SGVVT’s SIG AMC & H, KOPPAL / PG DEPT OF SHALYA TANTRA “A COMPARATIVE CLINICAL TRIAL TO STUDY THE EFFICACY OF NAARIKELA LAVANA WITH PASHANABEDA CHURNA AND URSODEOXYCHOLI ACID IN THE MANAGEMENT OF PITTASHMARI (CHOLELITHIASIS)” Name of P.G. Scholar: Dr.Shivakumar.C. K Name of Guide: Dr. B. S. Savadi MD, (Ayu). Name of the Patient: Group: Age: Date: Sex: Clinical Trial No: Religion: O.P.D. No: Occupation: LP.D. No: Marital Status: Socio-economic Status: Educational status: D.O.C: Address: Phone no: I. CHIEF COMPLAINTS: Duration Il. ASSOCIATED COMPLAINTS: Duration Ill. HISTORY OF PRESENT ILLNESS: “A Comparative Clinical Trial to Study the Efficacy of Naarikela Lavana with Pashanabeda Churna and Ursodeoxycholic Acid in the Management of Pittashmari (Cholelithiasis)” 106VIL. Vu. ad) @ GB) (4) (6) (6) qa HISTORY OF PAST ILLNESS: TREANTMENT HISTORY FAMILY HISTORY: History of similar complaintsOthers if any PERSONAL HISTORY: Appetite : Poor / Moderate / Good Bowel Habit / Regular / Irregular Sleep : Disturbed / Sound Habits : None / Alcoholic / Smoking / Tobacco Chewing / Others if any Diet : Veg / Mixed Water intake : Quantity/ 24 hours Micturition : Frequency : Day :times Night: times RESIDENTIAL HISTORY: _Jangala / Anoopa / Sadharana GYNAECOLOGICAL HISTORY GENERAL EXAMINATION: Prakruthi: Pulse: Temperature: Respiratory Rate: Blood Pressure: Built: Poor / Moderate / Well “A Comparative Clinical Trial to Study the Efficacy of Naarikela Lavana with Pashanabeda Churna and Ursodeoxycholic Acid in the Management of Pittashmari (Cholelithiasis)” 1077) Pallor: 8) Oedema: 9) Icterus: 10) Lymphadenopathy: 11) Hight 12) Weight 13) BMI XI. McGill pain Score Score No pain -0 Mild -1 Discomforting - 2 Distressing -3 Horrible -4 Excruciating - 5 XII. SYSTEMIC EXAMINATION CN.S.: CVA: RS: GALT: “A Comparative Clinical Trial to Study the Efficacy of Naarikela Lavana with Pashanabeda Churna and Ursodeoxycholic Acid in the Management of Pittashmari (Cholelithiasis)” 108XIV. LOCAL EXAMINATION: 1) Inspection: 2) Palpation: 3) Percussion: * Ultra Sonography of abdomen: ASSESSMENT CRITERIA: (A) Subjective: AT FU S.N Aeeeseinett Br 30" day Fi - Criteria 60" day 75" day 1 | Pain abdomen 2 | Nausea (B) Objective Assessment Criteria Br 1 | USG abdomen Signature of P.G. Scholar Signature of Guide “A Comparative Clinical Trial to Study the Efficacy of Naarikela Lavana with Pashanabeda 109 ‘Churna and Ursodeoxycholic Acid in the Management of Pittashmari (Cholelithiasis)