Wednesday, July 11, 2012

Nadi Pariksha (Pulse Examination)

Nadi Pariksha (Pulse Examination) 
Pulse examination is a special tool of diagnosis. According to Ayurveda, every cell in our body sends its own unique signal to the heart via different vital organs, and the blood stream. These Praanic (life energy) currents of energy are then compressed into rhythmic pulsation, which can be decoded to reveal what is going on in the body. It requires experience, meditative state and dedication on the part of Ayurvedic physician for reading pulse.
Pulse diagnosis is a technique used in traditional medicines such as in Ayurveda, Unani and Chinese medicine.

History of Nadi Parikshana (pulse examination in ayurveda)
The first Ayurvedic classic to describe pulse examination is Saarangadhara Samhita (13th century AD.). Later works such as Bhavaprakasa (15th century AD.), Yogaratnakara (16th century AD.), Basavarajeeyam (17th century AD.) etc. deal extensively with the subject.

Which pulse to be examined?
The nadi or pulse which is examined in ayurveda to assess the bodily condition is known as “the Jiva nadi”.
This jiva nadi can be understood as the “radial artery” according to the study of anatomy. Generally radial pulse is examined just below the base of the thumb on the wrist.

Choice of hand for ‘nadi’ examination
In males, the pulse of the right hand and in females the left hand is examined.
It is so because the main organ responsible for findings of the pulse (Nadi) is Kurma and its position differs in males and females. It is situated around Nabhi (umbilicus/center) in downward position in males and in upward position in females. The pulse is to be examined on the right side of Kurma. So due to this difference in position, pulse is examined on the right hand of males and left hand of women. Further the right side of a male and left side of a female is considered as auspicious, favorable and good

Method of examination
Patient and physician should sit comfortably facing each other, preferably at the same height; it is advisable to examine the pulse of the patient in sitting position.

The physician should sit on the right side of the patient and hold the right hand of male or left hand of female at wrist with his right hand while supporting the arm of the patient at the elbow with his left hand. The arm of the patient should be kept fully extended.  Then the physician should keep three fingers i.e. index, middle, and ring of his right hand on the radical pulse just adjacent to the ‘styloid’ process situated just 1 finger below the root of thumb. The position of the fingers should be such that index finger lies adjacent to the process. The fingers of physician should be half flexed so that he may gently press the pulse with the tips of the fingers. Then the physician should examine the pulse by applying gentle and equal pressure of his three fingers on the pulse.
Pulse can be measured in the superficial, middle, and deep levels thus obtaining more information regarding energy imbalance of the patient. 

Time of nadi examination
The pulse should be examined in the morning on empty stomach in a calm and peaceful atmosphere, but can be examined at any time in an emergency. Examined preferably when the patient is sitting in up upright position. The patient should be calm.

Precautions and Contraindications
Pulse diagnosis should be performed on patients under normal conditions to insure accuracy. The pulse should not be diagnosed after exercise, bathing, massage, sex, hungry or after eating or drinking or in a room in which the temperature is very hot or very cold. These factors may contribute to an inaccurate diagnosis. Ideally, both the patient and practitioner should be relaxed and breathing normally when the pulse is taken.

Position of fingers while performing nadi parikshana

Time required for pulse examination 
The minimum time mentioned for pulse examination is said to be 30 beats. A beginner who is learning and observing this sign must take his full time in observing the pulse before speaking anything in front of the patient. In contrast to it a well practiced ayurvedic practitioner may take a very short time in coming and reaching to the diagnosis. In this manner 3 counts have to be taken, leaving the hand completely at ease before a second examination is under taken. The time taken for testing the pulse cannot be restricted in a rule as it depends upon many conditions like tact and skill of the physician.

Factors influencing pulse
Natural Predominance of Tridosas in various units of time
Related to Meals
6 AM - 10 AM
6 PM - 10 PM
Immediately after meals up to approx. 1½ hr
10 AM - 2 PM
10 PM - 2 AM
From 1½ hr to 3 hrs after meals
Middle age and Young age
2 PM -  6 PM
2 AM -  6 AM
From 3 hrs to 4½ hrs. or till next meal is taken
Old age

How to conclude the examination

First of all the physician should try to ascertain beneath which finger, he is feeling the pulse. The rate, volume and rhythm of pulse should be carefully observed separately. The condition of the wall of the artery may also be helpful in diagnosis. In addition, force, tension, fullness or emptiness, character of pulse and condition of wall of vessel should also be examined in each case.
After examining the patient, the physician must wash his hands

Results obtained
Ayurveda advocates that by taking a pulse examination, Doshas imbalances present in the given situation, further course of the dosha imbalance and prognosis of the disease can be diagnosed.

