nadi pareeksha (pulse diagnosis) - an authentic scientific approach

NADI PAREEKSHA (PULSE DIAGNOSIS) - AN

AUTHENTIC SCIENTIFIC APPROACH

Foremost means of Pareeksha

First Avayava Pareeksha in Ayurveda.

Subjective and objective approach to disease diagnosis

Any ailment in body brings about a change in constitution of Vata, Pitta, Kapha transmits through Nadi sensed by fingers of an examiner varying pressure

Non invasive computer aided device which will eliminate all the human errors performed manually by the practitioners, should be developed

Introduction

• तस्मात् शास्त्रार्थ वि�ग्याने प्रवु्रतौ कम दशने भि�षक् चतुष्टे युक्त प्राणाभि�सार उच्यते

• एकं शास्त्रं अधीयतो न वि�द्यात् शास्त्र विनश्चयम् तस्मात् बहुश्रुतं शास्त्रं वि�ग्यानीयात् चिचविकत्सक

• प्रयोग ज्नान वि�ग्यनम् चिसधिधचिसध सुखप्रद जीवि�तभि�सरस्ते स्यु: �ैद्यत्�ं त्ेषु अ�स्थि6तत्�ं

Mythological Origin

Shiva → Brahma → Indra → Kanaada

Nadi vijnana exits from the time of origin of Ayurveda

In bruhathrayee – explained based on tridosha siddhanta

ACCORDING TO BRIHATHRAYEE

Caraka Indriyasthana

•Spandana – Aspandana•Swasa - Hraswa - Spandana - Aspanda •Spandana - Stambha

Caraka Shaareera

Sthana•Aspandana - Nagodara

Sushrutha Sutrasthana

•Garbhakshaya - Garbha Aspandana•Muda Garbha Nidana - Aspandana

ACCORDING TO LAGHUTHRAYEE

SHARANGADHARA SAMHITHA

First time in the history of Ayurveda

Fifteen types Pulse in certain physiological

states of the body. Pulse in certain mental states.

Pulse in certain pathological states of body. According to three Doshas involved the

movements of the pulse are correlated with those of the

birds, reptiles and amphibians.

BHAVAPRAKASHASpecification of sides - male

and femaleIndication of three fingers

unfavorable conditions Relation between fingers and different positions of

Doshas. Pulse in physiological

conditions of the body. Pulse in mental states.

pulse in pathological states.

YOGARATNAKARA Indication

Sites and method of pulse examination.

Pulse in physiological and mental states

Pulse in pathological conditions

Pulse indicating bad prognosis

Miscellaneous description related to

pulse

OTHER IMPORTANT REFERANCES

VaidyachinthamaniMethod of Nadi Pareeksha is

mentioned, explanation regarding Vata Nadi ,Pitta

Nadi , Kapha Nadi , Dwandwaja Nadi , Ajeerna

Nadi. He had also mentioned regarding Samshaya Nadi.

RavanaThantraRavana in his treatise Nadi

Pareeksha included following points (a) general description (b) pulse after taking certain

diets (c) pulse in certain physiological conditions (d)

pulse in certain mental states (e) pulse in general

pathological conditions and diseases (f) pulse in prognosis.

Site of Origin and Sankhya Sthula and sookshma nadi – 3.5 crore in number

All are connected to nabhi kantha

Forms urdhwa , adha and thiryak branches and sub branches

1000 sthula nadis – which transfers panchendriya gunas from one place to other

700 sookshma chidra nadi – circulates the annarasa for shareera pushti

24 are clear nadi situvated at nabhi

Among them only is yogya nadi for pareeksha

ART OF LEARNING

ACCORDING TO OTHERSKANAADA – morning time after

evacuvation of malas by both physician and patient before nadi pareeksha.According to condition nadi can be

looked at anytime.BASAVARAJEEYAM – nadi palpated over the kurpara sandhi madhya of

right hand with three anguli.Angushtamoolas pashchima bhaga

madhya nadi gathi is noted.In women kurpara sandhi kurma

urdhwa mukha an in men kurpara sandhi kurma adho mukha.

BHAVAPRAKASHA- males right hand and females left hand is examined.

Angushtamoola nadi is touched with the three fingers.

Bhishak will be knowing the sukha and dukha by examining the nadi of a

person.

Experts opinion Concentration of mind is the most important thing in nadi

pareeksha Physician should understand even the minute tactile tactile

perception even in the middle of distractions (proper sparshanendriya jnana)

Practice of manthras daily in early morning hours. Example : chanting of gayathri mantra and look for the beats of his own nadi

The practice of mantras and pranayama daily to get peaceful mind Should understand first which part of the finger gets the beat and

the flow of the beat , path of its movement Note the normal flow of nadi of ones own just after waking up ,

after bath , after having breakfast etc….

