Miller, Osteoporosis – A guide for clinicians, Walters Kluwer
(India) Pvt. Ltd., New Delhi, World Health Organization criteria for assessing osteoporosis
severity, Page.5)
Alpa shukrata – Oligospermia [Refer Shukravaha Srotas also]

1 Normal count (> 20 million) and motility of the sperms is also 0
normal (> 60%).
2 Sperm count is normal (> 20 million) but the motility is 1
reduced (< 60%).
3 Both sperm count and motility are reduced. 2
4 No Sperm is alive i.e. the count and motility is zero. 3
Parva bheda – Pain in finger joints

1 No pain in the phalanges 0
2 Mild pain in the phalanges 1
3 Discomforting pain in the phalanges 2
4 Distressing pain in the phalanges 3
5 Horrible pain in the phalanges 4
GRADATION OF SYMPTOMS: SHUKRAVAHA SROTAS
Aharshanam: Lack of Desire:

1 Normal desire 0
2 Lack of desire 1
3 Desire only on demand of partner 2
4 No desire at all 3
5 Stridvesha 4
Dhvajanucchraya: Lack of penile erection:

1 Erection whenever desired 0
2 Erection in 75% of the encounters 1
5 Only erection after severe manipulation 4
6 No erection at all 5
75
Lingashaithilya: Lack of Penile rigidity:
1 Proper stiffness to maintain erection and to continue the sexual 0
intercourse till last
2 Some loss of stiffness but can maintain the erection and continue 1
the act till last
3 Some loss of stiffness, able to maintain erection, but unable to 2
continue act till last
4 Loss of stiffness, can initiate sexual act but unable to maintain 3
erection till last
5 Total loss of stiffness and unable to initiate the sexual intercourse 4
Kshipram munchati shukram / Shighra shukra skhalanam: Premature ejaculation:

1 Ejaculation during sexual intercourse > 60 sec with at least 10 or 0
>10 pelvic thrusts
2 Ejaculation during sexual intercourse < 60 sec with at least 5 – 10 1
pelvic thrusts
3 Ejaculation during sexual intercourse < 30 sec with at least 1 - 5 2
pelvic thrusts
4 Ejaculation before penetration 3
5 Ejaculation during foreplay 4
6 Ejaculation on mere thoughts / sight 5
Shighravisarga / chirat praseka / badhnati shukram: Delayed / retarded ejaculation:

1 Timely ejaculation in 100% of sexual encounters 0
2 Delayed ejaculation in 75% of sexual encounters 1
3 Delayed ejaculation in 50% of sexual encounters 2
4 Delayed ejaculation in25% of sexual encounters 3
5 No ejaculation 4
Apraharsha: Lack of orgasm:

1 Enjoyment in every sexual intercourse by ejaculating the semen 0
2 Enjoyment in 75% of the encounters by ejaculating the semen 1
5 Lack of enjoyment in most occasions 4
6 No enjoyment at all 5
Maithunottar Shrama:Post - act exhaustion:

1 No exhaustion at all 0
2 Slight exhaustion occasionally 1
3 Exhaustion in 25 % of the encounters 2
6 Exhaustion after every sexual act 5
76
Maithunaavrutti: frequency of coitus per week
1 3 or > 3 coitus per week 0
2 2 coitus per week 1
3 1or no coitus per week 2
Maithune Svasakrucchrata: Difficulty in breathing during / after sexual act

1 No Svasakrucchrata 0
2 Mild Svasakrucchrata which does not disturb the act 1
3 Moderate Svasakrucchrata sometimes disturb the act 2
4 Severe Svasakrucchrata most of times disturb the act 3
5 Severe Svasakrucchrata which hamper every act 4
Maithune Prasvedanam: Perspiration during / after sexual act

1 No perspiration 0
2 Mild perspiration 1
3 Moderate perspiration 2
4 Severe perspiration 3
5 Severe perspiration which disturbs the sexual act 4
GRADATION OF SYMPTOMS: MUTRAVAHA SROTAS

GRADATION FOR SYMPTOMS OF ASHMARI
General Symptoms Score:
1 Complete absence of the signs and symptoms 0
2 Mild degree of the signs and symptoms 1
3 Moderate degree of the signs and symptoms 2
4 Severe degree of the signs and symptoms 3
5 Acute condition of signs and symptoms 4
Pain:
1 No pain 0
2 Occasional pain did not require treatment 1
3 Occasional pain but, required treatment 2
4 Constant dull ache pain, required treatment 3
5 Severe constant pain, but did not show relief even after treatment 4
Burning Micturition:
1 No burning micturition 0
2 Occasional burning micturition 1
3 Occasional burning micturition, required treatment 2
4 Constant burning micturition required treatment 3
5 Constant severe burning micturition but did not show relief even 4
after treatment
77
Dysuria: Krichchrata
1 No dysuria 0
2 Occasional dysuria 1
3 Occasional dysuria which require treatment 2
4 Constant dysuria which require treatment 3
5 Constant severe dysuria but did not show relief 4
even after treatment
Tenderness in Renal Angle:

1 No tenderness 0
2 Mild tenderness 1
3 Moderate tenderness 2
4 Severe tenderness 3
5 Acute tenderness 4
Hematuria: On the basis of microscopic urine analysis

1 No RBC/Hpf 0
2 0 – 5 RBC/Hpf 1
3 6 – 10 RBC/Hpf 2
4 11 – 15 RBC/Hpf 3
5 >16 RBC/Hpf 4
This is a Numerical / Qualitative data, so grading as per reading to be adopted.
Pus Cells: On the basis of microscopic urine analysis
1 No pus cells/Hpf 0
2 0 – 5 pus cells/Hpf 1
5 >16 pus cells/Hpf 4
This is a Numerical / Qualitative data, so grading as per reading to be adopted.
GRADATION OF SYMPTOMS: PURISHAVAHA SROTAS

Mala pravritti – consistency of stools
1. Samhata pureesha (well formed – solid), doesn’t change the shape on the 0
closet basin, includes Sandra
2. Asamhatam / shithilam / Shlatham (improperly formed – semsolid), 1
changes shape but do not spread on the closet basin, includes Apichilam,
Snigdham
3. Srusta pureesham, Sramsa, Bhinna, Bhramsha (Semi liquid), takes the 2
shape of the closet, adequate feces present, includes Kaphadhikam,
Phenilam, Picchanugatam, Tantumat,
78
4. Dravam / Tanu (liquid stool), watery spills throughout the closet basin, 3
includes, Jalopamam, Payabham, Ambutulyam, Udakaiva, Apureesham,
Vitvarjitham
5 Tilapistnibham, Dadhyabham, Vesavarabham, Vitjalam, Vasabham, 4
Medodakasannibham, Tailabham
Note: BRISTOL’S STOLL CHART may be used to assess the consistency of stool mass
Dravamala Pravritti: consistency of stool

1. Samhata pureesha (well formed – solid), doesn’t change the shape on the 0
closet basin, includes Sandra
2. Asamhatam / shithilam / Shlatham (improperly formed – semsolic), 1
changes shape but do not spread on the closet basin, includes Apichilam,
Snigdham
3. Srusta pureesham, Sramsa, Bhinna, Bhramsha (Semi liquid), takes the 2
shape of the closet, adequate feces present, includes Kaphadhikam,
Phenilam, Picchanugatam, Tantumat,
4. Dravam / Tanu (liquid stool), watery spills throughout the closet basin, 3
includes, Jalopamam, Payabham, Ambutulyam, Udakaiva, Apureesham,
Vitvarjitham
5 Tilapistnibham, Dadhyabham, Vesavarabham, Vitjalam, Vasabham, 4
Medodakasannibham, Tailabham
Kriccha Pravaritti – chirat pravritti - difficulty in defecation

1. 0 to 5 min time spent for defecation 0
5 Above 20 min time spent for defecation 4
Kricchra Pravritti - Krichhrena pravritti – straining during defecation

1. 0 to 5 min time spent for defecation without pain or strain 0
2. > 5 min time spent for defecation with shoola, shabda or with strain 1
3. > 10 to 15 min with shoola, Shabda, strain during defecation 2
4. 15 to 20 min time spent for defecation with shoola, shabda, strain during 3
and after defecatoin
5 Above 20 min time spent for defecation with shoola, shabda and strain 4
associated upadrava of Vyadhi.
Muhurmuhu pravritti – increased frequency:

1. 1 to 2 times / day 0
5 More than 15 times / day 4
79
Ati Grathitam – hard stool
1. Samhatam / Sandram – normal 0
2. Kharam / Parusham – dry but defecated with pain and difficulty 1
3. Kathinam / Gadham / Grathitam – dry, hard and passes segmented stool 2
4. Atigrathitam / Vigrathitam – Pellet like, stoneyhard and even froms 3
fecoliths
Mala pariksha:
- 1. Habits:
1. Regular 0
2. Irregular 1
- 2. Number of motions:
1. 1 time / day 0
2. 2-3 time / day 1
3. 4-5 times / day 2
4 6 –7 times / day 3
5 > 10 times / day 4
-3. Akriti – appearance of stool mass
1. Cylindrical 0
2. Not define 1
-4. Samhatatva: consistency of stool
1. Semisolid 0
2. Hard or Liquid 1
-5. Colour of stool
1. Dark brown (due to Malaranjaka Pitta) 0

2. Another colour 1
-6. Gadha – smell:
1. Avishesha 0
2. Bhrisha Durgandhi 1
-7. Jala nimajjana pariksha:
1. Floats in water 0
2. Sinks in water 1
Evaluation of Atisara:
1. Bowel evacuation 3 – 5 times per day 1
Atisarana < 12 hours chronicity
Pitta expelled out with purisha
Atisarana associated with pitta lakshanas
Atisarana without any dhatu lakshanas
2. Bowel evacuation 6 – 8 times per day 2
80
Atisara chronicity 12 – 24 hours
Pitta expelled out with atisara
Atisarana associated with kapha lakshanas
Atisarana with rasa dhatu Kshaya lakshanas
3 > 9 time bowel evacuation / day 3
Atisarana chronicity 1 day to 1 week
Rakta expelled out with atisara
Atisarana associated with vata lakshanas
Atisarana with rakta dhatu Kshaya lakshanas
4 >9 time bowel evacuation / day 4
Chronicity > 1 week
Purisha expelled out with mucus or kapha
Atisarna associated with Rakta / Anya vyadhi
Atisarana followed by Sangyanasha.
GRADATION OF SYMPTOMS: SWEDAVAHA SROTAS
Grade – Atisvedanama
1 Normal pattern of Sweating 0
2 Occasional excessive sweating with no features of Atisvedana or Svedavriddhi 1
3 Features of Sveda Vriddhi/Atisveda or localized sweating <100 cm2 during normal 2
room temperature/short burst of profuse sweating not affecting daily routine
activities
4 Features of Sveda Vriddhi /Atisveda with either Daurgandhya or Kandu or Moderate 3
generalized sweating affecting daily routine activity/Episodic sweating eg. Night
sweating
5 Maximum features of Sveda Vriddhi (Kandu, Daurgandhya, Atisveda, Murccha, 4
Trishna, Daha, PittaPrakopa, Sharira Sadana,Jvara,Bhrama,Shyavaraktamandala
Darshana,Pittasra Kopa,Svarasadana,Sandhipida?)/Excessive sweating >100cm2
during normal room temperature or normal psychological condition/sustained
sweating
Note: Objective Parameters may be used for hyperhidrosis such as:
Gravimetric Sweat test (Quantification Test)
Minor’s iodine Starch Test
Mapping out areas of excess sweating
Using Blotting Paper to assess the amount of Sweat
Grade - Asvedanama
1 Normal Sweating pattern 0
2 No feature of Sveda Kshaya/ No sweating even after exposure to heat or 1
stress condition but developing uncomfortable sense of warmth
3 Any 1 feature of Sveda Kshaya/ Slight sweating exposure to heat or 2
stress condition but developing malaise, easy fatigability,
headache/<1000 F
81
4 Any two features of Sveda Kshaya/ No sweating after exposure to heat 3
or stress condition but developing generalized features like nausea,
dizziness, tachycardia, palpitation, but to rule out compensatory
mechanism or heat acclimatization/100 -102 0 F/heat tolerance
5 All the features of Sveda Kshaya (Romachyuti, Stabhdaromata, 4
Sphutanam Tvacha)/ After exposure to heat or stress condition, No
sweating but developing generalized features (Hyperthermia>1030 F),
drowsiness, Hyperapnoea) but ruling out compensatory mechanism or
heat acclimatization/heat tolerance
Grade – Ati Shlakshnata

