1. Pulse Diagnosis in Cardiac and Hepatic Conditions
PROF. (Dr.) SURESH KUMAR MD (Ay), Dip.Yoga, (BHU) Ph.D Kayachikitsa.(BHU), Ph.D. (Med.Alt.) Formerly: Principal and Administrator RG Govt. Post Graduate Ayurvedic College, Paprola, HP and Dean, Faculty of Ayurveda, H.P. Uni., Shimla HP
Director, Indian Institute of Panchakarma (under CCRAS, Govt. of India) , Cheruthuruthy, Kerala Officer on Special Duty (Rank-Director Ayurveda (Technical)*
Department of Ayurveda, Shimla (H.P.)
Founding Editor-1982: The Journal of Research & Education in Indian Medicine - An International Quarterly ISSN :
and Phone : and HP

2. Introduction
Ayurvedic Medicine has been using the pulse as a form of diagnosis since it was created 5000 years ago.
In the seventeenth century, Yoga Ratnakara book mentions the pule examination technique.

3. Pulse examination is a component of
Eight fold Examination ” Ashtavidha Pariksha” It is primarily done to assist Samprapti (etio-pathogenesis) evaluation of a disease by knowing Doshaj Status in body.

4. During and after Medevial Period of Indian History Vaidyas practiced Nadi Pariksha for DIAGNOSIS ( Nidana) and PROGNOSIS (out come) of the disease.
It is during this period many books on art of pulse examination were compiled. Some like “Vasav-rajayam” and “Kanad Samhita” are available even now.

5. Synonyms of Pulse
Snayu, Nadi, Hansi, Dhamani, Dharani, Dhara, Tantuki, Jeevana Gyana.
It is also called as ‘Jeev-sakshi” - meaning Sign of life.

6. Nadi and Disease Pathology
Ayurveda considers that the root cause for all diseases is imbalance of Tridosha (Vata, Pitta and Kapha) and cause for Tridosha imbalance is improper food and activities. As the time goes by, one disease itself may become the cause for another disease.

7. Cont…..
Doctor should examine the pulse in the initial consultation to know about the extent of Dosha imbalance. After the treatment, at the end of disease also, doctor should do pulse examination to know the difference.

8. Nadi and Disease Pathology
As the strings of Veena generates all Ragas, similarly the pulse expresses all the diseases.

9. Dosha Gati and Nadi
Traditionally the pulse is examined at the base of thumb against lower end of radius.

10. Dosha Gati and Nadi Base of thumb Vata Middle part Pitta
Proximal Kapha.

11. Dosha Gati and Nadi
Vata pulse feels as if there is movement of snake and leech.
Pitta pulse feels like movement of Kak (crow), Lavak (common quail) and frog.
Kapha pulse feels like movement of Raja-hamsa (swan), (pigeon- Kapota Kukkuta (cock).

12. This can be understood as
Vata: Low volume but high rate.
Pitta: High Volume and High Rate.
Kapha: High Volume and Low rate.
Sannipataj ; Variable volume and variable rate.

13. Examining the pulse
Arterial pulses can be examined at various sites around the body. Systematic examination normally involves palpating:
Radial,
Brachial,
Carotid,
Femoral and other distal pulses.
Palpation of the abdominal aorta would also form part of this systematic examination (to identify abdominal aortic aneurysms for example). Other sites may be examined for pulses, in special circumstances.

14. Radial artery Radial side of wrist.
With tips of index, middle and ring fingers.
To assess rate and rhythm.
Simultaneously with femoral to detect delay.

15. Brachial artery
Medial border of humorus at elbow medial to biceps tendon.
Either with thumb of examiner's right hand or index and middle of left hand.
To assess pulse character.
To confirm rhythm.

16. Carotid artery Press examiner's left thumb against patient's larynx.
Press back to feel carotid artery against precervical muscles.
Alternatively from behind, curling fingers around side of neck.
Best for pulse character and, to some extent, left ventricular function.
To detect carotid stenosis.

17. Femoral artery Patient lying flat and undressed.
Place finger directly above pubic ramus and midway between pubic tubercle and anterior superior iliac spine.
To assess cardiac output.
To detect radio- femoral delay.
To assess peripheral vascular disease.

18. Popliteal artery Deep within the popliteal fossa.
Compress against posterior of distal femur with knee slightly flexed.
Mainly to assess peripheral vascular disease.
In people with diabetes.

19. Dorsalis pedis (DP) and tibialis posterior (TP) arteries (foot)
Lateral to extensor hallucis longus (DP).
Posterior to medial malleolus (TP).
Mainly to assess peripheral vascular disease.
In people with diabetes.

20. The abdominal aorta With the flat of the hand per abdomen.
In peripheral vascular disease.
To detect aneurysmal swelling.

21. Pulse Diagnosis of Cardiovascular and Hepatic Diseases
It is very easy to overlook the art of clinical examination of nadi when new technology can so easily be employed to make diagnoses of diseases of Heart and Liver.

22. Cont………
Systematic cardiovascular examination can provide a quick diagnosis of Diseases of Heart and Liver.

23. Cont…….
With advent of more objective and acurate diagnostic techniques the need of pulse examination to diagnose Cardiac and Liver disorders has decreased.

24. Basis of Nadi Regulations in Cardiac and Liver Diseases
Major component which determine Nadi or Pulse status is Heart.
Because it is responsible for
- Rate (gati),
- Volume (fullness),
- Rhythm (regularity) of pulse.

25. Conti…….
Similarly Liver also plays an important role in determining movement of Pulse by regulating the blood volume and its chemistry.
As such the pathological status of heart and liver can affect the pulse, thus its examination can help evaluation of disease status of Heart and Liver.

26. Conti…….. Pulse can also be effected in certain conditions such as:
Mental ailments like anxiety
Valvular Heart diseases Anemia, fever , etc.
- Capacity to evaluate these diseases is essential for interpreting the Pulse in an Individual.

27. Common Pulse conditions in Cardiac Ailments
CHF (Increases rate and Volume): Kaphaj Nadi
Left Ventricular Failure (Tachycardia with low volume): Vatic nadi
Aortic regurgitation (High rate and volume): Kaphaj nadi.

28. Cont……… Cardiomyopathy (Variable volume , high rate): Tridoshaj Nadi
Paroxysmal Ventricular tachycardia (High rate low volume) : Vataj Nadi.
Hypertension (High Volume and Normal or high rate): Kapha Pattiaj nadi.

29. Continued……..
Heart Block Grade II & III (Irregular , High Volume): Sannipataj nadi
Cardiac shock (low volume and low rate): Sannipataj nadi
Pericardial effusion (Variable volume): Sannipataj nadi

30. Continued……..
Myocarditis (High volume and High rate): Pattic nadi
Anxiety state (High rate and low volume): Vattic nadi
Fever (High rate and volume): Pattic nadi.

31. Doshaj status of Liver ailments
Liver has potential to change volume and rate of nadi due to
Fever
Retained Bile salt
Retention of fluids and electrolytes
Acidosis
Increased free nitrogen in Blood
Vomiting etc.

32. Pulse in Common Ailments of Liver
Hepatitis (High rate and volume): Pattic nadi
Obstructive jaundice (Low rate and high volume): Kaphaj nadi.
Cirrhosis (Low volume and High rate): Vataj nadi.
Liver abscess (High rate and Volume): Pattic nadi.

33. Contraindications for Pulse Reading
who has just taken bath
who has just taken food
who has just undergone snehana (oil massage or fat intake)
who are having thirst and hunger
who are asleep
in these, the pulse cannot be well appreciated and may lead to wromg inferences.

34. Pulse Examination and Prognosis
The pulse which beats for 30 times speedily and ten subsides abruptly, and that pulse which runs with lot of interruption.
The pulse which is weak, mild, feeble, stops in between, very minute, which is sometimes felt feebly in elbow and sometimes at wrist, such a Nadi indicates an incurable disease.

35. Continued……..
When the Nadi is like Damaru (musical instrument of Lord Shiva), sometimes observable, sometimes not, it indicates incurable disease. The pulse which is too high, too frequent and fast, suggests death in near future.

36. Continued……..
The Nadi which is stable but suddenly sparks up like a lightening, suggests incurable disease.
The feeble and cold Nadi suggests that death is certain within a day or two.

37. Continued………..
If the Nadi becomes steep (Gambheera), then it indicates that it runs in Mamsa Dhatu (Muscle tissue) – Mamsa-vahini.
If the pulse reading feels hot, it implies fever.

38. Continued………..
Due to Kama (sexual desire) and anger, the pulse rate increases. Due to worries and fear, low digestion strength and depleted body tissues (Ksheena Dhatu), it decreases.

39. Continued………..
When blood (Rakta Dhatu) is dominant and when Ama is there (altered digestion and metabolism), then it will be bulky, heavy and hot. When the digestion strength is more, Nadi will be light, and fast.

40. Continued…………
In hungry - satiated person (who has taken food), the pulse will be stable.
In case Nadi is not felt in hand, it should be examined in leg.

41. Continued…………
In case of Vataja Jwara (fever of Vata origin), Vakra – Nadi will be zig zag, swift, and cold to touch.
In sheetapitta Jwara (fever due to allergy), Nadi is fast and thin.

42. Continued…………
In Jwara due to Kapha, the Nadi is mild, stable, cold and sticky. Similarly, Nadi features of fever with duel Doshas are also mentioned.

43. Modern Instruments for Pulse Evaluation
Think of the pulse like a cardiograph: a computer readout graphically recording the physical or functional aspect of the heart.

44. Modern Instruments for Pulse Evaluation
Like the graph being sketched across the screen of the computer the pulse has its own rate, crest, wave, amplitude, and cessation. These individual characteristics define the overall movement, quality, and rhythm of the pulse. In these broader categories
Modern Instruments for Pulse Evaluation

45. Modern Instruments for Pulse Evaluation
The Doshas of Vata , Pitta , and Kapha can be distinguished based on the smaller movements sketched graphically by a cardiograph. In pulse diagnosis our fingers become the receptors that transfer the information of the heart beat graphically into a more concrete image.

46. Conclusion
Anyone can recognize that there are differences between their pulse and that of others. What these differences mean is - what Ayurveda has refined over its 5000 year existence.

47. Cont….
The Pulse can be read like a book, and the categories and qualities mentioned above are the alphabet that we will use to learn from this book.

48. Cont…
Understanding movement, rate, and rhythm of the pulse can be a tool for understanding the body. The beauty of this is that the symptoms of disease manifest in the pulse long before they do in the body.

49. Conclusion
Nadi Pariksha may serve as a clinical guide to further evaluation of a patient.

50. THANK YOU