Tarjani •Index finger •vataMadhyama •Middle finger

•pitta

Anamika

Basic information obtained from Nadi Pareeksha

VATA PITTA KAPHA

GATHI (movement) Sarpa Manduka Hamsa

VEGA (rate) 80 - 95 70 - 80 50 - 60

TALA (rhythm) Irregular Regular Regular

BALA (force) Low (+) High (+++) Moderate (++)

AKRUTHI (tension and volume)

Low High Moderate

TAPAMANA (temperature)

Cold Hot Warm to cold

KATHINYA (consistency of vessel wall)

Rough , hard Elastic , flexible Soft , thick

Three Basic Gathis of Nadi

VATA PULSE PITTA PULSE KAPHA PULSE

CHARACTERISTICS Fast , feeble , cold , light , thin , disappears on pressure

Prominent , strong , high amplitude , hot , forceful , lifts up the palpating finger

Deep , slow , broad , thick , cool , regular

LOCATION Best felt under the index finger

Best felt under the middle finger

Best felt under the ring finger

GATI Moves like a cobra Moves like a frog Moves like a swimming swan

Examples of gati and their conditions• Krumi gathi – parasites , worms• Pippilika gathi – terminal illness• Mayura gathi – arterial hypertension• Kukkuta gathi – diabetes , albuminuria• Ushtra gathi – aortic stenosis• Gaja gathi – elephantitis , lymphatic obstruction• Girija gathi – heart block• Vishama gathi – pulsus alterans , atrial fibrillation• Damaru gathi – fatal illness , renal failure , shock• Padma gathi – perfect health , enlightnment

Vega ( Rate )• Rate – number of beats per minute• To get an accurate resting pulse – take in early morning in a restful

condition• Physiologically – vega is high (80 – 90 beats/min) in vata , moderate (70 –

80 beats/min) in pitta and low (50 – 60 beats/min) in kapha• Relation with height – tall people have slower heart rates and short

people have faster heart rates (pulse rate inversely proportional to height)

• Relation with age – children have higher heart rates and older people rate is slow

• Relation with metabolism – slower the pulse rate slower the metabolism• Relation with agni – when agni is strong pulse is fast , light and hot and

agni is slow pulse is slow , heavy and cool• Pathology

Tala ( Rhythm )• Rhythm – defined as the time interval between two

consecutive or successive uplifts• In a healthy person – the time interval is regular ,

uninterrupted and rhythmic• Balanced tala reflects – symchronization function of prana

vayu , vyana vayu , avalambaka kapha , and sadhaka pitta• If regularly irregular – both kapha and vata are in imbalanced

state• If irregularly irregular – both vata and pitta are in imbalanced

state• Pathology

Bala ( Force )• Force – pressure of the pulse• Bala – the amount of force pressing on the blood vessel is being

exerted back onto the fingers• Force / pulse pressure (PP) = difference between systolic and

diastolic pressure• If systolic b.p is 120 and diastolic b.p is 70 then PP is 50 which is

normal• If PP is 170 which is high – heart is working under great stress and

if PP is 10 – person doesn’t receive oxygen to brain• If bala is high (+++) – force is full and bounding is high , deep

pressure of finger necessary in order to stop the pulsation• If bala moderate (++) – moderate pressure• If bala low (+) – superficial pressure causes the pulse to disappear

Akruthi ( Volume and Tension )• Volume – uplift to the palpating finger , amplitude• It is not necessary to depress the radial artery , just feel the uplift while the

fingers rest lightly on the artery• In order to feel the volume try to press the artery gently and feel the throb

pushing against the fingers • If throbbing is very prominent in middle finger , the volume is good (+++) ,

pitta.If throbbing is felt under ring finger , it is moderate volume (++) , kapha. If throbbing is barely felt under index finger , volume is low (+) , vata

• Don’t press too hard• Amplitude is high volume is high• The volume corresponds to systolic bp• High volume – pitta type of pulse , if good amount of water intake , high systolic

bp• Low volume – dehydration , congestive heart failure , anemia

• Tension – is felt by pressing the ring finger to stop the pulsation of the radial artery and then feeling the tension under the middle and index fingers

• Tension is the pressure between the two uplifts , diastolic pressure.