1 Absense of Ati Shlakshana Lakshana 0
2 Presense of Glossy Skin 1
3 Presense of Glossy and less Hairy Skin 2
4 Presense of Glossy, less hairy, Shiny Skin 3
Grade -Lomaharsha/horripilation
1 No Horripilation 0
2 Occasional Horripilation in presence of external or internal 1
stimuli
3 Mild Horripilation in environmental or psychological status 2
4 Moderate Horripilation in presence of external or internal 3
stimuli
5 Generalized Horripilation in absence of external or internal 4
stimuli
Another Gradation For Lomaharsha

Presence of Lomaharsha –Grade 1
Absence of Lomaharsha - Grade 0
GRADATION OF SYMPTOMS: ARTAVAVAHA SROTAS
Assessment of amount of blood loss: No. of fully soaked pads*/day

1 Up to 3 fully soaked pads / day 0
2 4 – 5 fully soaked pads / day 1
3 6 – 7 fully soaked pads / day 2
4 >7 fully soaked pads / day 3
A numerical / quantitative data, so reading itself may be taken as grade.
Amount* of blood loss: Total Blood loss Grade
1 61 to 80 gm 0
2 81 to 100 gm 1
3 101 to 120 gm 2
4 >120gm 3
82
*
A standard vaginal pads (Stayfree Secure-Regular) weighing10.25gms each was advised
during the menstrual period, starting from the first day of menstrual cycle, till its cessation.
Weight of soaked pads were measured on an electrical balance. Thus the total weights of all
the pads used in the period were measured. The difference of weight between dry and wet
pads was calculated.
**The mean score of this calculation gives us rough idea about the quantity of menstrual
blood loss.
***A simple visual assessment technique to discriminate between menorrhagia and normal
menstrual blood loss can also be adopted.
Frequency of passing of clots/ cycle Grade

1 No clots/ small clots/ up to 3 clots along with blood 0
2 4 – 5 clots along with blood 1
3 7 – 9 clots along with blood 2
4 >9 clots along with blood 3
Duration of menstrual bleeding:

1 <5 days of menstrual bleeding 0
2 6 to 7 days of menstrual bleeding 1
3 8 to 9 days of menstrual bleeding 2
4 >9 days of menstrual bleeding 3
Assessment of Inter Menstrual Period:

1 25 to 35 days interval 0
4 < 15 days/irregular interval 3
Angamarda (Bodyache):
1 No pain 0
2 Generalized pain of and on during the day 1
3 Generalized pain/ache during most part of the day not affecting any work 2
4 Generalized pain pain/ache throughout the day but person is able to do 3
normal routine
5 Generalized (sarvanga) bodyache/pain enough to affect routine work for all 4
the day
Vedana (Lower Abdominal Pain during Menstrual period):

1 Menstruation is not painful 0
2 Menstruation painful but daily activity is not affected, 1
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no need of analgesic
3 Daily activity affected, needs to take analgesic 2
4 Daily activity inhibited, pain continue 3
after administration of analgesic
Note: Visual Analogue Scale and “Verbal multidimensional scoring system” may be used
to assess the severity of pain.
MANASA PARIKSHA BHAVA (MENTAL FACTOR EXAMINATION):
Ayurvedic classics have explained mental factor examination deliberatively and the
means to assess all mental factors by inference are described in Charaka Samhita. Utilizing
these means, a specialized rating scale for mental factor examination is prepared by giving
scores to various presentations of mental state. This scale may be used in the research works
for clinical evaluation and analysis and is given below:
Manasa- Arthesu Avyabhichranena
1 No deviations 0
2 Getting deviated very rarely 1
3 Deviation often and knowledge perception impairs 2
4 Deviation and perception frequently disturbed 3
Vignyanam vyavasayena
1 Normal functioning in routine 0
2 Gradual hampered performance in functioning 1
3 Impaired motivation towards functioning often 2
4 Loss of pace and motivation in functioning 3
Rajah-Sangena i.e. “Naryadisangena tatkaranam rajoanumiyate” (Chakrapani)

(Affection to opposite)
1 Normal affection 0
2 Gradual decreased affection 1
3 Loss of affection occasionally 2
4 Frequently and totally loss of affection 3
Moha – Avijnanena
1 Normal functioning capacity 0
2 Gradual affliction towards objects 1
3 Increased affliction, oftenly towards objects 2
4 Totally involvement and affliction with objects 3
Krodha – Abhidrohena i.e. “Parapidartha Pravrittih” (Chakrapani)

1 No violent tendencies 0
2 Violent thoughts very rarely 1
3 Violent, Sadistic functions oftenly 2
4 Frequent thoughts and functions of violence and sadistic 3
84
Shoka Dainyena i.e. “Rodanadi” (Chakrapani)
1 No feeling of Sorrowness 0
2 Feels inferiority and sorrow at occasion 1
3 Inferiority complexes and greedy oftenly 2
4 Weeps and feels inferior very frequently 3
Harsha – Amodena i.e. “Nritya gita vaditradutsavakaranama” (Chakrapani)

1. Totally cheerful on all occasion 0
2. Cheerful and initiative with good circumstances 1
3. Cheerful and active in that, only at occasion 2
4. No feeling of cheerfulness 3
Priti – Tosena i.e. Mukhanayanprasadadih” (Chakrapani)

1 Always happy and pleased 0
2 Happy and pleased occasionally 1
3 Express happy mood oftenly 2
4 No feeling of happiness at all 3
Bhayam – Vishadena
1 No fear 0
2 Fearful only at reasonable cause 1
3 Fearful even in reasonable cause 2
4 Always fearful emotion 3
Dhairyam-Avishadena i.e. Manaso Adainyam” (Chakrapani)

1 No fear or sorrow at any cause 0
2 Fearful only at reasonable at any cause 1
3 Fearful occasionally 2
4 Always in fearful and depressed emotions 3
Viryam – Utthanena i.e. “Kriyarambhena” (Chakrapani)

1 Starts and works very quickly 0
2 Works with less interest 1
3 Delayed and decreased in working capacity 2
4 Not able to start any work 3
Avasthan - Avibhramena i.e. “Sthiramatitvam” (Chakrapani)

1 Always confident and stable in perception 0
2 Often stable in knowledge perception 1
3 Rarely confident and stable in perception 2
4 Not stability or confidence in perception 3
Shraddha – Abhiprayena i.e. “Abhyarthanena” (Chakrapani)

1 Always very good in attitude and interest 0
2 Occasionally good in attitude and interest 1
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3 Impaired attitude and interest 2
4 Totally loss of attitude and interest 3
Medha – Grahanena i.e. “Granthadidharanena” (Chakrapani)

1 Always grasps the events at an instance 0
2 Grasps the event but confused 1
3 Delayed in grasping the events with confusion 2
4 Unable to grasp or understand 3
Sandnya namagrahanena
1 Completely attentive in all occasions 0
2 Attentive occasionally 1
3 Attentive rarely 2
4 Absolutely no attentiveness 3
Smriti smaranena
1 Very good in recalling and remembering 0
2 Recalls and remembers with difficulty 1
3 Delayed recall and remembers with difficulty 2
4 Delayed recall and remembers with confusion 3
Hriya apatrapanena
1 Shyness intact always completely 0
2 Feeling of shyness in unknown atmosphere 1
3 Feeling of shyness only in front of some unknown persons 2
4 No shyness at all 3
Shila anushilanena
1 Very good conduct at all instances 0
2 Impaired conduct only at occasions 1
3 Impaired conduct recurrently 2
4 Totally abnormal conduct 3
Dvesha – Pratishedhena i.e. “Vyavrutya” (Chakrapani)

1 No revenging tendency at all 0
2 Thoughts of revenge only at few events 1
3 Thoughts and acts of revenge oftenly 2
4 Always thoughts and acts of revenge 3
Upadhi- Anubandhanena i.e. “Uttar Kalinaphalena” (Chakrapani)

1 Normally short impact that can be solved by the person himself 0
2 Prolonged, disturbing impact but able to solve by self efforts 1
3 Impact can only be solved by the perseverance effort and counseling by 2
others
4 Even other can not help in resolving the impact of concerned problem 3
86
Dhriti- Alaulyena
1 Not greedy for anything (Good controlling power) 0
2 Greedy and willing for few objects (Mild) 1
3 Greedy but not strongly willing (Moderate) 2
4 Greedy for all objects (Can not control) 3
MANASA VIBHRAMA PARIKSHA:

