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Ayurveda Assessment form
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Name of the client
Age / Gender
Health concern 1: History
Health concern 2: History
Other concerns
Any history of hospitalisation or continuous medication including the supplements
Any history of parent/siblings – hospitalisation or continuous medication including the supplements
Bowel – Appetite – Micturition – Sleep – Digestion – Hemorroids
Breakfast, Lunch and Dinner Patterns
Ayurvedic Assessment
Pulse/Nadi: Vata – Varying and irregular
Pulse/Nadi: Pitta – Regular and bouncing
Pulse/Nadi: Kapha – Slow and gentle
Body warmth/Sparsham: Vata – Cold hands and feet
Body warmth/Sparsham: Pitta – Warm body
Body warmth/Sparsham: Kapha – Clammy and uses heater always
Physic/Roopam: Vata – Slender and boney prominence
Physic/Roopam: Pitta – Medium built or change of skin colour
Physic/Roopam: Kapha – Heavy built or oily skin
Voice/Shabda: Vata – Weak voice or breathing sounds
Voice/Shabda: Pitta – Active voice or dominant
Voice/Shabda: Kapha – Gentle voice or mucousy chest
Eyes/Netra: Vata – Small or dry
Eyes/Netra: Pitta – Medium or red or muddy
Eyes/Netra: Kapha – Big or mucousy
Stool/Purisha: Vata – Floating
Stool/Purisha: Pitta – Loose
Stool/Purisha: Kapha – Sinking
Urine/Mutra: Vata – Dark
Urine/Mutra: Pitta – Yellowish
Urine/Mutra: Kapha – Whitish
Tongue/Jihwa: Vata – Dark
Tongue/Jihwa: Pitta – Yellowish
Tongue/Jihwa: Kapha – Whitish
Red Flags – Remedial Massage
Remedial Therapy Assessment
Postural Observation – Need improvement
Gait Analysis – Need improvement
Joints need improvement and massage therapy
Neck
Shoulders
Elbows
Wrist
Upperback
Mid back
lower back
Hip joint
knee
Ankle
Small joints
Adam ’ s test to discriminate idiopathic and functional scoliosis
Cervical compression test for pressure on a nerve root (increased peripheral pain), joint damage or ligament strain (increased local pain)
Iliac compression test for sacroiliac lesion
Kemp ’ s/quadrant test – Leg pain suggests nerve root compression or radiculopathy; low back pain suggests local sprain/strain or facet syndrome
Painful arc for impingement syndrome, rotator cuff or AC pathology
Level of disomfort / Ama
Blocked ear / sinus / congestion (Srotorodha)
Weakness and tired (Balabramsha)
Heaviness and dull (Gauravam)
Low appetite (Anila moodata)
Lethargy in the morning (Alasya)
Reduced digestion (Apakti)
Salivation (Nisteeva)
Constipation (Mala sanga)
Reduced appetite (Aruchi)
Mentally exhausted and confused (Klama)
Emotional state
History of trauma
Childhood difficulties
Stress from workplace
Difficulty to manage stress
Lack of motivation
Manages emotions well
Message
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Ayurveda Treatment Plan
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AYUR HEALTH _ INTEGRATIVE HEALTH CENTRE FOR CHRONIC ILLNESSES
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"When the diet is correct, no need for medicine; When diet is incorrect, no purpose for medicine." Ayurveda
For the next three weeks, it’s advisable to steer clear of or reduce consumption of the following ingredients.
To support your digestive health over the next three weeks, it’s best to limit intake of dry nuts and seeds, deep-fried chips and crisps, cauliflower, cold drinks and fruits, refrigerated food eaten directly from the fridge, and raw green salads. Additionally, avoid consuming tea and coffee when they are not hot, as this may reduce appetite and contribute to bloating. These adjustments can help prevent digestive discomfort and bloating during this period.
For the next three weeks, it’s recommended to refrain from consuming “nightshade” vegetables, such as tomatoes, chilies, eggplants, capsicum, and bell peppers. These vegetables contain inflammatory properties that may contribute to increased heat and acidity levels in the body.
During this treatment period, it’s advisable to refrain from consuming fast food, rich restaurant meals, and alcohol. Deep fried-oily food, too salty and creamy – sugary food should cut down.
