Nadi Pariksha - Pulse Diagnosis

                       To understand the concepts of nadipariksha, we should first understand the concept of strotsa sirs, dhamani and nadi. We genersally relate all these as the channels of the body wihich aree assigned a job of carrying substances within the body. It is well admired fact that Maharishi Sushurut manage to trace even minute-minute channels present in the body even when they were very difficult to be traced with naked eyes. He was able to recognize the ever pore in it. It was calculated that there were about 700 siras, two hundreds dhamanees, which could be easily enumerated but when the minute siras and dhamanees were counted with there tributaries and branches, there number was estimated to be the same as the number of  hair follicles which was distributed thoughout the body. Approximately their number was calculated at two lakh ninety thousand five hundred and fifty six.
The study of nadi however was specialized technique which was perfected by yogis. They classifed the big nerves as two and the smaller branches as seventy two thousand. A yoga text mentions fourteen nadis with there functions which are as follows.Susuhmana   this nadi runs up in spine till the brahmarandra.

Pingla   this nadi runs upon the right of sushmna and ends in right nostril
Ida    it runs upon the left sushmna and ends in the left nostril
Hastijiva   it runs down in the left and ends in the big toe.
Yasasvini    the trunk in the leg ends in the right big toe.
Kuhu     the nadi that has its sphere of influence terminating in the vagina
Alambusha    it terminates at the end of the anus
Gandhara    it ends in the left eye.
Pusha  it ends in the right eye.
Sankhini   it terminates in the left ear.
Payavaini   it terminates in the right ear
Sarasvati   it terminates in the tongue
Viswodara     it terminates in the face
Varuna    it has its influence spreading through out the body.
                                       Except these 14 nadis there is also mentioning of five afferent sensory nerves which carry impulse from the periphery to the centre. These are
Sabda (hearing) Sparsha(touching) Roop (vision) Rasa (taste)  Gandh (smell)
                                     There is also mention of five efferent or motor nerves, which start from the centre and discharge impulses at the periphery. These are
Vak (speech) Pani (reception by hand) Pada (locomotion by legs) Payu (excretion) Upastha (procreation)
                                     It is very important to understand the full implication of nadi parksha. It is not just to study the venous pulsation in the wrist. Nadi science is the sceience of the nadi or nerves, which includes the study fo life processes that are responsible for living and existence of man. Nadi is said to be jiva sakshi, the evidence of life.
                                     Nadi gets influenced by various affects that influence the physiology of the body , especially the three doshas. i.e. Vata, Pitta and Kapha. The dhamani or the nadi  mentioned here simply refers to radial artery. Its gati-motion does not merely indicate the rate or the rhythm of the pulse, the size and condition of the arterial wall or the volume of blood that flows through the artery or the force with which the blood flows. The gati or the motion of this nadi also indicates the imbalance of the three doshas ie. vata,pitta and kapha
                                      The nadi investigation is chiefly performed to ascertain the imbalance of dosha or doshas. The extent of derangement can also be known by this methodology. The pulse is recogniszed to be jiva sakshi. The prognosis of a physician at very critical moments when death is threatening, depends upon his accurate study of pulse and all the capacity of the physician should then be at his command. The knowledge of pulse investigation embraces in itself a vast science. It is partly based on the physical examination of the artery on the concentration of the mind that the physician can bring to bear at the moment of examination. It is not the counting of the pulse rate, The whole concept of examining the pulse is still faraway the reach of modern  system. To be expert in nadi pariksha one should have a good yogic powers like concentration of mind and bringing our mind nearer to the sould to acheve a ideal condition etc. hence to achieve a infinite forces which modern science has yet to explore.
Vata, Pitta and Kapha pulses To understand the nadi examination one should consider the three parameters on which it is based. 1.      Size or volume of the pulse.2.      Number or rapidity of the pulse3.      Rhythm or regularity of the pulse.
                      The size and volume denotes the condition of the blood vessel wall. Number and rhythm denotes the condition and working of the heart. The size depends upon the state of kapha predominance, the rapidity upon the state of pitta predomination and the regularity on the vata condition. This is the basic idea of the basic influences of vata, pitta and kapha on the vessels. But now it has to be examined in the greater details. In a nut shell we have to classify all our observation under these three doshas. In order to make easier to understand this concept, the three main divisions in the gati (movement) of the pulse, they gave illustration of the gati or gait of various animals, birds and reptiles which are commonly seen around.
Size: 1.      The volume of food material that are absorbed into the blood stream and that again depend upon the condition of lymphatic system. This is mainly due to influence of kapha dosha which its generating seat in the area of the amashya (stomach) and digestive organs2.      The number or rapidity indicates the condition of vascular or the circulatory system. This is because of the influence of pitta dosha or the heat mechanism ad determined by the metabolism. 3.     The rhythm of regularity indicates the general condition of the nervous system or the vasomotor control of the body as a whole and this is mainly due to the influence of vata or the nervous mechanism or vital power.
            Having a concept of these fundamental influences, it is necessary to give a concern to other details like kaal i.e. time (morning, midday, evening or midnight and cold and warm seasons), aahar i.e. food (light or heavy), roga i.e. disease and internal or external changes that takes place in the human body and its environments.
Gait: The movements of the nadi are compared to those of various birds and reptiles as mentioned by various rishis. As an example, in aggravated vata the pulse movements would be competitive to be like the gait of leech or a serpent, in pitta aggression it will be like gait of a sparrow i.e. jumping in nature and in kapha aggression, gait will be like that of swan. Following is the detailed mentioning:
Vata pulse    It is world wide 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. Vata rakta or 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.
                     It should always be kept in mind, while studying pulse an idea of the fullness of the artery and of the volume of the fluid that is passing through the system at any moment. This is again determined by the condition of the lymphatic system or the watery constituents in the patient’s body.
                       The above mentioned information just gives a brief idea of diagnosis through pulse investigation. These are the basic information in obtaining the general idea regarding this science. It is like imagining the whole events that can happen due to the discrepancies found in the pulse. Here the involvement of yogic powers like concentration comes into play as lots of eternal power is needed to imagine various conditions and situations. For this purpose one usually closes hi eyes for a moment. While examining the pulse and concentrate his whole attention on the study of the whole man and the disease he might suffer from. This stage is the stage of no contact with the surrounding. This is the Samadhi, which I said the physician shall enter into while studying the pulse. A physician who is steadfast in mind i.e. with his whole attention fixed on pure changeless consciousness (sthir chitt). The person is free from all the felling such as desire and hate and is peaceful in mind. Person must have perfect sense of judgment. A pulse expert should touch the pulse at the wrist in right hand of the patient with the tips of his fingers and learn for himself all about the condition of the patient. One must think over the adjectives used to describe the mental state when a physician is studying the pulse of a patient in the calmest way.