Charaka has described eight specific characteristic perversions in context of Unmada. On
which Chakrapani commented deliberatively to explain its applications. An eight fold Manas
Vibhrama Pariksha (mental perversion examination) scale is formulated accordingly to test
its applications as well as to assess efficacy of drug on it. The explanatory definitions of
terms are given below:
1) Mano vibhrama ( perversion of mind):
Mano vibhramat Chintyan arthan na chitayate, Achintyanshch chitayate I
Means due to perversion of mind, the patient does not think the things which are worth
thinking; on the other hand he thinks of the things not to be thought of.
2) Buddhi vibhrama ( perversion of intellect ):
Buddhi vibhramat tu nityam anityam iti, priyam cha apriyam iti pashyati I
Due to perversion of intellect, he understands eternal things as ephemeral and useful
things as harmful.
Depersonalization and de-realization:
0 Absent
1 Mild Such as:
2 Moderate Feeling of unreality
3 Severe Nihilistic ideas
4 Incapacitating
3) Sangnya vibhrama ( perversion of consciousness):
Sandnya dnyanam, tad vibhramat Agnyadi daham na buddhyate; kimva sandnya
namollekhena dnyanam I
Due to perversion of consciousness, the patient is unable to have perception of burns
caused by fire etc.
4) Smriti vibhrama ( perversion of memory ):
Smriti vibhramat Na smarati ; Ayathavad va smarati I
The patient either does not remember anything or remember things incorrectly due to
perversion of memory.
5) Bhakti vibhrama ( perversion of desire or interest ):
Bhaktihi ichcha, tat vibhramat yatrechcha purvam aasit, tatra anichcha bhavati I
Due to perversion of desire, disinclination develops for things desired previously.
6) Shila vibhrama ( perversion of manners ):
Shila vibhramat akrodhanah krodhano bhavati I
Due to perversion of manners, the patient, who is otherwise normal, gets enraged.
7) Cheshta vibhrama ( perversion of behavior):
Cheshta vibhramat Anuchita cheshto bhavati I
Due to perversion of behavior, the patient indulges in undesirable activities.
87
8) Aachara vibhrama ( perversion of conduct):
Aacharah shastra shiksha krita vyavahara; tad vibhramat ashouchyadi aacharati I
Due to perversion of Conduct, the patient resorts to such activities as are against the rules
prescribed in religious works.
Patients were interrogated for having such experiences and scored depending upon the
frequency of these experiences as follow:
• Not present - 0
• Occasional (once in a month) – 1
• Often (once in a week) – 2
• Always (daily) – 3
The standard modern scales to evaluate the anxiety and depression may be used as
supplementary to the above scoring / grading pattern like -
• HAMILTON ANXIETY RATING SCALE (HAM-A):
• HAMILTON’S DEPRESSION RATING SCALE (HAM-D):
• BRIEF PSYCHIATRY RATING SCALE (BPRS):
SOME GENERAL SYMPTOMS:

JWARA- FEVER
1. No 0
2. Occasional 1
3. Daily once 2
4. Constant 3
Another grading for Jvara : fever
1 No fever 0
2 Occasional fever subsides by itself 1
3 Occasional fever subsides by drug 2
4 Remittnent fever 3
5 Continuous fever 4
GAURAVA - heavyness
1. Absent 0
2. Occassional gaurava 1
3. Frequently 2
4. Regular 3
BHRAMA (VERTIGO): ability to balance

1. No Bhrama 0
2. Vertigo, able to maintain balance without support 1
3. Vertigo, not able to maintain balance but can maintain balance 2
with support
4. Severe vertigo, not able to maintain balance even with support 3
Other grading for Bhrama – (vertigo)
1 No bhrama 0
2 Fairly bhrama for some moment during change of posture. 1
3 Often bhrama for some moment during change of posture. 2
88
4 Often bhrama for each moment in lying condition also. 3
5 Patient unable to hold himself with any support. 4
BHRAMA :- dizziness, giddiness

1. Absent 0
2. Occassional giddiness 1
3. Frequently attacks of giddiness 2
4. Regular attacks of giddiness 3
Pipasa – thirst
1 No excessive thirst 0
2 Upto 1.5 times the normal thirst 1
3 Upto 2 times the normal thirst 2
4 Upto 2.5 times the normal thirst 3
5 Upto 3 times the normal thirst 4
Note: It is a numerical quantitative data and so should be based on quantity of liquid
consumed per day
Twak rookshata – Dryness of skin

3 Linging & even words can be written by anil 2
4 Excessive rukshata leading to kandu 3
5 Rukshata leading to crack formation 4
Another grading for Rukshata (Dryness)
1 No dryness. 0
2 Occasional dryness without winter season 1
3 Visible dryness, mild dull white streaks after scratching on the 2
skin which disappears after sometime.
4 Dryness/roughness, bright white streaks on the skin remaining 3
for a considerable time.
5 Dryness/roughness and criss-cross visible cracking of skin. 4
Kandu – Pruritis
1 Never 0
2 Rarely 1
3 Sometimes 2
4 Often 3
5 All the times 4
Sweda – sweating
1 Normal sweating (Sweating) 0
2 Mild sweating 1
3 Mild sweating after exercise 2
4 No sweating – even after exercise 3
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Srava – discharge (exudation)
1 No Srava 0
2 Mild srava after itching 1
3 Moderate srava without itching 2
4 Severe srava without itching 3
Another grade for Srava:

1 No Srava 0
2 Mild Srava 1
3 Moderate Srava 2
Vedana – Pain
1 No vedana 0
2 Mild vedana 1
3 Moderate vedana 2
4 Severe vedana 3
Note: Visual Analogue Scale may be used here.
Kandu – Itching
1 No itching 0
2 Mild / occasional itching 1
3 Moderate frequent itching 2
4 Severe frequent itching 3
5 Very severe itching, which disturb sleep and other routine 4
activities.
Rukshata - Dryness
3 Linings and even words can be written on scrubbing by nail 2
4 Excessive Ruksata leading to itching 3
5 Ruksata leading to crack formulation and Bleeding 4
Daha – Burning sensation

1 No Daha 0
2 Mild Daha 1
3 Moderate Daha 2
4 Severe Daha 3
Nidra - Sleep
1 Sound Sleep 0
2 Sleep sound when interrupted can sleep again 1
3 Sleep sound when interrupted can’t again 2
4 Disturbed sleep but can sleep for few hrs 3
90
Kasa – cough
1 Abent 0
2 Few times, does not need medication 1
3 Frequent coughing, can be controlled by medication 2
4 Very frequent coughing not even controlled by medica tion 3
Shwasa: Difficulty in breathing

1 Absent 0
2 Slightly difficulty I breathing, due to exertion or activity, does 1
not needs medication
3 Difficulty in breathing, without exertion or activity, requires 2
medication
4 Difficulty in breathing, with or without exertion or activity, 3
not easily controlled by medical intervention
Daurbalya (Weakness):
1. Can do routine exercise/work 0
2. Can do moderate exercise with hesitancy 1
3. Can do mild exercise only, with difficulty 2
4. Can not do mild exercise too 3
Another grading for Daurbalya (General Debility)
1 No daurbalya 0
2 Not able to perform strenuous activity. 1
3 Not able to perform moderate activity. 2
4 Cannot perform moderate activity but can perform mild 3
activity without any difficulty.
5 Even mild activities cannot be performed. 4
Daurbalya (General Debility):
1 No daurbalya 0
2 Not able to perform strenuous activity. 1
3 Not able to perform moderate activity. 2
4 Cannot perform moderate activity but can perform mild 3
activity without any difficulty.
5 Even mild activities cannot be performed 4
NOTE: For assessment of Daurbalya – TM Test may be adopted
Alasya/Utsahahani (lazyness / absence of enthusiasm)

1 No Alasya (doing satisfactory work with proper vigor & in time) 0
2 Doing satisfactory work/late initiation, like to stand in comparison 1
to walk
3 Doing unsatisfactory work/late initiation, like to sit in comparison 2
to stand
4 Doing little work very slow, like to lie down in comparison to sit. 3
5 Don’t want to do work/no initiation, like to sleep in comparison to 4
lie down
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Other method of scoring:
1 Gaurava – heaviness in the body 1
2 Aalasya – lazyness to do any work 2
3 Shrama – tiredness in doing works 3
Shula (Joint Pain):

1 No pain 0
2 Pain in joint, routine movements normal 1
3 Pain in joint, slight limitations of movements 2
4 Pain in joint, limitations of movements with very reduced 3
activity.
NOTE: Pain may be assessed with visual analogue scale or other appropriate pain
measurement scales.
Ruchi - taste feeling in food

1. Equal willing towards all the foods 0
2. Willing towards some specific foods or Rasavishesha 1
3. Willing towards only one among Katu, Amla, Madhura food stuffs 2
4. Willing towards only most liking foods and not to the other 3
5. Unwilling for any food, could take meal 4
6. Unwilling for any food, also could not take meal 5
Aruchi – Tastelessness in food

1. Normal instinct of taking food 0
2. Person even dislikes the touch or smell of food 1
3. Though the person is hungry he had dislike for food 2
4. Due to fear, anger etc 3
5. Person doesn’t like to take food due to Sharira/Manas doshas 4
Another grading for Aruchi:
1. Normal taste in food, feeling to eat food in time 0
2. Aruchi – feeling to take food but not having taste 1
3. Anannabhilasha – not feeling to take food even if hungry 2
4. Bhktadvesha – aversion to food 3
5. Abhaktachchanda - 4
Agnimāndya (diminution of the agni):

1. Feels good hunger and proper digestion regularly 0
2. Feels good hunger but irregular digestion 1
3. Feels less hunger and irregular digestion 2
4. Feels very less hunger and the very less digestion 3
1. Matravat Ahara, feels confortable, proper digestion 0

2. Matravat Ahara, discomfort, proper digestion 1
3. Less than matravat ahara, more discomfort 2
4. Not able to digest even little food feels more discomfort 3
92
Utsaha hani : Aalasya
1. No Alasya (doing work satisfactory with) proper vigor in time 0
2. Doing work with desire with initiation but late in time 1
3. Does work without desire with lot of mental pressure and late in time 2
4. Does not initiate work, does little work very slowly 3
5. Doesn’t take initiative to work neither want to work even after pressure 4
Angagauravata (Sluggishness of Activities):

1. No heaviness in body 0
2. Feels heaviness in body but it does hot hamper routine work 1
3. Feels heaviness in body, which hampers daily routine work 2
4. Feels heaviness in body, which hampers movement of the body 3
5. Feels heaviness, flabbiness all over body, which causes stress 4
Sarvanga gaurava (Heaviness of the body)
1 No feeling of heaviness. 0
2 Occasional feeling of heaviness not affecting the daily routine 1
3 Frequent feeling of heaviness mildly affecting the daily routines. 2
4 Feeling of heaviness throughout the day moderately affecting the daily 3
routines.
5 Feeling of heaviness throughout the day. Daily routines are totally 4
hampered.
SHRAMA - fatigue
1 No fatigue 0
2 Fatigue occasionally on doing heavy work 1
3 In carrying out routine work 2
4 Even without doing work 3
Vibandham – constipation
1. 1 time / day 0
2. 1 time / 2 days 1
5. 1 time / 54 days 4
6. 1 time / 6 dyas 5
7. 1 time in more than 7 days 6
Parushya - dryness
1 No dryness 0
2 Visible dryness of skin with no roughness, mild (fade) dull white 1
streak after scratching on to skin, disappearing after sometime (Ruksha)
3 Dryness with roughness, bright white streak on scratching on to the 2
skin remaining for a considerable time (Khara)
4 Dryness, roughness, slight thickening of the skin with visible criss- 3
cross marking with no cracking of the skin
5 Dryness, roughness, slight thickening of the skin with visible criss- 4
cross marking with cracking of the skin (Daruna)
93
Paridaha - burning sensation
1 No Burning Sensation 0
2 Occasional Localised Burning Sensation 1
3 Localised mild Burning sensation in a particular hr.of day 2
4 Burning sensation throughout the day but tolerable and relieved after 3
cold medications e.g.Mahatikta Ghrita for Ext.or Int.
application,Dhanyaka hima for Int.application
5 Intolerable(Affecting daily routine activity) generalized burning 4
sensation throughout the day which can’t be relieved by any cold
medications e.g.Mahatikta Ghrita for Ext.or Int. application,Dhanyaka
hima for Int.application
Twak Pārusya / Twak Rukshata/ Twak Kathinata (dryness of skin):