Throughout the treatment, it’s advisable to steer clear of highly acidic fruits like citrus (orange, lime, lemon, mandarin). Better minimise green apples and pineapples during this time.
Frequent consumption of meat can result in constipation in your situation, leading to feelings of heaviness and hindering weight loss efforts. Therefore, it’s advisable to reduce intake of chicken and red meat for the next three weeks. Cooked fish is better to take . However avoid shelled fish, especially shelled varieties like prawns and mussels.
Processed meat and dairy products are challenging to digest and can lead to increased Kapha mucous production. Therefore, it’s best to avoid foods such as sausage, ham, salami, pepperoni, bacon, full cream milk, salted butter, cakes, pastries, milk chocolate, flavored yogurt, mayonnaise, cheese, whipped cream, and desserts.
Consumption of egg yolk (egg white is acceptable), cold tap water or juices, and cold coffee can lead to a sense of heaviness in the body.
What can I eat?
All vegetables listed except for those previously mentioned are suitable for consumption. This includes beetroot, carrot, beans, cucumber, celery, spinach, sweet potato, kale, onion, lettuce, cabbage, asparagus, Swiss chard, turnips, spring onions, and silverbeets.
Using nuts and seeds that have been soaked overnight is preferable. Opt for dark chocolate as a preferable choice.
All fruits are suitable for consumption except citrus and pineapple. Red apple (stewed apple is preferable), banana, pear, grapes, watermelon, blueberry, papaya, cranberry, and goji berries are all acceptable options.
It’s best to drink water when it is at body temperature (37°C) for optimal hydration.
Skipping meals can lead to low energy levels and increased chances of acid accumulation. It’s important to maintain regular meal times with proper intervals, consuming three meals throughout the day. Ensure your last meal is consumed at least four hours before bedtime.
All types of lentils, including red lentils, yellow dal, mung dal, green peas, chickpeas, and rajma beans, are suitable sources of protein. While black lentils are acceptable, it’s better to avoid them for dinner. It’s advisable to wash lentils after cooking before using them to make a curry.
For easy meal planning, consider the following light meal options: – Start your day with porridge for breakfast, and vary the fruits as desired. – Enjoy rice or a wrap filled with cooked lentils and vegetables for lunch. – Opt for soup as a light and nourishing dinner choice. http://ayurhealth.com.au/blog/35-alkalising-vegetables-healthier-body/
Herbal Recommendations: Religiously take the herbal suppliments for next 3 weeks
Aswagandha: Take 1/2 teaspoon of powder with 1/2 cup of boiled warm (milk/water/almond milk) twice daily 10 minutes before the meals
Bacopa: Take 1/2 teaspoon of powder with 1/2 cup of boiled warm water/almond milk/honey twice daily on empty stomach 7AM and 5PM
Moringa: Take 1/2 teaspoon of powder with 1/2 cup of boiled warm water/almond milk/honey twice daily on empty stomach 7AM and 5PM
Manjishta: Take 1/2 teaspoon of powder with 1/2 cup of boiled warm water/almond milk/honey twice daily on empty stomach 7AM and 5PM
Satavari: Take 1/2 teaspoon of powder with 1/2 cup of boiled warm water/almond milk/honey twice daily on empty stomach 7AM and 5PM
Kapikachu: Take 1 teaspoon of powder with 1/2 cup of boiled warm water/almond milk/dairy milk at night bed time before sleep
Aswagandha: Take 1 teaspoon of powder with 1/2 cup of boiled warm water/almond milk/dairy milk at night bed time before sleep
Triphala: Take 1 teaspoon of powder with 1/2 cup of boiled warm water/fruit juice at night bed time before sleep
Additional Recommendations:
Yoga practices that are recommended:
Sun Salutation: https://www.youtube.com/watch?v=73sjOu0g58M
Cobra pose for lower back: https://www.youtube.com/watch?v=fOdrW7nf9gw
Child pose: https://www.youtube.com/watch?v=eqVMAPM00DM
Legs up: https://www.youtube.com/watch?v=FfzQ1UOPmto
Meditation: https://www.youtube.com/watch?v=mMMerxh_12U
Breathing practice: https://www.youtube.com/watch?v=8VwufJrUhic
Shoulder exercise: https://www.youtube.com/watch?v=yX0bx64FJws
Upper back exercise: https://www.youtube.com/watch?v=8HLhv3vekwc
Lifestyle modifications thats helps your condition:
Self-Massage Routine: Engage in self-massage sessions using warm oils like sesame, coconut, mustard, or almond oil 2-3 times per week. Self massage video https://www.youtube.com/watch?v=_HQLsfZh5js
Oil pulling – It is recommeded to practice oil pulling atleast 3 times a week. Oil pulling video https://www.youtube.com/watch?v=XVUaBDV64hU
Regular walking: it is recommeded to practice regular walking for 30 minutes for next 3 weeks.