Understanding the PULSE (NADI)
One should consider the following parameters on which it is based. 
Index finger
Middle finger
Ring finger
Medium fast
Slow / Steady
Low +
High +++
Moderate ++
Warm to cool
Vessel wall
Rough, hard
Elastic, flexible
Soft thickening
Fast, feeble, cold, light, thin, disappears on pressure
Prominent, strong, high amplitude, hot, forceful, lifts palpating finger
deep, slow, broad, wavy, thick, cool or warm, regular

Practical demonstration of pulse
In order to make easier to understand this concept, the three main divisions in the movement of the pulse, they gave illustration of the gait of various animals, birds and reptiles which are commonly seen around.
In vata - the pulse movements would be competitive to be like the gait of leech or a serpent.
In pitta - the gait will be like of a sparrow, crow or frog. 
In kapha - the gait will be like that of a swan, elephant or pigeon.

These may be present in any combination and should be understood accordingly.

Vata pulse    It is accepted that the movement of vata pulse resembles the gait similar to that of a leech or serpent. The points to be studied here are the creeping and crooked movements of the serpent and the wavy movements of the leech. Crookedness is the chief characteristic of vata predominance which is beautifully illustrated by movements of snake. A stringy thinness of a serpent running very fast is also one of the characteristics of vata pulse. When studying the vata pulse, we must keep in mind the missing character of the beats which resembles the movements of leech which stops for a time and then moves again, halting and moving at its pleasure.

Pitta pulse    It is known that the gait of pitta resembles the movement of a sparrow, crow or a frog. One must be attentive to note the quickness of the movements of the sparrow, the hopping movements of the crow and the jumping movements of the frog. While studying the pitta pulse one should always count the pulse rate, which is an indication of the rapidity of the heart beats and of the metabolism.

Kapha pulse    It is accepted by many people that the movement of kapha pulse have resemblance to the movement of a swan or the elephant or pigeon. The points to note here are the steadiness of the gait of the swan, the bigger the size as indicated by heavy and steady movements of the elephant and the gentleness of the movements of the pigeon.
Vata pitta kapha pulse or “Sannipaata nadi” 
This type of pulse categorizes in the patient in which all the three dosha are imbalanced. This is demonstrated by the alternative slow, intermitted, wickedness and indecisiveness movements. The pulsatile mode of the artery shows pulsation at one time and at the other time it disappears and then again appears. It is inconsistent and faint. The pulsation is sometimes felt in the arm or it may be only just detectable to the touch of the examining fingers.
Different gurus have mentioned different views but ‘sharanghdhar’ describes the movement of sannipaata pulse as similar to the gait of “laavaka and “titthiri” birds because these  birds flutter rapidly for some time and on a sudden, they stop their movements altogether, to repeat their quick movements once again. 
Another saint has compared the movement of sannipaata pulse with that of a mouse that has the tendency to run here and there, forwards and backwards. A movement of mouse is sometimes rapid and some time it is not moving. 
Nadi of Healthy person:
The learning physician must first be able to identify the normal features of pulse and then practice on a large number of apparently healthy persons, and then only he can appreciate the pathogenic changes in pulse. 

The pulse of a healthy person is said to have the balanced movement. Along with it the face of the patient also looks cheerful. 

Nadi in Different States of Body & Mind

·         Happy person: Pulse is steady
·         When satisfied pulse is steady
·         Hungry Persons: Pulse is tremulous
·         During Sexual urge and anger the pulse is fast
·         Pulse is weak in worry, fear, sorrow and disgust.
·         Pulse in Fever: In fever, the pulse becomes fast and is felt hot to touch.
·         Pulse in Psychological conditions: In condition of anger and excitement, pulse becomes fast. 
·         Pulse in Digestion: In the state of poor digestive power, the pulse becomes very slow and low in volume. In ‘Ama’ it becomes heavy. In a person whose digestive power is good, the pulse is felt light and fast. In a hungry person the pulse is felt inconsistent in rate, rhythm and volume. In a person with satiety, the pulse is consistent.  
·         Pulse in Dhatu depletion: In the state of diminished tissues, the pulse becomes very slow and low in volume. 

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  9. The precision of the beat examining depends on upon the instinctual care of the peculiar and similarly the ability to grasp and interpret the unassumingness of vibrations. This sensitive discernment deciphers the accomplishment of Nadi Pariksha.

  10. Nadi or pulse is that indispensable stream of vigor that courses through form basically in veins and empowers the vaidya to ponder doshas. Subdoshas and their communication with dhatus. Ayurvedic Pulse Diagnosis learning work at an exceptionally profound level to altogether scrub the group of poisons and uproot physiological irregular characteristics.

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