1. O dryness 0
2. Dryness felt by the patient 1
3. Dryness felt by the examiner 2
4. Dryness felt by all 3
Śwāsa kaşţa (Dyspnoea):-

1. Dyspnoea after heavy work but relieved soon and up to tolerance 0
2. Dyspnoea after moderate work but relieved later and up to tolerance 1
3. Dyspnoea after little work but relieved later and up to tolerance 2
4. Dyspnoea after little work but relieved later and beyond tolerance 3
5. Even in resting condition. 4
Pāndutā (Pallor): In - Twaka, Nakha, Netravartma, Karna Pali, Jihva, Hastapadatala

1. Absent 0
2. Present in one site 1
3. Present in 2 – 3 sites 2
4. Present in all sites 3
PANDUTA – pallor : - Twaka, Nakha, Netravartma, Karna Pali, Jihva, Hastapadatala

1. Not Visible, pink all over 0
2. Visible 1
3. Visible with yellow discolouration 2
Panduta: colour of body parts;

1. Red 0
2. Pink 1
3. Whitish / pale 2
4. Yellowish 3
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Signs & Symptoms produced by Ama in General (Due to the circulation of
Sama Rasa Dhatu)
Srotorodha (obstruction to the channels cell pores) - Present / Absent
Bala Bhramsa (loss of strength) - Present / Absent
Gaurava (feeling of heaviness of the body) - Present / Absent
Anilmudhata (inactivity of Vaata) - Present / Absent
Alasya (Lassitud) - Present / Absent
Apakti (Indigestion) - Present / Absent
Nishthiva (Expectoration of Sputum) - Present / Absent
Malasanga (Accumulation of waste materials in the body) - Present / Absent
Aruchi (loss of taste / appetite) - Present / Absent
Kiama (exhaustion) - Present / Absent
VAATA
SAMA LAKSHANA
Vibandha (constipation) - Present / Absent
Agnisada (poor digestive activity) - Present / Absent
Antrakujan (Intestinal gorgulings) - Present / Absent
Angashula (pain in the body parts) - Present / Absent
Sotha (Odema or Swelling) - Present / Absent
Nistoda (pain moving simultaneously to different parts causing distress & catching) – Y / N
Pain incresing by anointing oils, exposure to sunlight, on cloudy days & during nights. Y/ N
PITTA
SAMA LAKSHANA
Amlika(sour belching) - Present / Absent
Kanthahriddaha (burning sensation in the throat and region of the heart) - Present / Absent
Elimination of foul smell - Present / Absent
Greenish blue, sour, thick and heavy Pitta comes out of the body - Present / Absent
(either in vomit or purgation)
KAPHA
SAMA LAKSHANA
Avila (dirty) Phlegm - Present / Absent
Tantula (thready) phlegm - Present / Absent
Styana (thick, solid) phlegm - Present / Absent
Durgandha (foul smelling) phlegm - Present / Absent
Phlegm accumulates in the throat - Present / Absent
Phlegm obstructon to belching - Present / Absent
Loss of hunger - Present / Absent
95
AGNIBALA
Jaranashakti
Scoring according to Jeerna Aahara lakshana present after 4-6 hrs after taking food. They are
Utsah, Laghuta, Udgarshuddhi, Kshut, Trishna pravritti Yathochit malotsarga.
Presence of five symptoms 0
Presence of four symptoms 1
Presence of three symptoms 2
Presence of two symptoms 3
Presence of one symptom 4
Absence of all the symptoms 5
Abhyavaharan Shakti
Taking food in good quantity twice / thrice 0
Taking food in normal quantity twice a day 1
Taking food in moderate quantity twice a day 2
Taking food in less quantity twice a day 3
Person taking food in less quantity once in a day 4
Person not at all taking food. 5
Ruchi
Equally willing towards all the Bhojya padartha. 0
Willing towards some specific Aahara / Rasavisesha 1
Willing toward only one among Katu/Amla/Madhura food stuffs. 2
Willing towards only most liking foods not to the other. 3
Unwilling for food but could take the meal 4
Totally unwilling for meal. 5
Vaata Mutra Purisha Retasam Mukti

Occurs easily in normal routine times 1
Difficulty in defecation but Malapravritti daily with discomfort in 2
abdomen
Can't pass stool daily & feeling heaviness in abdomen. 3
Passes stool after 2-3 days having gaseous distension 4
Passes stool after 3-4 days with Grathita, Sakasta Malapravritti 5
& having gaseous distention with Udgarapravritti.
DEHA BALA
Balavriddhi
No weakness 0
Slight weakness 1
Feeling of weakness but ability to work unaffected 2
Ability to work affected 3
Can't do any type of work 4
96
Swara Varna Yoga (Texture, Lusture & voice)
Patients look cheerful 0
Lethargic & tired 1
Patient look gloomy 2
Sharira Upachaya – body built (height, weight etc.)
As recorded before and after treatment
SATVABALA
Nidra Labho Yathakalam (adequate sleep at night)
Sound sleep 0
Sleep gets disturbed in the early morning 1
Sleeps with disturbed interval & remains unsatisfied with sleep 2
Disturbed sleep in night tries to compensate in day 3
No sleep in night 4
Sleep neither at night nor at night hours 5
Sukhena - Cha – Pratibodhanam

Total relief & feeling of well being at physical & mental level 0
Discomfort at mental level 1
Discomfort at physical level 2
Discomfort at both mental & physical level 3
Not feeling well still can pursue work or study 4
Not feeling well & not interested in any activity at all (Avarasatva) 5
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GUIDELINES FOR CLINICAL RESEARCH METHODOLOGY IN AYURVEDA
Glossary of Ayurvedic words

Aachara - Conduct
Abhyavaharana Shakti - Power of assimilation of ingested food
Adhidanta - Supernumerary tooth
Adhmana - Distention
Agni - Digestive power
Agnimandya - Diminution of the Agni
Agnisada - Poor digestive activity
Aharshanam - Lack of Desire
Alasya - Lassitude
Alasya/Utsahahani - Laziness / Absence of enthusiasm
Alpa shukrata – Oligospermia
Amla Śeeta Prārthanā - Desire for sour, cold stuff
Amlika / Amlodgara - Sour belching
Angagandha - Bad bodily odour
Angagauravata/ Angasada/Gaurava - Sluggishness of Activities
Angamarda/ Angashula - Body ache
Anilamudhata - inactivity of Vata
Annavaha Srotas - Channel of Digestion/ Digestive system
Antrakujana - Intestinal gurgling
Apakti - Indigestion
Apraharsha - Lack of orgasm
Artavavaha Srotas - Reproductive system in females
Aruchi - Loss of taste / Appetite
Arumshika - Abscess
Ashmari - Calculus particularly urinary calculus
Asino Labhate Saukhyam - Relived from symptoms on sitting
Asthi kshaya lakshana - Signs and symptoms of depletion of Asthi dhatu
Asthi Sandhi baddhata - Stiffness in bones & Joints
Asthi shula/bheda - Pain in bones
Asthi shunyata / Asthi saushirya - Hollowness on bones viz. Osteoporosis
Asthivaha Srotas - Skeletal system/ concerned with bone metabolism
Asthivedana – pain in bones
Asvedana - Anhidrosis/hypohidrosis
Asyapraseka - Excessive Salivation
Ati Grathitam - hard
Atisara - Diarrhea
Atishlakshna - Excessive Smoothness /Glossiness
Atisvedana - Hyperhidrosis
Avastha - Stage
Avila - Dirty / cloudy
Bala Bhramsa - Loss of strength
Balavriddhi - Increase in Strength
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Bhakti - Desire or interest
Bhaya - Fear
Bhrama – Dizziness/ giddiness/Vertigo
Buddhi - Intellect
Cheshta vibhrama - Behavior
Chhardi - Vomiting
Daha - Burning sensation
Danta vikara/pata - Dental deformity/fall
Dantabheda - Fracture tooth
Dantashoola - Toothache
Daruna - Hardness
Daurbalya - General Debility/ Weakness
Deha Bala - Physical strength
Dhmatabhstiprakasha - Like a bloated leather bag
Dhvajanucchraya - Lack of penile erection
Dirgha shopha - Large Swelling
Durgandha - Foul smelling
Gatrashula – Pain in body parts
Gaurava - Feeling of heaviness of the body
Hridaya Spandanādhikya - Palpitation
Hrillasa - Nausea
Jarana Shakti – Capacity of digestion
Jwara - Fever
Kampa - Tremors
Kandu - Pruritis
Kanthahriddaha - Burning sensation in throat and heartburn
Karnakshweda – tinnitus particularly loud pitched sounds
Kasa - Cough
Kathinya - Stiffness/Firmness
Katishoola – Back ache
Kesha Patana - Hair fall
Khara - Hardness/Roughness/Broken
Klama - Exhaustion
Krichchrata - Difficulty
Krichhra Vyavayta - Loss of Libido
Kshipram munchati shukram / Shighra shukra skhalana- Premature ejaculation
Kshudha - Hunger
Kshudha adhikya - Increased Appetite
Kshudra Shwasa - Dyspnoea due to exertion
Laghuta - Lightness
Lingashaithilya - Lack of Penile rigidity
Lomaharsha - Horripilation
Mahavastu - Large area
Maithunaavrutti - Frequency of coitus per week
Majjavaha Srotas - Related to Bone marrow
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Malasanga - Accumulation of waste materials in the body
Mamsabhilasha - Desire of eating meat
Mamsavaha Srotas - Related to Muscles
Manas Vibhrama - Mental perversion
Mandala - Circular
Matsyashaklopama - Like Fish scales
Medovaha Srotas - Related with Lipid metabolism
Muhurmuhu pravritti – Increased frequency
Mukha Shosha – Dryness in mouth
Murchha - Fainting
Mutravaha Srotas - Urinary system
Nakha Vikara/ Nakhdusti - Nail deformity
Netra gaurava - Heaviness in the eye
Nidra Labho Yathakalam - Adequate sleep at night
Nidra - Sleep
Nidradhikya - Increased Sleep
Nishthiva - Expectoration
Nistoda - Pain moving simultaneously to different parts causing distress and
catching, usually in bone or skeletal system
Panduta – Pallor, due to anemia
Pandu Twak - Pallor of skin
Pandu Nakha - Pallor in nail bed
Pandu netravartma - Pallor of eye lids and conjunctiva
Pandu Karna Pali - Pallor in external ear i.e. pinna
Pandu Jihva - Pallor of tongue
Pandu Hastapadatala - Pallor of palm and soles
Paridaha - Burning sensation/ conflagration
Parshvasula - Pain in Flanks
Parushya –Hardness/ Roughness/ lichenification
Peenasa - Running nose
Pindikodweshtanam - Pain in calves especially cramp-like
Pipasa adhikya - Increased Thirst
Prabhuta Mutrata - Polyurea
Pranavaha Srotas - Related with Respiration and Circulation
Purishabaddhata - see Vibandha
Purishavaha Srotas - Related with defeacation; especially colon
Rakta Mandala - Erythematous patch
Raktavaha Srotas - Related with Raktadhatu
Roga - Disease/ Infirmity/ Illness
Ruchi – Appreciation of taste in food
Ruksha - Dryness/Arid
Sadana – Tiredness/Fatigue
Sandhi Shaithilya - Looseness/Weakness of Joints
Sandhishoola - Pain in joints
Sangnya vibhrama - Consciousness
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Sarvanga gaurava - Heaviness of the body
Sashabda Shwaasa - Added sounds in respiration
Satvabala - Mental strength
Shighravisarga / Chirat praseka / Badhnati shukram- Delayed / retarded
ejaculation
Shila vibhrama - Manners
Shosha - Dryness/ Loss
Shrama - Fatigue
Shrama Swasa - Dyspnoea due to exertion
Shukra Kshaya - Depletion of semen
Shukravaha Srotas - Reproductive system especially in males
Shula - Pain
Shwasa/ Shvasakrichhrata - Difficulty in breathing
Smriti vibhrama - Memory
Sotha - Odema/ Swelling
Srava - Exudation
Srotorodha - Obstruction to the channels cell pores
Sthaulya - Obesity
Styana - Thick, solid
Suptata - Numbness
Swara Varna Yoga - Texture, Luster & voice
Sweda - Sweating
Swedavaha Srotas - Related with sweating
Tama - Darkness
Tantula - Thread like
Trishna - Thirst
Twak Pārusya / Twak Rukshata/ Twak Kathinata - Dryness of skin
Udakavaha Srotas - Channels related with water balance
Udgarashuddhi - Clarity of Belching
Unnati - Elevation
Utsaha - Enthusiasm
Vedana - Pain
Vega - Urge
Vibandha - Constipation
Vibhrama - Perversion
Vivarnata/ Vaivarnya - Discolouration
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INSTITUTE FOR POST GRADUATE TEACHING & RESEARCH IN AYURVEDA, JAMNGAR.
Experts meet on “Developing Guidelines for Clinical Research methodology in Ayurveda”
5th & 6th March, 2011
Brief Report of the Expert meet:

