N.H. 27, VILLAGE BANSADA, TEH. GOGUNDA, UDAIPUR (RAJ.
RECORD BOOK FOR THE SYLLABUS OF AYURVEDACHARYA (B.A.M.S)
AS PER MSE-UG 2022 & NCISM GUIDELINE
SECOND PROFESSIONAL – B.A.MS.
SWASTHAVRITTA EVAM YOGA
(STUDY OF AYURVED CLASSICAL TEXT)
(SUBJECT CODE: AyUG-SW)
Name of the Student : ________________________________________________
Name of the College : ________________________________________________
Roll No. : ________________________________________________
Academic Year : ________________________________________________
KALA ASHRAM
AYURVED MEDICAL COLLEGE & HOSPITAL
DEPARTMENT OF SWASTHAVRITTA EVAM YOGA
SWASTHAVRITTA EVAM YOGA RECORD
Name: ……………………………………………………………….
Class: ………………………………. Register No.; …………...….
I certify that this is a bonafide Journal for Swasthavritta Evam Yoga done
during the Second Profession (Batch 2021-22) by the candidate with
Register No. ………………………
Date: ………............... Signature of the Teacher
Record Verified
Internal Examiner External Examiner
1. 1.
2. 2.
Contents
Name of the chapter Name of the practical Page no.
Dinacharya Dantadhawana Churnas
Jiwha Nirlekhana Yantra
Kavala and Gandusha
Anjana
Nasya
Dhoomapana
Abhyanga
Udwartana
Dinacharya module
Lifestyle based Advise /counsel
Ahara Ahara Varga
Preparation of recipes
Diet and lifestyle regimen
Diet counselling
Yoga Shatkrama
Pranayama
IDY Protocol
Disinfectants Disinfectants
Fumigation of the operation theatre
working and uses of an autoclave
IEC Communication methods for health
education
Health education materials
Community Survey Family surveys
Family surveys
Local health Pasteurization of milk
educational visits Water purification plant
Modern sewage treatment plant
Measures adopted for the prevention
andcontrol of occupational diseases
Food safety standards and
methods of foodprocessing
techniques
Treatment modalities adopted in
Naturopathy and Yoga canters.
Visit to National health Primary health centre/Community
programs and health centre/Rural hospital/District
Ayurveda centre hospital
Structure and functioning of a
Ayurveda Dispensary/ Taluk Hospital
/District Hospital available in the
district
Monitoring of Health Periodic check-ups from community
and hygiene Health status analysis
Water sanitation, waste disposal
including biomedical waste in the
hospital
Dinacharya
Jiwha Nirlekhana Yantra
Name of the tongue Type of material used Picture
cleaner
Appropriate one for Swastha –
Kavala and Gandusha
Name of the product Composition Picture
mouth wash/gargle
available in the
market
Anjana
Types of Anjana Medicinal purpose / Benefits
available in market Cosmetic purpose
Materials required:
Procedure:
Swastha Hitkara Anjana in daily regime –
Nasya
Materials required:
Drugs used:
Procedure:
Benefits of Pratimarsha Nasya-
Occupations/ conditions indicated for Pratimarsha nasya-
Dhoomapana
Materials used:
Procedure:
Benefits:
Abhyanga
Materials required:
Procedure:
Benefits:
Occupations/ conditions where abhyanga is essential -
Udwartana
Materials required:
Procedure:
Different types of dravyas used in Udwartana/Utsadana with their benefits
Dinacharya module
Name: Age: Sex:
Occupation:
Daily travelling hours:
Mode of travelling:
Time of sleep:
Time of awakening -
Total hours of night sleep:
Quality of Sleep: Sound/ disturbed/ late sleep
Day sleeping: Yes/No
Prakriti –
Kshudha – Yes /No
Consumption of food – Due to hunger / As per time
Asatmya of specific food –
Food Timings –
Meals - Breakfast - Lunch - Evening food Dinner -
-
Timings
Foods often
consumed -
Consumption of –
Present Absent
Abhishyandi (daily curd
/ fermented etc.)