• It is the constant pressure of blood in the artery• Water hammer / collapsing pulse

Tapamana ( Temperature )

• There is relation between gati of the pulse , the wave of the pulse , the temperature of the pulse and the agni or metabolic fire of the person

• If pulse is cold , fast and light – vata is high , agni is low ,vishama agni

• If pulse is hot , sharp and light to touch – pitta high , agni high , tikshna agni

Kathinya ( Consistency of the Vessel Wall )

• The consistency of vessel wall , felt by rolling the artery between the palpating finger and the radial bone

• Palpating reveals – vessel wall is thick or thin , elastic or inelastic , rigid , hard or rough

• If vata – rough and hard vessel – vessels becomes narrow

• If pitta – elastic and fragile , bruise easily• If kapha – broad and thick

NADI IN MENTAL STATUSMENTAL STATUS NADI

Kaama Fast

Krodha Fast

Chintha Feeble

Bhaya Feeble

NADI ACCORDING TO DIET• Madhura rasa - vakra , mayura gathi• Amla rasa - ushna , plava gathi• Katu rasa - kulinga pakshi gathi• Tikta rasa - kechuva ?• Kashaya rasa - kathina• Taila - pushti• Ksheera - sthimitha• Guda , guda vikara - pushti , vata pitta prakopa• Mamsa - lagutakruthi ?• Phala varga - • Kushmanda , mulaka - manda

According to biological clock

• Praatha kaala - snigdha ,manda gathi• Madhyanna kaala – ushna , vega gathi• Saayam kaala – vata nadi• Rathri kaala – uthejarahitha nadi

NADI IN PREGNANCY

• Nadi shifts towards lateral side (thumb side , radial border) or medial side (little finger side , ulnar border)

• It can be felt both right and left sides• If nadi shifts laterally – male foetus• If nadi shifts medially – female foetus• Can be felt within fifteen to thirty days after

conception• She should give her complete attention while taking

nadi

Jwara Ajeerna

Athisara

Grahani

Prameha

Gulma

Raktapitta

Rajayakshma

Arsha

Muthraghata

Pandu

Amaja vikara

Malajeerna

Vrana

Visha

Shalya

Urdhwajathrugata roga

Pulse Conditions with Unfavorable Prognosis

The following pulse conditions are indicative of bad prognosis• Rapidity of the pulse• Hardness (this indicates that the pulse is felt between the beats)• Extreme slowness of the pulse • High tension pulse• Extreme smallness• Extreme arrhythmia• Displacement of the pulse from its normal site• Imperceptibility of the pulse• Irregularly irregular pulse• A pulse which is only felt under the index finger at vata spike , is

very feeble and moves like an ant

Nadi in Arishta

Vibrating and pulsating like that of lightening. More rapid and sometimes very thin runs extremely weak /

fast / cold Not felt in hand but in leg and mouth remains open Creates Dehashaithya along with Swasa and Daha – die

within 15 days Teevra and Manda sometimes with Sweda – die within 7 days. Mukha Nadi sensation disappears, Shaithya and Klama in body

– die within 3 days Not felt at proximal end, cold in middle, appears tired at

terminal – die within 3 days. Feeble and felt like cloth wave and cold - die within one yama

CONTRAINDICATIONS 1. Sadyosnatha2. Sadyabhukta3. Kshudhitha4. Trushitha5. Atapa , dhooma , dhoopa sevitha6. Vyavaya shrantha deha7. Bhuktha8. Nidritha9. Upavasina10. Vyayama shrantha deha11. Bhoothavesha12. Rodana13. Madyapana14. Mathibhrama15. Gandhara bhikshana16. Pavanabhyasa sadhaka17. Sneha avagaahina18. Kukkuta , shasha , manduka , sarpa mamsadi bhakshaka19. Apasmara20. Shrantha deha21. Tailabhyanga

CONCEPTS UNABLE TO EXPLAIN

Seven levels of pulse

• 1st level – vikruthi• 2nd level – manas vikruthi• 3rd level – subdoshas• 4th level – ojas , tejas , prana• 5th level – dhatus• 6th level – manas prakruthi• 7th level - prakruthi

WHY NADI VIJNANA – A SUBMERGED AREA

• In olden days through various zoological ways Acharyas interpreted the Nadi

• Achieved by feel or experience which was unexplainable.

• Needs very special skill, advanced knowledge and sharp perception of even minute character which is achievable after decades of study and practice.

• For diagnosing we come to the curriculum without any special acquaintance of such skills as our Acharyas have

• Minimum amount of time

SPHYGMOGAPH

SPHYGMOGRAPH• three identical piezo film based sensors to

capture the waveform• by applying varying pressure• collected are filtered, amplified and• read by the software application • which plots the graphs accordingly.• read by the software application • DVSOFT software

Percussion wave (P) Tidal wave (T)

Dicrotic wave (D)

Percussion (P) wave • raises fairly rapidly

without any interruption on itRounded peak.

• The percussion wave first raises due to rapidly transmitted shock of left ventricular contraction and then fells towards the end of systole.

Tidal (T) wave• Sometimes after a

slight depression from the peak there may be another systolic wave near the peak between Percussion wave and Dicrotic wave

Dicrotic (D) wave• The descenting limb

of the pulse less steep due to a more gradual fall in pressure corresponding to the elastic recoil of the arterial walls

CONCLUSION

• Simile • Blind person climbing the mountain • Person moving through darkness. • Nadi Vijnana should be known to all Vaidhyas

which is decreasing now a days• Future researches can be done concentrating

on the diagnosis of disease using an improved version

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