Experts meet on “Developing Guidelines for Clinical Research methodology in Ayurveda” was held
on dates 5th & 6th March, 2011 at the Committee room of IPGT&RA, Gujarat Ayurved University,
Jamnagar. It was the part of project sponsored by WHO Country Office India, under DFC Scheme
[Direct Finance Cooperation (DFC) Regn. No. 2010/99074-1, Purchase Order No. 200271516-1 –
Developing guidelines for Clinical Research methodology in Ayurveda, 16 Oct 2010 to 30 March
2011: WHO reference 2010/99074-1, Purchase order 200271516-1.]. The following persons were
present in the meeting;
1. Prof. Gurdip Singh, Hassan

2. Prof. G Shrinivasa Acharya, Udupi
3. Dr. Rammanohar, Coimbatore
4. Prof. CP Shukla, Jamnagar
5. Dr. SH Acharya, Jamnagar
6. Prof. PK Prajapati, Jamnagar
7. Dr. Anup B Thakar, Jamnagar
Prof. KS Dhiman, Prof. Nishteshwar, Prof. VD Shukla, Dr. KS Patel, Dr. SK Gupta, Dr. Mahesh Vyas, Dr.
LP Dei, and Dr. AD Dave as heads of various departments were present in the program and Prof. MS
Baghel, Director of the Institute and Chief Investigator in the project and Dr. Rajagopala S,
Investigator were also present. Apart from the above members, few nominated Ph.D. scholars of
various departments too took active participation in the meeting by giving technical support and
other necessary supports.
The meeting started with a formal inauguration at 09.30 AM on 5th march 2011 and the venue was
the committee room of IPG&RA, Jamnagar. Prof. CP Shukla, a renowned Ayurvedic physician and
local expert member of the meeting inaugurated the program by lighting the lamp.
Prof. MS Baghel, Director of IPGT&RA welcomed the gathering and introduced the theme of the
meeting, he also stressed on the need of a separate research methodology and guidelines for pure
Ayurvedic clinical research. Till date what so ever research works have been carried out have
contributed to the modern medicine at large, not to Ayurveda specific. There are ample of disparity
among the gradation of symptoms adopted at different centers and this has lead to disparity in
results as well as reproducibility of the data and methodology. With these in mind a workshop was
conducted in November 2009, and the outcome of the workshop is presented before the expert
group he added.
Prof. CP Shukla in his inaugural address highlighted the importance of clinical examination and
evaluation of a clinical study as per Ayurvedic methods which are being supported by the classical
texts like Charaka Samhita. There are three methods of treatment now a day adopted by many i.e.
Ayurvedic diagnosis – Ayurvedic treatment; Modern diagnosis – modern treatment and Modern
diagnosis – Ayurvedic treatment. And the third modality is adopted by him, which is suitable for the
present day he said. The established techniques of diagnosis of a disease are to be adopted and
efforts to be made to interpret it with Ayurvedic fundamentals, and he quoted many examples for
the same. He also shared some of his clinical experiences with the gathering.
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Prof. Gurdip Singh, an external expert member commented his opinion and said it is the need of the
hour to have this type of efforts, this will help in producing uniformity in clinical research and there
will be chances of reproducibility of the data too. He emphasized more on the uniformity in
approach, gradation, out come and also in presentation for international acceptance.
Dr. Rammanohar opined that the effort is good, and CRF 1 circulated should be treated as initial
screening proforma and it may be put for field trial first for validation and corrections needed if any.
The symptoms should be first classified in to subjective and objective and each symptom needs
specific definition as it is given in Ayurveda specific to the context.
Dr. G Shrinivas Acharya opined that biological variations are not given due importance in the
modern clinical research, but it is different in Ayurveda, biological variations are many and play vital
role in Ayurveda therapeutics.
Prof. VD Shukla : Vyadhipratyatma lakshana should be taken in to consideration for gradation. Roga
prakriti, vyadhi prakriti, rogi prakriti, roga bala, rogi bala etc. are to be considered before hand.
The expert group after the inauguration and introduction of the program, started to look into the
materials in detail, as per the program schedule, and on the second day the following points were
discussed during the closing ceremony:
Prof. Gurdip Singh: Drug trails and therapeutic trails are different particularly with reference to
Ayurveda, which has multiple drug approach as well as multiple therapeutic procedure are involved
in treatment of one disease. Approach of Ayurveda to a patient is different from that of modern
medicine and so is the research approach too. Till date more than 80 medicinal plants have been
added to Indian Pharmacopoeia of modern medicine, but no substantial contribution has been made
to Ayurveda by the existing research protocol and methodology. Biological variations are not given
importance in modern research but in Ayurveda biological variations play very vital role.
Prof. G Shrinivas Acharya: Variables are many , data is less, data generation is needed. No one
protocol is fit to all patients of same disease, Drug trail is different for Ayurveda trail
Dr. Rammanohar: Variable to be defined first, one variable only to be kept in question in the clinical
trails, all other variable should be constant in the inclusion criteria, to avoid the bias. Base proforma
should have maximum variables in it. Specified proforma should have minimum variable in it.
Stratified sampling is better in variable selection, Principles and practice of Ayurveda: principles
remained static and practice went on changing,
Prof. CP Shukla: Dosha hara V/s Vyadhihara drugs are to be assessed for their efficacy and Diagnosis
and Samprapti of Ayurveda should be given more stress in Ayurvedic clinical research.
At the end of the program Prof. MS Baghel, Chief Investigator in the project gave the concluding
remarks, all the suggestions made by the experts in the meeting will be incorporated in the
corrected version of the document and will be submitted to the sponsoring agency i.e. WHO, he
added.
The meeting ended with thanks to all experts and participants by Dr. Rajagopala S, the investigator
of the project.
Refreshments, High tea, and working lunch etc. were provided to all participants during the meeting
hours of 2 days.
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Expert meet: 5th & 6th March, 2011, IPGT&RA, Jamnagar.
Name & address of Experts attended the Expert Meet:
Sl. No. Name & Address