Examine the patient as a whole 
                          A physician must be awared about the physical condition of the patient and must be very attentive to note the general conduct and habits of the patient, facial expression, the reaction toward the climatic conditions, appetite, strength, nature of sleep, breathing pattern history of ailments, all these facts should also be discussed by the patient so as to confirm the diagnosis made through pulse.
Pulse indicating death 
                            You may call it an assert or trouble inviting factor but by observing nadi or the pulse, there have been mentioned certain criteria in ayurvedic texts, that can help in judging the death of patient in near future. But it is a very controversial task to declare a persons death in near future. This can lead to a damaged reputation of the physician if his said words are not being able to come to the truth. Ayurveda has mentioned certain methods by which a death of a person can be forecasted but it requires lots and lots of clinical practice and a great observational power so as to reach the stage of much accuracy if not the certainty. There have been mentioned various methods in indriye sthan (a complete set of 12 chapters in charak samhita) which deals with the Arishata Lakhsnam (signs and symptoms which helps in forecasting the death). Take an example, a careful observer should easily recognize impending death by slow and yet dangerous pulse of uremia or by the stringy, crooked and quick pulse of septicemia or the halting distorted a collapsing patient, with his nose immensely cold, his eyes fixed without winking and his pulse displaced from original position. This pulse confirmation is known as mrityu nadi (death pulse).
Combination of Pulse Vata pitta pulse
                            Not only imbalance in the doshas individually, but also the imbalance of the various degrees of each dosha and their combinations have to be studied through the pulse. A combination of vata and pitta is indicated by frequent association with the movement of snake and frog with the feel of pulse. The nadi or pulse in many cases of blood pressure may be classified as vata pitta pulse.
Vata kapha pulse  A combination of vata and kapha (also known as shleshma) presents pulse which has movements like that of a snake and a peacock. In a patient having swelling or edema combined with the weak action of aortic imbalance, as directed by the water hammer pulse, it may be said to be introduced in vata kapha pulse. There is a peculiar fullness in the artery combined with easy compression.
Pitta kapha pulse  The combined effect of vata and kapha pulse is denoted by jumping gait of a frog or toad and the alternative slow and steady gait of the peacock. In such a pulse we can include certain conditions of hypertension. This situation arises due to im balance in pitta and kapha dosha. The pulse in hypertensive patient can not be said to be belonging to certain particular dosha pulse. But it may be said that it has maximum involvement of vata and pitta. The pulse should in each case be studied very critically and the conclusion may depend upon the degree of vitiation of vata and pitta dosha. One case of hypertension may indicate more of vata and the pulse is thready and wavy without much jumping and yet the blood pressure reading is very high. In other care presentation the jumping may be more prominent. This is explained by the disturbance of the vaso motor system and the metabolic system which may be affected in different degrees.
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 rishis have mentioned different views but sharanghdhar describes the movement of sannipaata pulse as similar to the gait of laavaka and titthiri birds because the birds flutter rapidly for some time and on a sudden, they stop their movements altogether, to repeat their quick movements once again.
                        Another rishi 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.
                     Some authors and rishis have describes the sannipaata pulse as full and steady. This is due to the fact that in some cases of typhoid fever which are of the sannipaata type all the doshas i.e. vata, pitta and kapha are eventually excited and the pulse is full and fairly slow. The pulse is full due to kapha dosha, the jumping movement is due to the pitta presence and vata is pretty normal.
                   One thing can be said that vata vitiation is the most dangerous of all the situations. If it is in excess it leads to convulsions and fits and a person even can collapse. Vata is the king that leads the other two doshas i.e. pitta and kapha, either for good or bad purpose.
Usage of left hand in females 
                      It has been a frequently asked question, that weather to investigate a woman's pulse on her left hand. The answer of it has been given in a famous ayurvedic text known as yoga ratnakar.
                       Many explanations have been given in this regard. It is world wide accepted fact that pulse may vary in both hands of a same individual. It has been mentioned in ayurvedic texts that the nadi chakra (nerve plexus) differs in males and females. The chakra or the plexuses which lies at the level of nabhi (umbilicus), known as kurma chakra is said to influence the nadi or the pulse of an individual. It is said that this kurma chakra is faced upwards in women and downwards in men. Hence here makes the difference in the pulse pattern in either of the sexes. Yoga ratnakar text has given three reasons.
These are:- 1.      Saastraa (science)2.      Sampradaaya (tradition)3.      personal experience
                       If by courtesy this has been traditionally adopted by us, there is no reason for disobeying the rules set by our ancestors. More over it has been the practice for generations to test the pulse in the right hand for a man and left hand for a woman. There is also no reason to condemn people who do not obey the rule as it is just for courtesy sake.