Paryushit (stale food)
Adhyashan
Vishamashan
Samashan
Anashan
Viruddhashan
Any other specification regarding food habits –
Prescription/ Advice:
1. Ahara-
2. Vihara:
i) Dinacharya measures:
ii) Nidra:
iii) Occupation/lifestyle advice:
lifestyle based Advise /counsel
Date:
Name: Age: Gender: M/F Occupation:
Address:
Chief Complaints (If Any)
History of present illness
History of Previous Illness:
Family/ heredity illness -
General Examination:
Wt. - kg. Ht. cm. BMI-
Samhanan- Hina/ Madhya/ uttam Sara: --
Agni: Manda/ tikshna/ vishama Koshtha: Mrudu/ Madhya/ Krura ú
Ashtavidha Parikshana
Nadi: B.P.-
Mutra pravritti- - Mala pravritti:
Jivha: Sama/ Niram Shabda-
Sparsha: Ushna/ shita -
Druk: Akruti: Sthula/Krusha/ Madhyam
Menstruation: Regular/Irregular, after every _ days,
Prakruti Assessment:
Vata/Pitta/Kapha/vata-pitta/ pitta vata/ vata-kapha/kapha-vata/ pitta kapha/
kapha-
Information Regarding Dinacharya:
Time of sleep – Time of awakening -
Total hours of night sleep-
Quality of Sleep: Sound/ disturbed/ late sleep/ if disturbed cannot sleep again
Day sleeping: Yes/No
Vyayama -Exercise: Yes/No Type: and hours /Minutes Daily -
Yogasana: Yes/No, Pranayam: Yes/No
Type of Asanas Practicing: hours daily
Food: Vegetarian/ Non-Vegetarian
Tea/ Coffee /Milk: Yes/No, Time of consumption:
Kshudha: Yes/No /Sometimes Yes
Trishna (Thirst): Yes/No/ very less / excess
Food Timings –
Meals - Breakfast - Lunch - Evening Dinner -
snacks -
Timings
Foods often
consumed -
Consumption of –
Yes No
Abhishyandi (daily curd
/ fermented etc.)
Paryushit (stale food)
Adhyashan
Vishamashan
Samashan
Anashan
Viruddhashan
Any other specification regarding food habits –
Water Intake: After getting up from sleep/ During meals/ after meals/ at bed
time
Total consumption in a day: litres a day
Fasting: Yes/No, times a month, Food Items -
Addictions: Tobacco smoking/Tobacco chewing/ alcohol/ any other/
Screen Time: hours daily, Screen- TV/ mobile/ tab/laptop
Vihara- Type of occupation: Intellectual/ Physical work
Natural Urges (Vega): Suppression: Yes/No, if Yes which vegas are suppressed:
symptoms, if any after suppression of the vega:
Mental Status (Mana swasthya): Stress- Yes/No, if Yes- family/ work/ any
otherstress
Dharaniya vega udirana: Yes/No, if Yes- kama/krodha/ moha/ lobha/ dvesha/
Any medication taking currently: Yes/No, if Yes, name of the medicines:
Advice:
Ahara (Diet): Pathya/ Apathya (Mention food items, do’s and don’ts) -
Vihara: Vyayama/ Yoga (Specify-) –
Regarding Nidra:
Dinacharya Measure: Anjana/Nasya/ Dhumapana/ Kavala/gandusha/
Abhyanga/ Vyayama/ Udvartana/ any other
For Mental Health: Pranayam/ Stress counselling/ any therapy to be done:
Yes/No, If Yes- name of therapy: Shirodhara, Shiropichu, any other
Ritu Shodhana: Yes/no, If Yes- Vamana/Virechana/ Basti/ Raktamokshana/
Shirovirechana
Shamana: Pacahana/ Dipana/ Vyayama/ Atap sevana/ Anila sevana/ Upawasa
(Kshudha rodha)/ Trishna rodha
Rasayana – Medhya/ Suvarna prashana/ vatatapika
Seasonal Advice:
Name of the Student Signature of the
student
Signature of the Faulty
Aahara
Aahara
SL PARTICULARS DETAILS
NO
1 Name of the Ahara Dravya (food
stuff)
2 Classification as per
Ayurveda and
contemporary science
3 Brief description about the food
stuff
4 Ayurveda Guna Karma analysis
5 Nutritional analysis
6 Currently practiced preparations
7 Other observations ( usage,
quantity ofconsumption etc)
11 Photograph of the food stuff Attach a snap or mention Google
drive link.
SL PARTICULARS DETAILS
NO
1 Name of the recipe
2 Brief description about the food
stuff
3 Ingredients required
4 SOP of preparation
5 Ayurveda Guna Karma analysis
6 Nutritional analysis
7 Therapeutic indications and
dosage
8 Other observations ( usage,
quantity ofconsumption etc)
9 Photograph of the food stuff Attach a snap or mention Google
drive linkof preparation video.
Diet counselling
Name of the patient:
Age/Sex:
OPD/IPD No:
Referring consultant:
Diagnosis:
Date:
Occupation
Anthropometric measurements:
Ht:
Weight:
BMI: IBW:
Prakriti: VP / PK / KV
Diet History:
Particulars
Type of Diet Vegetarian Ova – Mixed Others
vegetarian
Habituated Daily Weekly Fortnightly Monthly
Fooditems
Ex: Pickle/
papad/chats/outs
idefoods/
beverages etc.
Timing of Regular Irregular Occasion
Consumpt ally
ion Irregular
Practice of Regular Occasio
viruddhaahara practice nal
practice
Nutritio High Calorie Low Protein High protein Bland diet
nal Diet Diet diet
Evaluati
on
Nature of Food Vataja ahara Pittaja ahara Kaphaja ahara Combined
consumed
Therapeutic Diet advices:
Particulars
Nature of
Diet
Advised
Specific Rice/ Boiled rice/Jowar/Wheat/ / Others -
Cereals
Specific Ragi/ Navane/ Saame/ Sajje/ harka/ Koral/ oodalu/ Baragu
millets
Specific Pulses Green Gram/ Toor dal/ Black gram/lentils Horsegram/
Soyabean/others
Specific oil Olive/ Sunflower/ Safflower/ mustard / sesame/ groundnut
Specific All leafy
Vegetable,
vegetablesIn
Rootsand
tubers specific:
Specific fruits All fruits
Milk and Skimmed milk/ Buttermilk/ Curds/ Cheese/ Butter/
its bi- ghee/paneer
products
Non-veg Egg/ Fish/ Chicken/ Red meat/ prawn/ pork/ beef
Dietetic advice
Particulars Modification Advises
1 Diet pattern – vegetarian
/nonveg/vegan/ovovegetarian
2 Timings of food intake -
Morning
drink/Breakfast/midday
snacking/lunch/high
tea/dinner
3 Food quantity and quality analysis
4 Nutritional analysis of food in
all servingtimes
Formulated diet plan
Timing +/_ Food items with serving size Therapeutic Peya
15 min advised
Morning 6am
drink
Breakfast 8.30am
Lunch 1.30pm
Evening 5pm
high tea
time
Dinner 8pm
Lifestyle management’ counselling and Therapeutic Diet sheet
Name of the patient: Age/Sex: Diet pattern:
OPD/IPD No: Date:
Referring consultant: Occupation:
Chief complaints for which patient got admitted:
General examination findings:
Height:
Weight:
BMI status:
BP:
HR:
Other systemic examination findings:
Whether K/C/O DM, HTN, allergic to any drugs? On regular medication?
If Yes, Details
Diagnosis:
Treatment details in brief:
On-going procedure:
Life style Observations
Observations Specific
observations
if any
1 Physical health
2 Psychological
health
3 Family Health
4 Occupational
health
5 Financial health
6 Social health
1. Daily routine observations:
Particulars Observations
1 Waking up time
2 Oral hygienic practices
3 Physical exercises/Yoga
practices/brisk
31
walking/jogging/swimming/
meditation/others
4 Working pattern-
official/sedentary/laborious/str
essful
5 Evening routine
6 Habits
7 Sleeping time
8 Duration of sleep and nature
of sleep
2. Dietary Observations
Particulars
1 Diet pattern – vegetarian
/non veg/vegan/ovo-vegetarian
2 Timings of food intake -
Morning
drink/Breakfast/mid-day
snacking/lunch/high
tea/dinner
3 Food quantity and quality
analysis
4 Nutritional analysis of food in
all serving times
32
Advices:
1. Life style modifications:
Modifications advised
1 Physical health
2 Psychological
health
3 Family Health
4 Occupational 1. Fix working hours
health
2. Schedule the work
3. Mark priority to the assigned work and work
accordingly
4. Cooperation and coordination with workmates
5. Patience while completing the tasks
5 Financial health
6 Social health
33
2. Daily routine practices advise:
Particulars Modification advises
1 Waking up time
2 Oral hygienic practices
3 Physical exercises/Yoga
practices/brisk
walking/jogging/swimming/meditatio
n/others
4 Working pattern-
official/sedentary/laborious/stressful
5 Evening routine
6 Habits
7 Sleeping time
8 Duration of sleep and nature of sleep
34
3. Dietetic advice
Particulars Modification Advises
1 Diet pattern – vegetarian
/nonveg/vegan/ovovegetarian
2 Timings of food intake -
Morning
drink/Breakfast/midday
snacking/lunch/high
tea/dinner
3 Food quantity and quality
analysis
4 Nutritional analysis of food in
all serving times
Formulated diet plan
Timing Food items with serving size Other
+/_15 min additional
information
Morning 6am
drink
Breakfast 8.30am
Lunch 1.30pm
Evening 5pm
high tea
time
Dinner 8pm
35
Yoga
36
SHAT KARMAS
Jalaneti
Materials required:
Procedure
Benefits and Indications:
Contraindications:
37
Kapalabhati
Materials required:
Procedure:
Benefits and Indications:
Contraindications:
38
Trataka
Materials required:
Procedure:
Benefits and Indications:
Contraindications:
39
PRANAYAMA
Anuloma – Viloma
Procedure:
Benefits & Indications:
Contraindications ( If any):
40
Nadishuddhi Pranayama
Procedure:
Benefits & Indications:
Contraindications ( If any):
41
Suryabhedana Pranayama
Procedure:
Benefits & Indications:
Contraindications ( If any)
42
Ujjayi Pranayama
Procedure:
Benefits & Indications:
Contraindications ( If any):
43
Shitali Pranayama
Procedure:
Benefits & Indications:
Contraindications ( If any):
44
Sheetkari Pranayama
Procedure:
Benefits & Indications:
Contraindications ( If any):
45
Bhastrika Pranayama
Procedure:
Benefits & Indications:
Contraindications ( If any) :
46
Bhramari Pranayama
Procedure:
Benefits & Indications:
Contraindications ( If any):
47
Common Yoga Protocol of IDY (International Day of Yoga)
48
DISINFECTANTS
Name:
Dose:
Dilution:
Contact period:
49
Procedure of fumigation of the operation theatre
Date:
Name of the OT:
Name of the material used for fumigation:
Procedure of fumigation:
Contact period:
50
Mode of working and uses of an autoclave
Date:
Name of the autoclave:
Working principle:
Use:
51
IEC
SL NO PERTICULAR DETAILS
1 Name of the IEC to be prepared
2 Type of IEC prepared Chart/model/PPT/Video/GIF/others
3 Brief description about the
material
4 Objectives
1.
2.
3.
52
5 Specific points to be conveyed
1.
2.
3.
6 Duration of the presentation
7 Target population
8 Pretest questions to be asked
53
9 Post test questions to be asked
10 Overall impact on population
11 Photograph of the event
54
4. Community Survey
Name of the village/ Ward: Sub Centre:
PHC:
Family studied:
Head of the family:
Address:
Habituated since ..years
If migrated, details. Duration........, previous place...... , reason of migration:
Family Profile
Family structure:
Age Males Females Total
Infants
1-5 years
6-15 years
16-64 years
Above 65 years
55
FAMILY SIZE:
Total no of persons in the family:
Demographic family size:
Number of children women has given birth at a
point of time:Dependency status: total
dependency:
Family type:
Per capita monthly income:
Marital status:
Physiological conditions:
Medical conditions:
Social conditions:
SOCIO -ECONOMICAL STATUS ASSESSMENT
Social status of the family: religion:
cas
56
t:Language known:
Literacy status:
Head of the family:
57
Literacy rate of the family:
Occupational status of the family:
Economic status:
Cultural Practices
Family cultural practices:
Practices among women and children:
58
LIVING ENVIRONMENT
Physical environment:
House:
Type:
Construction:
Kitchen:
Water supply:
Waste disposal:
Dietary assessment
Food practices:
59
Family Health Profile
Examine and interact all persons present during your visit, by giving priority to
vulnerable individuals. Briefly summarize the findings
Pregnant women not registered:
Family planning non-acceptors:
Seriously/ chronically ill patients:
Low birth weight child:
Severely malnourished child:
Unimmunized child:
Maternal, neonatal or child death:
Severe anemia:
Pneumonia, diarrhea, vitamin A deficiency in child:
Availability and utilization of Health Services
60
Curative:
Allopathy
Ayurveda
Homeopathy
Others ( Yoga, Naturopathy, Siddha, Sowa-rigpa)-
Preventive:
Immunization
Prophylactic or Promotive:
Brahme muhurta uthishthet
Usha jalapana
Dantadhavana
Jihwanirlekana
Gandusha / Kavala
Yoga practice or Physical Exercise
Rasayana sevana
Abhyanga
61
Snana
Bhojana
Tambula sevana
Sandhya kala vidhi
Ratriaharasevana
Ratrinidra
Type of Dead body disposal
62
Visit to Observe National Health Programs & Health Centre
Date of Visit:
Name of the Primary health Centre/Community health Centre/Rural hospital/District
hospital:
Medical officer in charge:
List of available staff:
List of the National Health Programmes implemented through this centre:
Programme wise Details:
1. Name of NHP:
• Services rendered:
63
• Number of beneficiaries in last calendar year
Ayurveda Dispensary/ Taluk Hospital /District Hospital visit
Date of Visit:
Name of the Primary health Centre/Community health Centre/Rural hospital/District
hospital:
Medical officer in charge:
List of available staff:
Infrastructure Details:
Total Area:
Number of Blocks:
List of sections/departments available:
List of services rendered:
Average OPD patients in the last calendar year:
Average IPD patients in the last calendar year:
List of medicines available:
Other details:
Signature of student Signature of faculty
64
Educational Visits Report
1. Visit No:
2. Date of Visit:
3. Place of the visit:
4. Purpose of the visit:
5. Details about the Visit: (Attach geo-tagged photo and link)
65
Case Sheet of Monitoring of Health and Hygiene
Name of the individual: CR Number:
Age: Gender:
Address:Category: Community/
Employee of the college or hospital
Occupation/Designation:
Date of first check-up: Current Ritu:
Marital status: Income group:
LIG/MIG/HIGPersonal Habits/ addictions:
Personal Hygiene:
Examination:
Prakriti (to be assessed using App
of NCISM):Maanas Prakriti:
Satva: Pravara/ Madhyama/ Avara
Periodic check-up:
Sr. No. Examination First check-up Tri- Six-monthly
monthly checkup
check-
up
1. Sara
2. Nadi
3. Mutra
4. Mala
5. Jihva
6. Shabda
7. Sparsha
66
8. Druk
9. Akruti
10. Agni
11. Weight
12. Height
13. Body Mass Index
14. Temperature
Respiratory Rate
15. Heart Rate
16. Blood Pressure
17. Any other
Symptoms
18. Difficulties faced at
workplace (if any)
19. Laboratory
Investigations
(if any)
67
Periodic Treatment Follow up (if any):
Treatment advised after first Follow up at Follow up at
check-up tri- monthly Six- monthly
check-up check-up
78
Counseling and Pathyapathya Advice:
Healt h Advice on First Check up Health Advice on Tri-monthly Health
Status Status Check- up Status on
on First Upakrama Pathya Apathya on Tri- Upakra Pathya Apathya Six-monthl
(Do’s) Don’ts ma (Do’s) Don’ts
Check monthl y Check-
up y up
Check-
up
Ahara Ahara
Vihara Vihara
(including
dinacharya
upakrama)
Yoga Yoga
Nisargopa Nisargop
cara achara
Signature of student signature of faculty
79
water sanitation, waste disposal including biomedical waste in the hospital
Name of the Hospital:
Date of observation:
Details of Water Sanitation:
Source of water supply to the hospital:
Capacity of the water reservoir:
Cleanliness and maintenance of the reservoir tank:
Method of Sanitation adopted:
Frequency of sanitation:
Periodic check-up of the valves/ pipes and the taps:
Frequency of Periodic internal audit:
Frequency of Periodic external audit:
No. of cases of water borne diseases reported during last calendar year:
Dedicated staff appointed:
Sewage Treatment Plant Available or not:
80
Disposal of waste disposal
BMW Management committee functioning or not:
BMW Management
guidelines displayed in:
OPD: IPD:
OT:
Pathology Lab:
Colored dustbins available:
Segregation of Dry and Wet waste:
Staff sensitized regarding BMW management:
Frequency of waste collection:
Waste collection vehicle availability:
BMW report registers available and maintained:
Subsequent management: Dumping/ Incineration/ Chemical treatment
Signature of student signature of faculty
82