Prof. Gurdip Singh
1.
Director, PG Studies, SDM College of Ayurveda, HASSAN. Karnataka
Prof. Srinivas Acharya
2. Professor & Head, Dept. of Kayachikitsa, SDM College of Ayurveda, Kuthpady, UDUPI,
Karnataka
Dr. Rammanohar
3.
Director, AVATAR, Ayurveda Trust Campus, Coimbatore – 45. Tamilnadu
Prof. CP Shukla
4.
Ex Dean, Patel Colony, JAMNAGAR
Dr. S. H. Acharya
5. Reader & Head, Dept. of Panchakarma, SGA Mahavidyalaya, Guj. Ayurved University,
JAMNAGAR
Prof. PK Prajapati
6.
3rd floor, Satkar, near Sri Guru Dattatreya mandir, JAMNAGAR
Dr. AB Thakar
7.
4th Floor, Satkar, near Sri Guru Dattatreya mandir, JAMNAGAR.
Prof. HM Chandola
8.
Professor & Head, Dept. of Kayachikitsa, IPGT&RA, Jamnagar
Prof. VD Shukla
9.
Professor & Head, Dept. of Panchakarma, IPGT&RA, Jamnagar.
Prof. KS Dhiman
10.
Professor & Head, Dept. of Shalakya Tantra, IPGT&RA, Jamnagar.
Prof. Nishteshwar
11
Professor & Head, Dept. of Shalakya Tantra, IPGT&RA, Jamnagar.
Dr. SK Gupta,
12
Reader & Head, Dept. of Shalya Tantra, IPGT&RA, Jamnagar.
Dr. KS Patel,
13
Associate Professor & Head, Dept. of Kaumarabhritya, IPGT&RA, Jamnagar.
Dr. LP Dei,
14
Associate Professor & Head, Dept. of Striroga & Prasuti Tantra, IPGT&RA, Jamnagar.
Dr. MK Vyas,
15
Reader, Dept. of Basic Principles, IPGT&RA, Jamnagar
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Institute for Post Graduate Teaching & Research in Ayurveda
GUJARAT AYURVED UNIVERSITY, JAMNAGAR
National Workshop on developing Guidelines for
Clinical Research Methodology in Ayurveda
28th to 30th November 2009
Brief Technical Report and Proceedings of the Workshop:
Introduction:
A national workshop on developing guidelines for clinical research in Ayurveda was
conducted from 28th November 2009 to 30th November 2009 at IPGT&&RA, Gujarat Ayurved
University, Jamnagar.
This program was financially sponsored by WHO Country Office India, New Delhi,
vide sticker No. SE/09/104507, a sum of Rs. 05, 41, 000/- was sanctioned by WHO for
conduction of the workshop.
A total of 30 persons were invited from outside Jamnagar city as resource persons
for this workshop and 13 teaching faculty members of IPGT&RA were nominated as
resource persons. All the resource persons were accommodated in the guest house of the
institute. High tea was served for all the participants during the workshop days. All the
participants were given with TA and DA as per WHO DFC norms.
All the teachers and scholars of PG and Ph.D. actively participated in the workshop,
the official machinery [IPGT&RA office, Accounts Dept.] too were in action for all these
three days. The brief details of the 3 days workshop is as under:
Day 1: 28.11.2009; Saturday
Registration: 09.00 AM to 10.00 AM
30 resource persons from outside Jamnagar, 13 teaching faculty from Institute for
Post Graduate Teaching & Research in Ayurveda registered in the workshop. All registered
resource persons were distributed with a Kit Bag containing writing pad, pen, photocopy
materials and a CD containing technical materials. 23 faculty members and 129 PG and Ph.D.
scholars of Institute also got registered in the workshop. The list of participants is enclosed.
Inauguration: 10.00 AM to 12.00 Noon
The inaugural ceremony was chaired by Hon’ble Vice Chancellor and Director of the
Institute Prof. M. S. Baghel. Dr. Nandini Kumar Ex Dy. DG from ICMR, Dr. Manoj Nesari
from Dept. of AYUAH, Prof. R. H. Singh, Professor Emeritus, BHU, Prof. Gurdip Singh
Director (PG Studies) SDMCA, Hassan were on the dais as guests of honour, and Prof. H. M.
Chandola, Dean of the institute was also on the dais.
The program started with lighting the lamp by dignitaries and prayer to Lord
Dhanwantari.
Prof. H. M Chandola, Dean and Head of department of Kayachikitsa offered the
welcome address followed by floral welcome.
Prof. Gurdip Singh in his opening remark highlighted the importance of Ayurvedic
pathogenesis and how it is different from modern approach, accordingly the research
105
approach in clinical medicine too varies he added, and the present workshop has come in
right time and he wished for the success of the workshop.
Dr. Manoj Nesari in his opening address highlighted the different issues present
before the Ministry and AYUSH department pertaining to Ayurveda and its global
acceptance. He touched the different areas like ICD 11 classification for diseases in
Ayurveda, GMP & GCP norms, the different guidelines available for Traditional Medicines,
and he too felt the need of a separate guideline for Ayurveda in particular without hurting
its holistic approach.
This was followed by 1st scientific presentation along with guest address by Prof. R.
H. Singh.
Prof. Singh in his presentation on the topic “Development of Research Methodology
in Ayurveda - Creating Clinical Protocols”, briefed why research is required for Ayurveda
which is a time tested system of medicine, and the early attempts for the same by national
agencies such as RRL Jammu, CDRI Lucknow, CCRAS, AYUSH, GTP project etc. there is a 2
fold research requirement in Ayurveda i.e. first one for the science of Ayurveda and the
second one is for therapeutics in Ayurveda he added. The emerging issues in research, the
sectorial knowledge base issues were also touched by him in the address. Trust, Truth and
Team are the basic requirements for any research activity he added. He also suggested
some strategies for the action in this regard and highlighted the priority areas. His
conclusions were:
• Thus there is a need of new strategy & new methodology of research in Ayurved. The
ongoing research using conventional methodology may bring some minor benefits to
conventional Modern medicine without any major break through. The major inputs to
Ayurveda are still more remote.
• Hence Ayurved has to be studied and investigated as it is, critically adapting an
Ayurvedic approach in tune with its basic principles. This needs new protocols.
• However the technical tools will have to be borrowed from modern basic and
biosciences critically developed through an intense interface between Ayurved and
counterpart sciences.
The second scientific presentation was presented by Dr. Nandini K. Kumar, in her
presentation she highlighted WHO TRM protocol, IMCR ethical guidelines, ICH guidelines
etc. along with GCP norms. The areas where Ayurveda can contribute effectively was also
highlighted along with problems for modern world to accept ayurvedic researches. Safety of
herbals in modern times are matters of concern because of - Mistaken use of wrong species,
Adulteration, Innate toxicity, Incorrect dosing, Drug-herb interaction and Misuse as OTC
products. Traditional medical ethics - Rules for a good physician as told by Charaka was also
highlighted in her speech. For traditional medicines used traditionally for number of years,
no efficacy tests required, but validation for evidence-based medicine are required – reverse
pharmacology and here the scientific validation is to be done through trial design
incorporating appropriate GCP guidelines, she opined. Essential – To be done only when a
competent Ayurvedic, Siddha or Unani physician is one of the investigators or collaborators
in such a clinical trial. Under ethical consideration points she opined that based on
106
references in ancient literature of Traditional System of Medicine, no Modern Medicine
expert can carry out clinical evaluation of the plant; and the necessity of the joint evaluation
clinical trial with associate specialist from these systems. While framing a Scientific Protocol
Design the following are to be kept in mind - Justification of research topic, Preparation of
formulation , Enrollment - Informed consent, Conduct of trial, Monitoring, and Statistical
evaluation - usefulness sometimes difficult to explain. The Problems of Research Design are
Complex interventions, Holistic, Individualized , Focus on Symptoms, rather than Disease,
Intra & inter variation in response. Problems of RCT are Broad exclusion criteria/ highly
selective patient recruitment, Patient’s preference for particular treatment, easy access to
marketed products may confound results in control group, Finding appropriate control drug
is difficult many times, Double blinding not fool proof, Multiple similar studies in same ward
detrimental. the Challenges in Clinical Trials on TRM as highlighted by her are - Use of
placebo, Use of standard therapy in the control arm, Informed Consent process & patient
information sheet, Compensation/Insurance coverage, Access to products after Trial, Post
trial responsibilities , Loss of basic concepts, Choice of drugs - use of placebo/ standard
therapy in the control arm ?, Informed Consent process & patient information sheet,
Recruitment for self limited disease in rigorously investigated study difficult, and Migratory
population/ drop outs in follow-up studies. She concluded with the following - Classification
of traditional medicine in India is unique, Ethical and regulatory requirement are same as for
synthetic drugs except in case of reverse pharmacology, Multidisciplinary approach is
needed in traditional medicine research, conduct of research as per ICMR and GCP
guidelines (ASU in future) should be made mandatory, national and International
collaborative research works should be planned and the impact of traditional medicine on
national health economy is potentially great.
Prof. R. R. Dwivedi delivered the 3rd technical presentation of the inaugural session,
he highlighted the areas of research wherein scholars often face problems particularly in
evaluation. The concept of research and research methodologies are well explained n
ancient texts as Pratijna – Problem, Sthapana – Hypothesis, Hetu – Reasoning - Aims &
Objectives, Udadaharana - practical, experimentation, collection of data, Upanaya –
interpretation & Discussion and Nigmana – Conclusion, and it is similar to the modern
concept in research too he added. Tantra-Yukti, Tatchilya, Vyakhya, Arthashraya, Kalpana
etc. for Literary Research, there are reference on Pharmacological Research [Ca.Su.26],
Pharmacognostic Research, [Ca.Vi.8], Pharmaceutical Research [Ca.Ka.1] in the classical
texts. Āyurvedic Science believes in treating man as a whole & using drug as a whole; the
holistic approach of Ayurveda in context of the different kinds of the Researches like Drug &
Dietetic Research, Diagnostic Research, Clinical Research etc. were also highlighted by him.
The ‘Pramanas’ could become the parameters of research for the enhancement of Good
Clinical Practice (GCP) he added. Difficulties in selection of problem in regarding their
priorities as well as concern to their discipline, problem in regarding the formulation of
hypothesis, Vague selection of the Aims & Objectives, Non availability of standard
parameters for material and in designing the different method for a specific plan, doubts in
regarding use and interpretations of modern tools and controversies in techniques of
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advanced medical sciences, Lesser number of data material, not well valuable discussion at
par in relation to the hypothesis, discipline and as per the aims and objectives etc. are the
problems faced by research scholars of today.
Prof. M. S. Baghel in his presidential address and presentation highlighted the need
of uniformity in research which is the need of the day. He overviewed the present status of
Ayurvedic Clinical Research and sectarian interest of the science is not preserved properly
he added. The 12 point examination explained by Charaka is the most suited examination
required to be adopted in Clinical research and the general principles as laid by ICMR ethical
code are to be followed he added. Assessment criteria as per Ayurveda and karya of end
point should be Dhatu Saamyam (Equilibrium of Dhatus) and roga bala, rogibala or
quality of life parameters are explained in Ayurveda under the heading of Agni bala,
dehabala, and chetasa bala. A Research Proforma based on Conceptualization of Samprapti
Process viz. Dosha, Dooshya, Srotasa , Rogi – Roga Pariksha (Ekvidha, dwividha, trividha,
chaturvidha, Panchavidha, Shad Vidha, Ashtavidha, Dashvidha, Dwadashvidha Pariksha) is
needed and following the same guidelines, he presented a general CRF for evaluation of
patients without much repetitions and covering all points of Ayurvedic Clinical evaluation
i.e. Roga Bala, Rogi Bala, Agni Bala and Chetasa Bala. He concluded his presentation with a
warm wish for the successful completion of the workshop.
The program was compared and the vote of thanks was given by Dr. Rajagopala S.
With this a short break was given for the session.
st
1 scientific deliberation: 12.15 PM to 01.30 PM
The first scientific deliberation started after the short break and this session was
chaired by Prof. H. M. Chandola, Co-chaired by Dr. A. R. Dave and Dr. Mandeep Kaur acted
as moderator. There were 2 scientific presentations in this session. The brief details of
presentations are given below:
The first presentation in this session was by Dr. Rammanohar, on the topic
“Suggestions on clinical research suitable for traditional medicines”. In his lucid presentation
he highlighted the lacunae in traditional medicine and suggested suitable modifications to
fill this lacunae. The presentation was well received by the hall.
The second presentation was delivered by Prof. Gurdip Singh, and his topic of
deliberation was “Problems of preparing ayurvedic research format”; he highlighted the
common research format generally followed by research scholars in majority of the
institutions. He also discussed various points of the format like dashavidha pariksha, srotas
pariksha etc. and highlighted the areas of problem in filling and maintaining this format, the
subject was open for discussion.
The house dispersed for lunch after this deliberation.
Post lunch sessions:
The house reassembled at 3.00 PM after the lunch break and the theme of this
session was “Preparation of general clinical research protocol for ayurvedic clinical
research”. The session was chaired by Dr. Nandini Kumar and Co-chaired by
Prof. K. S. Dhiman and moderator was Dr. Ravinarayana Acharya.
108
In the first scientific deliberation of this session Dr. Dilip Gadgil presented a talk on
topic “Problems in grading ayurvedic symptomatology”. Ayurvedic terms for symptoms are
to be identified in particular context, the adjectives of these symptoms are to be thoroughly
studied for gradation of them, the visual analogue for subjective symptoms like pain may be
used wherever necessary and logical consideration of particular symptoms are necessary for
gradation of these subjective symptoms he concluded.
The next presentation was delivered by Dr. Sulochana Bhat and she spoke on
“Application of good clinical practice (GCP) in Ayurvedic clinical trials - difficulties and
possible solutions”. In her presentation she focused on topics - The two main
recommendations of GCP are – it should be scientific, authenticity of biomedical should be
there with data be generated, ethically sound, and the protection of the rights of human
subjects should be well preserved. The oobjectives of Ayurvedic clinical trials should aim at
creating the evidence that is understandable and acceptable by the Biomedical Researchers,
Doctors, Academicians, Policy makers, Industry as well as by the Consumers. So the
contemporary guidelines framed should be integral in nature. The problem areas in
Ayurveda are - system specific, lack of standardization, non-availability of Preclinical Safety/
toxicity/ efficacy data, Non chemical entities- veerya, vipaka, prabhava or relying on
principles like doshaghnata, Panchabhautikatwa etc. and diagnosis as per Ayurvedic
principles is poorly understood. For e.g. differentiation between tamaka shwasa &
mahashwasa is clinically not clear. The selection of outcome parameters, multiple
interventions- medicines, procedures, life style, diet etc. which are individualistic and are
difficult to monitor for the compliance, conclude which intervention has what role and try to
adopt gold standards. The present requirements are motivation and orientation of research
scholars, the AYUSH specific Guidelines for Methodology of research, Interdisciplinary
integration and Dissemination i.e. Publication of the research outcome. It is essential to
register in Clinical trial registry before the starting of the work and once the work is over,
clinical trial reporting is essential. She concluded with remarks - Identify the suitable
guideline for reference- WHO, ICMR, CDSCO; Prepare a frame work for general protocol;
Identify priority areas and specific diseases according to ICD 10….; Prepare a list of general
parameters as per Ayurveda to be applied in all the trials for all the subjects; and Prepare
the list of outcome parameters and the criteria for the assessment of the results of all the
identified priority diseases.
These two presentations were followed by open house discussion and an active
discussion took place in the house. At the end Dr. Nandini Kumar gave her chairperson’s
remarks.
The second session of the afternoon was chaired by Prof. R. H. Singh and Co-chaired
by Dr. T. N. Pandya and Dr. Anup Thakar acted as moderator.
In this session one technical presentation was delivered by Prof. Tanuja Nesari on
the topic of “Guideline for Clinical Research in Ayurveda”. She highlighted the need for a
specific guideline considering the holistic approach and fundamental principles of Ayurveda
and suggested that ICH – GCP guidelines are suitable for Ayurveda. She also highlighted the
109
assessment of mental status as per Ayurveda. The subject of case documentation was also
touched in her speech.
This presentation was followed by open house discussion and an active in house
discussion took place for about one hour.
The working groups were formed at the end of the session and 11 different working
groups were made and were assigned with specific task. They were asked to assemble at
09.00 AM on the second day at designated venue. 11 different venues were also made
ready for the purpose.
The house dispersed with thanks to the chair.
Day 2: 29.11.2009; Sunday
Working Group meetings
The 11 different working groups met at designated venues and started working from
09.00 AM, with a short lunch break at 01.00 PM the group reassembled and continued their
work till 04.00 PM. These working groups were having experts and coordinator among the
teachers of the institute. PG and Ph.D. scholars provided help in discussions.
From 04.00 PM onwards the pre-final presentation by each group took place in the
main seminar hall of the institute. After presentation by each group, the subject was open
for discussion. The session was chaired by Prof. Gurdip Singh and Co-chaired by Prof. C. B.
Bhuyan, Dr. Anup Thakar acted as the moderator of the session. 5 working groups could
complete their presentation by 07.00 PM, and then the house was dispersed with thanks to
chair and a note of reassembling at 09.00 AM on the third day.
Day 3: 30.11.2009; Monday
As per the scheduled plan, the different working groups met again at their
designated venue for 2 hours and made corrections in their work as per the suggestions
given by the house. The house reassembled in the seminar hall at 11.00 AM. The session
was chaired by Prof. R. R. Dwivedi, and Co-chaired by Prof. P. K. Prajapati, the session
moderator was Dr. Darshana Pandya. 5 working groups could complete their presentation
by 01.30 PM, and then the house was dispersed for lunch after thanks to chair and a note of
reassembling at 03.30 PM for continuation of presentation and discussion followed by
valedictory session.
The post lunch session was chaired by Dr. Dilip Gadgil and Co-chaired by Dr. K. S.
Patel, Dr. Galib was the moderator in this session. The general protocol developing group
presented the summary of their discussions in this session, Dr. Galib, coordinator of the
working group presented the gist of their discussions.
The subject opened for discussion by the chair and a healthy discussion took place
with some suggestions too. The session concluded with chairpersons remarks and thanks to
the chair.
The valedictory session started at 4.30 PM and Hon’ble Vice Chancellor and Director
of the Institute Prof. M. S. Baghel chaired the session. Dr. Nandini Kumar, Dr. Tanuja
Nesari, Dr. P. S. Shrivastav, Dr. A. R. Trivedi, Dr. M. M. Padhi and Dr. H. M. Chandola were
on the dais. All the dignitaries on the dais shared their views of this 3 days workshop and
suggested fruitful suggestions for successful completion of the task of developing guideline
110
for clinical research in Ayurveda. From the participant’s side, Dr. Rama Jayasundar, Dr.
Bhavana Parashar, Dr. Anukul Chandra Kar, Dr. Gopakumar, Dr. Vasanth Patil, Dr. V. D.
Shukla presented their views on the workshop.
Chairman of the session, Prof. M. S. Baghel in his presidential address presented a
common research format developed by his team, which was placed before the General
Protocol development working group and as per decision of the group it will serve as CRF 1
which will be common for all clinical trials, the disease specific CRF 2 should be developed in
due course of time he added. More than 100 symptoms have been graded in the working
group meetings and it will be summarized and sent to all participants in due course of time
for consensus and he also appealed before the august gathering to give suggestions on this
CRF 1, it will be circulated among all institutions and research bodies for suggestions and in
the next phase of the work, the suggestions received will be reviewed by experts and
necessary modification will be made before final copy, he added. He thanked all the august
resource persons who have come from different parts of the country for the good cause of
Ayurveda and mankind.
The recommendations made by the general protocol working group which are to be
taken as final decisions of the workshop he added.
The recommendations made by the general protocol development working group
are:
• There is one paper on research methodology in M.D. (Ayu) curriculum contents of which
should be elaborated including basic research guidelines formed by WHO, ICMR & other
relevant good practices of Ayurveda (GMP etc.).
• Man power of Traditional Systems of Medicine (TSM) / Ayurveda should be
strengthened and trained in research methodology of concerned fields. Govt. of India
Dept. of AYUSH may initiate the intensive CME on Research Methodology for PG
Teachers, at least 3 CME in three years to all the teachers for recognition as PG
Teachers.
• Need of registering Ayurvedic clinical trials in CTRI (Clinical Trial Registry of India):
initially the clinical trials should be enrolled in the existing registry.
• The institutions and research organizations of India may be requested to enroll their
clinical trials under CTRI and inform regarding the output of the studies.
• AYUSH may create separate forum for registry of clinical trials as soon as possible.
• Recommendation on including parameters mentioned under QOL in every CRF with due
elaboration towards consideration on relevant modern parameters. While including
parameters of QOL physical, physiological, psychological and spiritual parameters should
be considered and well focused.
• Parameters for safety should be added in all CRFs respectively and parameters for
Dhatvagni and Jatharagni are to be exercised.
• The generic protocol which is finalized is to be circulated among the respective technical
people for providing inputs which will be incorporated into the final format. This will be
communicated to the selected institutions and research organizations in turn.
111
• Basic clinical research format should have clearly two portions dealing with Rogi
Pariksha and Roga Pariksha.
• Besides the generic protocol, a specific protocol for each disease will be prepared. In
addition, a manual will be prepared based on these protocols for proper execution of
the project. It was also decided to form a working group of experts who will monitor the
progress of the work and refining of the prepared CRFs and also will do interim analysis
after pilot testing of the protocols, which is mandatory.
• After finalizing the standard formats and manuals, training sessions / training of the
trainers programes can be initiated with due permission of the concerned authority.
• It was also recommended to include a Bio statistician in future discussions on protocol
formation.
Future action plan:

1. Circulation of CRF 1 and gradation of symptoms prepared during the workshop among
all leading institutes and inviting their comments.
2. Conduction of a workshop for finalization of CRF 1 and preparation of CRF 2 and
finalization of the grading and assessment criteria and preparation of User’s manual.
3. Circulation of Final Draft of CRF 1 and CRF 2 at least for 15 diseases to all Ayurvedic
teaching and research institutes.
4. Organizing a national workshop of 10 selected external experts for evaluation of
comments, finalization of symptom grading and final draft of CRF 1 & CRF 2,
preparation of user’s manual.
5. Conducting pre implementation evaluation of CRFs and gradings at least at 10
institutes.
6. Submitting the draft report to sponsoring body, authorities of AYUSH, circulating
among leading research institutions for adopting the same.
7. Training program for Trainers for proper implementation of the Clinical research
protocols developed.
Dr. Rajagopala S, organizing secretary of the workshop conducted the session and
presented the Vote of Thanks.
All the invited participants were distributed with participation certificate.
The session ended at 06.00 PM, followed by a tea.
All the faculty members of IPGT&RA, postgraduate and Ph.D. scholars of the institute
participated actively in all the 3 days of the workshop.
112
List of Participants attended the National Workshop on developing Guidelines for Clinical
Research Methodology in Ayurveda 28th to 30th November 2009
Resource persons – Outside
Sl. No. Name & Address of Resource persons
Prof. R. H. Singh
11.
Professor Emeritus, IMS, BHU, Varanasi.
Prof. Gurdip Singh
12.
Director (PG Studies), SDM College of Ayurveda, Hassan.
Dr. Rammanohar
13.
Director, AVATAR, Ayurveda Trust Campus, Coimbatore - 45
Dr. Gopakumar
14.
Asst. Professor, Dept. of Roga Nidana, Govt. Ayurveda College, Trivandurm.
Dr. Anukul Chandrakar
15.
Asso. Professor, Dept. of Roga Nidana, Faculty of Ayurveda, IMS, Varanasi.
Dr. Bhavna Palan
16. Scientist Fellow, Planning & Performance Division, CSIR, Anusandhan Bhawan,
2, Rafi Marg, NEW DELHI - 110001
Prof. Srinivas Acharya
17.
Professor, Dept. of Kayachikitsa, SDM College of Ayurveda, Udupi.
Dr. Manoj AK
18.
Asso. Professor, Dept. of Kayachikitsa, VPSV Ayurveda College, Kottakkal.
Dr. Dilip Gadgil
19.
Consultant Physician, Pune.
Dr. Rama Jayasundaram
20.
Asso. Professor, Dept. of Nuclear Medicine, AIIMS, Ansari Road, New Delhi
Prof. B. L. Mehra
21.
Professor, Dept. of Kayachikitsa, RGGPG Ayurveda College, Paprola. HP
Dr. P. K. Panda
22.
Reader, Dept. of Roga Nidana, Govt. Ayurveda College, Bolangir, Orissa
Dr. Nandini Kumar
23. Consultant, Division of Basic Medical Sciences, ICMR, Ansari Nagar,
NEW DELHI - 110029.
Dr. Supriya Bhalerao
24.
Dept. of Clinical Pharmacology, Nair Hospital, MUMBAI
Dr. Rama Chandra Bharadwaj
25.
Head, Clinical Research Division, FRLHT, Bangalore
Dr. Sulochana Bhat
26.
Asst. Director, CCRAS Head Quarters, Janakpuri, New Delhi.
Dr. PS Shrivastav
27.
Professor & Head, Dept. of Kayachikitsa, State Ayurveda College, Lucknow.
113
Dr. Bhimsen Behra
28.
Tech. Officer, Terminology Commission, Ministry of HR & D, New Delhi.
Dr. M. M. Padhi
29.
Joint Directro (Tech), CCRAS Head Quarters, Janakpuri, New Delhi.
Dr. Sonika Verma
30.
Basic Medical Sciences Division, ICMR Head Quarters, New Delhi
Dr. R. N. Tripathi
31.
Professor & Head, Dept. of Kayachikitsa, Govt. Ayurveda College, Raipur.
Dr. Haridra Dave
32. Professor & Head, Dept. of Shalakya, Govt. Akhandanada Ayurveda College,
Bhadra, Ahmedabad.
Dr. Vasanth Patil
33. Research Officer, SMRI (Ayurveda), Santhigiri Research Foundation, Santhigiri
Ashram P.O. TRIVANDRUM – 695 589
Dr. Tanuja Nesari
34.
Professor, Dept. of Dravyaguna, Tilak Ayurveda Mahavidyalaya, Pune.
Dr. M. Shrinivasulu
35. Professor & Head, Dept. of Kayachikitsa, BRKR Govt. Ayurveda College,
Hyderabad.
Dr. Pradeep Dua
36.
Research Officer, RRI, Gandhi Bhavan, Mandi. HP
Dr. Umesh Shukla
37. Professor & Head, Dept. of Kayachikitsa, Pt. KL Sharma Govt. Ayu College,
Bhopal
Dr. Manoj Nesri
38.
Joint Adviser – Ayurveda, Dept. of AYUSH, Ministry of Health & FW, New Delhi
Dr. Gaurav Sharma
39.
Research Officer, Dept. of AYUSH, Ministry of Health & FW, New Delhi
Dr. S. H. Acharya,
40. Reader & Head, Dept. of Panchakarma, SGA Mahavidyalaya, Guj. Ayurved
University, Jamnagar.
Dr. Girish Tillu,
41.
CDAC, Pune.
Resource persons - Internal
Sl. No. Name & Address of Resource persons
Prof. R. R. Dwivedi
42.
Professor & Head, Dept. of Basic Principles, IPGT&RA, Jamnagar.
Prof. H M. Chandola
43.
Dean, Professor & Head, Dept. of Kayachikitsa, IPGT&RA, Jamnagar.
114
Prof. V. D. Shukla
44.
Professor & Head, Dept. of Panchakarma, IPGT&RA, Jamnagar.
Prof. C. B. Bhuyan
45.
Professor & Head, Dept. of Shalya tantra, IPGT&RA, Jamnagar.
Prof. P. K. Prajapati
46.
Professor & Head, Dept. of Rasashastra, IPGT&RA, Jamnagar.
Prof. K. S. Dhman
47.
Professor & Head, Dept. of Shalakya tantra, IPGT&RA, Jamnagar.
Dr. T. N. Pandya
48.
Reader & Head, Dept. of Dravyaguna, IPGT&RA, Jamnagar.
Dr. K.S. Patel.
49.
Reader & Head, Dept. of Kaumarabhritya, IPGT&RA, Jamnagar.
Dr. L.P. Dei
50.
Reader & Head, Dept. of Striroga & PT, IPGT&RA, Jamnagar.
Dr. Manjusha R
51.
Reader, Dept. of Shalakya tantra, IPGT&RA, Jamnagar.
Dr. Anup B. Thakar
52.
Reader & Dept. of Panchakarma, IPGT&RA, Jamnagar.
Dr. A. R. Dave
53.
Reader, Dept. of Kayachikitsa, IPGT&RA, Jamnagar.
Dr. S. K. Gupta
54.
Reader, Dept. of Shalya tantra, IPGT&RA, Jamnagar.
115
List of Teachers participated in the workshop: IPGT&RA
Sl. No. Name
1 Dr. Mahesh Vyas, Reader, Dept. of Basic Principles, IPGT&RA, Jamnagar.
2 Dr. A. S. Baghel, Reader, Dept. of Basic Principles, IPGT&RA, Jamnagar.
3 Dr. R. N. Acharya, Reader, Dept. of Dravyaguna, IPGT&RA, Jamnagar.
4 Dr. B. J. Pattagiri, Reader, Dept. of Rasashastra & BK, IPGT&RA, Jamnagar.
5 Dr. Galib , Asst. Professor, Dept. of Rasashastra & BK, IPGT&RA, Jamnagar.
6 Dr. H. A. Vyas, Asst. Professor, Dept. of Basic Principles, IPGT&RA, Jamnagar.