Usage of three fingers in examining the pulse
                          It is been discussed earlier also that mind is very notorious and easily fitters here and there and easily changes in fraction of seconds. It is also the fact that mind can pay attention to one subject at one time. Mind plays a very important role in pulse investigation as we have to control its notoriousness. This nature of mind causes great difficulty in assessing the three dosha i.e. vata, pitta and kapha with one finger. It has been observed that it becomes much easier to evaluate a pulse of a person with three fingers than by one. It has been now converted into a rule that vata is established by the tip of the index finger of right-hand, placed on the radial artery next to the root of the thumb of the right hand of the pateint and that pitta pulse should be studied by the touch of the tip of middle finger placed next to it and that the kapha pulse by touch of the tip of the ring finger placed to the middle finger on the artery.

Best time for examining the pulse
                      It is clearly mentioned by all the rishis and ayurvedic practitioners that the pulsation of pulse varies from time to time and day to day. Kapha pulse is predomninat in morning time, pitta dosha is predominant during mid day and the vata pulse can be observed in late afternoon and evening. Modern sciences have not yet been able to explain the phenomenon of variation of pulse during different times. Ayurvedic science explains the phenomenon related to the planetary action and the effect of moon and sun that has a major control over the changing of rythmicity of the pulse.

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 any thing 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 can not be restricted in a rule as it depends upon many conditions like tact and skill of the physician.

Method of examining the pulse
                         The hand of the patient should be free and slightly flexed at the forearm, so that the left hand of the physician, the 3 fingers of the right hand, namely the index finger, the middle finger and the ring finger of the physician gently touch the skin over the radial artery. The index finger is comfortably placed nearest the thumb and the other two fingers are placed next to it. The hand of the thumb should not be extended too far nor too much fixed. Above all, it is important that the patient should not be unconvinced for this purpose

Variation of Pulse
                    It should be remembered that the pulse has the tendency to change its pulsation activities which is precipitated by following factors mentioned below:-1.      Shudha (hunger) 2.      Pipasa (thirst)3.      Nidra (sleep) 4.      Guru aahar (heavy meals)5.      Ratri bhraman (waking in night) 6.      Comfortable lifestyle7.      Sitting and standing postures8.      Bhraman (walking)9.      physical activities10.  Exposure to sun11.  Mental conditions such as sexual excitement,12.  Time like morning , mid day and evening, 13.  Seasons like grisham ritu (summers) etc 14.  Other environments and habits to which a human being is subjected.