Meditation: Yes meditation is extreamly recommeded for you. To learn meditation please follow the link.https://www.youtube.com/watch?v=xdbEogwiLmQ
Use of tongue scraper on a regular basis in the morning after brushing teeth.
Use of beanie to cover your ears when weather is cold. Use a hat when whether is too hot.
Recommended Remedial Therapies
Abhyanga: Therapeutic Massage
Nasya – Nasal Sinus detox
Kati Vasti – Spine therapy
Netra Vasti – Eye therapies
Udwarthana – Dry friction massage
Lepana – Anti inflamatory herbal paste
Bashpa sweda – Steam bath (sweating)
Podi Kizhi – Herbal bolous bag massage
Sirodhara – Oil / Milk/ Buttermilk
Navara kihi – Rice bag therapy
Upanaha sweda: https://www.youtube.com/watch?v=rQZ8z2CwRu4
Home detox: http://ayurhealth.com.au/blog/detox-at-home-virechana/
Remedial Sports therapy
Remedial Myofacial Resease
Remedial Lymphatic drainage
Remedial Deep tissue therapy
Remedial Trigger point therapy
Weight loss Program: http://ayurhealth.com.au/blog/weightloss-in-21-days/
Anti inflammatory program: http://ayurhealth.com.au/blog/autoimmune-inflammation-body-detox/
Ayurveda warm drink for your condition
Combine 1 teaspoon each of cumin, coriander, and fennel seeds, along with several slices of fresh ginger. Bring 4 cups of water to a boil and add the ingredients, then simmer for 30 seconds. Let it steep for 10 minutes, then strain the mixture. Enjoy the herbal infusion throughout the day for its health benefits.
Take 1 litre of boiled warm water in a thermos and add 1 table spoon of coriander seeds into it. Take this drink through out the day.
Take 1 litre of boiled warm water in a thermos and add 1 teaspoon of both dry ginger powder and fennel seeds powder into it. Take this drink through out the day.
If your complaints are chronic in nature (lasting more than 3 months time), a follow up assessment is required. No additional cost for followup consultation
Followup is recommended after 5 days
Followup is recommended after 3 weeks
Panchakarma therapy is recommended- http://ayurhealth.com.au/blog/pancha-karma-detox/
Preparation for Panchakarma – http://ayurhealth.com.au/blog/panchakarma-3/
More information to read
In Ayurveda, Vata, Pitta and Kapha are the three primary doshas, and when it becomes imbalanced, it can lead to a variety of physical, mental, and emotional symptoms. Recognizing the signs of Dosha imbalance is essential for addressing it effectively. Here are common signs and symptoms of imbalance of dosha and strategies to bring their balance.
Signs of Vata Imbalance: http://ayurhealth.com.au/blog/vata-imbalance/
Vata Balance Strategies: http://ayurhealth.com.au/blog/vata-pacifying-strategies-2/
Signs of Pitta Imbalance: http://ayurhealth.com.au/blog/pitta-imbalance/
Pitta Balance Strategies: http://ayurhealth.com.au/blog/pitta-pacifying-strategies/
Signs of Kapha Imbalanc: http://ayurhealth.com.au/blog/kapha-imbalance/
Kapha Balance Strategies: http://ayurhealth.com.au/blog/kapha-pacifying-strategies/
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8 Rules in Diet and Lifestyle Care in Pregnancy: