A brief over view of clinical case sheet that can be used in dermatology related cases in Ayurveda/Allopathy.

1. 1
Post Graduate Department Of Kãya Chikitsa
Dr. BRKR Government Ayurvedic College & Hospital
Erragadda, Hyderabad.
(Affiliated to Dr. NTR University of Health Sciences)
Special Case Sheet for the clinical evaluation of Dãrvãdi yoga
and Kushţãdi lepa in the management of Dadru kushta
Name of the patient: Serial no:
Age/Sex: OPD/IPD reg No:
Religion: Date:
Education details: Diagnosis:
Marital status: Result:
Social status:
Occupation:
Address:
Phone no:

2. 2
Chief complaints with duration:
(Pradhãna Vedhana with Avadhi)
Associated Complaints:
(Anubandha Lakshanas)
History of Present illness:
(Roga Vruttãntam)
Mode of onset of lesion(s) -
Site of lesion(s) -
Characteristic of lesion(s) - Intermittent / Progressive
Earlier similar episodes (if present any) - Yes / No
H/o any aggravating / relieving factors - Yes / No
If yes,
1. Food - veg / non veg
2. Season - rainy / winter / summer
3. Others -
H/o Photo allergy/ any allergic skin reactions
History of Past illness:
(Rogi Pũrva Vruttãntam)
Family History:
(Parivãrika Ithihas)

3. 3
Treatment History:
(Chikitsa Vruttãntam)
Personal History:
(Vyakti gata Charithra)
1. Diet - Veg / Non veg / Mixed
2. Addictions - Alcohol / Smoking / Others / No addictions
3. Appetite - Good / Average / Poor
4. Sleep - Sound / Disturbed
5. Micturition - Free / Dysuria / Polyuria / Oliguria
6. Bowels - Regular / Irregular / Constipated / Loose stools
Menstrual History:
Obstetric History:
General Examination: (vitals) Systemic Examination:
1. BP - 1. CNS -
2. Pulse - 2. CVS -
3. Temp - 3. RS -
4. Resp.rate - 4. GIT -
5. Built - 5. GUS -
6. P/A - 6.MS /LS -

4. 4
Ashţa Sthãna Parĩksha: Dasha Vidha Parĩksha:
1. Nãdi - 1. Prakruthi -
2. Mala - 2.Vikruthi - Dosha:
Dũshya:
Srotas:
3. Mũtra - 3. Satwa -
4. Jihwa - 4. Sãtmya -
5. Śabda - 5. Samhana -
6. Sparśha - 6. Sãra -
7. Dhruk - 7. Āhãra Śakti -
8. Ākruthi - 8. Vyãyãma Śakti -
9. Vayah -
10. Pramãna -
Examination of Integumentary System:
I. General Examination
 SKIN (Twak)
Texture:
Color:
 NAILS (Nakha)
Color:
Nature: Normal/ Onychomycosis/ Onycholysis
 HAIR (Kesha)
Color:
Distribution:

5. 5
II. Local Examination
1) Site of lesion -
(Pidaka Sthãna)
Scalp/ Face/ Neck/ Hands/ Feet/ Trunk/ Groins/ Nails/ Others
(Flexor surfaces/ Extensor surfaces)
2) Distribution -
(Vyãpti)
Symmetrical/ Asymmetrical
3) Character of lesion -
(Pidaka Lakshanas)
Size:
Color:
Type: Maculae/ Annular scales/ Annular plaques with erythematous base/
Annular plaques with peripheral papules or vesicles
Arrangement: Single/ Grouped
4) Itching - Present /Absent
(Kandu)
Severity: Mild/ Moderate/ Severe (pruritic)
Time: Day/ Night/ Both
5) Inflammation - Present / Absent
(Rãga)
Severity: Mild/ Moderate/ Severe

6. 6
6) Discharge - Present/Absent
(Srãva)
Color: watery/white/red
Contents: blood/pus/clear fluid
7) Superficial Sensation on lesion - Anasthesia/ Parasthesia/Normal
(Pidaka Sthãna Sparśha)
Pain: Present/ Absent
Swelling: Present/ Absent
Investigations:
1. Routine investigations:
CBP, ESR, RBS, CUE
2. Special investigations:
(Optional)
Fungal Culture
Skin biopsy
Woods Light examination
Treatment Schedule:
(Chikitsa Krama)
 Duration of treatment (trial) for 40 days -
1. Oral administration of
“Dãrvãdi Yoga” 6gm, bid with Luke warm water (after
food)
2. External application of “Kushtãdi lepa”
 Review - Every 10 days

7. 7
Clinical Parameters:
Itching, Inflammation, Color, Nature of lesion, Size of lesion,
Number of lesions.
Sl
no
Parameter
Before
Treatment
Review
After
Treatment
10days 20days 30days 40 days
1. Itching
2. Inflammation
3. Color
changes
4. Nature of
lesion
5. Size of lesion
6. Number of
lesions

8. 8
Grading scale:
Sl.
no
Parameter
Grade
0
Grade
1
Grade
2
Grade
3
Grade
4
Grade
5
1.
Itching
No
itching
Occasi
onally
mild
itching
Mild
itching
Modera
te
itching
Severe
itching
Severe
continu
ous
itching
2.
Inflammatio
n
No
inflam
mation
Mild
inflam
mation
Modera
te
inflam
mation
Severe
inflam
mation
Severe
inflam
mation
with
promin
ent
erythe
matous
base
3.
Color
changes
No
color
change
Pink
color
Pinkish
red
color
Red
color
Black-is
blue
color
Black/
Violace
ous
black
color
4.
Nature of
lesion
No
lesion
Mild
visible
lesion
Modera
tely
visible
lesion
Promin
ent
visible
lesion
Promin
ently
evident
lesion
associat
ed with
dischar
ge
5.
Size of
lesion
(diameter)
Below
0.5/
1cm
1 to
2cm
2 to
3cm
3 to
4cm
4 to
5cm
Above
5cm
6.
Number of
lesions
No
lesion
Only
1lesion
2
lesions
3
lesions
4
lesions
More
than 4
lesions

9. 9
Results Assessment:
Finally over all result is calculated by taking average of all parameter
results.
Sl.
no
Parameter
Before
treatment
After
treatment
% of
improvement
1. Itching
2. Inflammation
3. Color
changes
4. Nature of
lesion
5. Size of
lesion
6. Number of
lesions
Percentage Result
Below 40 % - Poor
40 to 60 % - Average
60 to 80 % - Good
80 to 90 % - Very good
90 to 100 % - Excellent
(Reduction from initial treatment)
Date of Commencement of treatment:
Date of Completion of Treatment:
Over all Response to Treatment: Poor/Average/Good/very good/Excellent
Signature of PG scholar Signature of Guide

10. 10
Consent Form
I ----------------------------- Son/ Daughter/ Wife of ------------------------
After being explained thoroughly the entire purpose of clinical trial and
nature of treatment to my satisfaction, I hereby willingly agree to participate
as a subject in the above clinical study of “Dadru Kushta”.
I am aware of my right to opt out of the treatment schedule at any
time during the course of clinical trial.
Signature of Witness Signature of Patient
1.
2.