Dr. Shubhangi Kamble, Asst. Professor, Dept. of Basic Principles, IPGT&RA,
7
Jamnagar.
8 Dr. V. K. Kori, Asst. Professor, Dept. of Kaumarabhritya, IPGT&RA, Jamnagar.
9 Dr. Shilpa Donga, Asst. Professor, Dept. of Striroga & PT, IPGT&RA, Jamnagar.
10 Dr. Mandeep Kaur, Asst. Professor, Dept. of Kayachikitsa, IPGT&RA, Jamnagar.
11 Dr. Darshana Pandya, Asst. Professor, Dept. of Kayachikitsa, IPGT&RA, Jamnagar.
12 Dr. Rajagopala S, Asst. Professor, Dept. of Kaumarabhritya, IPGT&RA, Jamnagar.
13 Dr. D. S. Vaghela, Asst. Professor, Dept. of Shalakya tantra, IPGT&RA, Jamnagar.
14 Dr. Bhupesh Patel, Asst. Professor, Dept. of Dravyaguna, IPGT&RA, Jamnagar.
15 Dr. TS Dhudhmal, Asst. Professor, Dept. of Shalya tantra, IPGT&RA, Jamnagar.
16 Dr. Santosh Bhattad, Asst. Professor, Dept. of Panchakarma, IPGT&RA, Jamnagar.
17 Dr. Nilesh Bhatt, Panchakarma Asst, Dept. of Panchakarma, IPGT&RA, Jamnagar.

18 Dr. B. Ravishankar, Head, Pharmacology Laboratory, IPGT&RA, Jamnagar.
116

WHO Scoring of Ayurveda Symptoms

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WHO – DFC sponsored Project on

DEVELOPING GUIDELINES FOR CLINICAL

INSTITUTE FOR POSTGRADUATE TEACHING &

Research is a process that converts data into information, information to

The current methodologies of research being applied in Ayurveda should be

Need of Ayurveda clinical trials is for revalidation of facts enumerated in

Overall assessment of therapy:

ROGA BALA (60)

OVERALL ASSESSMENT OF THERAPY:

AGNI BALA INDEX:

(A)Evaluation of Jarana shakti (Digestion power)

A -Scoring according to Jeerna Ahãra Laksana

B) Assessment of Abhyavaharan Shakti

C) Evaluation for Ruchi

1. Totally unwilling for meal 0

A.I. = Test dose (T.D.)

A.B.I. =T.D. /G,D. X time (t) =A.I. X t.

A.B.I. = 30 I 300 X 7 = 0.7 [T.D. = 30 ml, G.D = 300 ml. t = 7 hr.]

Religion : H / M/ S / Ch / J / B / Other Desha Jangal/ Anoopa/ Sadharana

Marital Status : UM/ M / D / W O.P.D. / I.P.D. No. :

PRADHAANA VEDANAA (Chief Complaints with duration)

VEDANA SAMUCCHRAYA: (History of Present Illness with duration)

POORVA VYAADHI VRITTA: (History of Past Illness)

VAIYAKTIKA ITIVRITTA: (Personal History) BT AT

2. VYASANA (Addiction): Tobacco (Smoking / Chewing) / Alcohol / Drug abuse / Other

6. MOOTRA PRAVRITTI- MICTURITION:

7. ARTAVA PRAVRITTI - MENSTRUAL HISTORY:

8. PRASAVA - OBSTRETIC HISTORY:

9. AGNI: Sama / Vishama / Manda / Ati agni

Dhatu Assessment BT Assessment AT

FAMILY HISTORY OF DISEASES HAVING GENETIC PREDISPOSITION:

HISTORY OF AUPASARGIKA ROGA:

HETU (NIDAANATAH) PARIKSHA:

Iatrogenic causes (if any):

ADR as cause (if any):

Sparshana Loss of sensation Jwara Shaitya

MAMSA & MAMSAVAHA SROTASA PARIKSHAA:

MEDA & MEDOVAHA SROTAS PARIKSHAA:

MAJJA & MAJAAVAHA SROTAS PARIKSHAA:

SHUKRA & SUKRAVAHA SROTASA PARIKSHAA:

PRAANAVAHA SROTASA PARIKSHAA:

PITTA VARGA PARIKSHAA:

PIITA DOSHA PARIKSHA:

RAKTAVAHA SROTAS PARIKSHAA:

SWEDAVAHA SROTAS PARIKSHAA:

AGNI PAREEKSHA PRAKRITITAH VIKRITITAH

MOOTRA & MOOTRAVAHA SROTAS PARIKSHAA:

VAATA VARGA PARIKSHAA:

VATA STHANA PARIKSHA:

ASTHI & ASTHIVAHA SROTAS PARIKSHAA:

PURISHAVAHA SROTAS PARIKSHAA:

SANGYAVAHA, MANOVAHA, CHETANA VAHI SROTASA:

SAAMA / NIRAAMA PARIKSHA:

B) PRADHANA KARMA Name of the Karma:

C) PASCHATA KARMA (SAMSARJANA KARMA)

After Pariharakala Shamana Yoga to be applied (for ____ duration).

ASSESSMENT OF SHARIRIKA PRAKRUTI

FEATURES OF SOMATIC CONSTITUTION (self answering questionnaire)

6. Your nails are Thin, Rough Thin, Soft Thick, Smooth

11. Quantity of food Variable More Less

PRAKRITI: Vata: __ Pitta: _ Kapha: ___