Ancient Pulse Science

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o f future work and opens new er vistas for research on ancient pulse science. Prof. U padhyaya is one o f the noted alum ni o f Banaras H indu University. He graduated from this University in early seventees 'and subsequently obtained his M . D. and Ph. D . degrees frbm the D epartm ent o f K ayachikitsa of this U niver­ sity. H e is personally known wjth the reviewer for several years. H e is a popular clinician, a l^een researcher and a successful teacher. The present work is definitely an outcom e o f his scholarship and enthusiasm to work for the advancem ent o f Ayurveda. I am happy to write preface for this im portant work and wish all the best to this publication and the author.

R. H. Singh
Professor and Head. Deptt. o f Kayachikitsa Faculty o f Ayurveda Banaras Hindu University

Contents
Introduction
Ayurvedic Review
Part One : Ayurvedic Review t Historical Perspective.
Chapter I : The use o f term N ad i in classical Ayurvedic L iterature. Chapter I I : Pulse in other systems o f m edicine o f the world before its introduction in A yurveda. Egyptian pulse-lore 15; G reek pulse-lore 16; Chinese pulse-lore 18; A rabic pulse-lore 25; Pulse-lore id T antrik literature 31; 11-14 15-46 3 -6

Part Two : Ayurvedic Review : Applied Literature.
Chapter I I I : Pulse from Sharngadhara onwards. Sharngadhara 49; B havaprakasha 54; Y ogaratnakara 58; N adivijnana by K anada 63; N adi-P ariksha by R avana 75; Chapter T V : Pulse in other treatises o f sphygmology. Pulse in Prognosis 87 49-86

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Modern Review
Part Three*: Modern Review of Literature. Chapter V : A natom y and histology of radial artery. 101-104 A natom y o f radial arteiy 101; H istology o f arteries 102; Chapter V I : Phisiology o f arteries and m echanism o f pulse form ation. 105-109 Physiology o f arteries 105; Mechanised o f pulse fbrm ation 106; Chapter V I I : Poiseuille’s law; Haem odynam ics; Peri­ pheral pulses; Form ation of radial pulse; Diseases of arteris; Factors affecting the pulse pressure a n d clinical exam ination o f pulse. 110-149

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Poiseuille’s law and'its application 110; H aem odynamics o f pulsating stream and its general role in the pulse form ation 114; Peripheral pulses and role o f reflected waves 120; F orm ation o f radial pulse 124; The diseases o f arteries 129; Clinical exam ination o f th e pulse 134; Chapter V I I I ; Frequency analysis and current status o f sphygmology. \ 150-154 Frequency analysis o f the pulse 150; C urrent status o f sphygmology 152;

Part Four ; Clinical and Experimental Studis on Nadi-Pariksha. ■ M ethods and m aterials 157; Experim ental study 162; Observations 166; Part F ive: Discussion. Conceptual 194; Clinical study 197; Experim ental study 202; Part S i x : Conclusions. Clittical study 213; Experim ental study 215; Part Seven: Summary. H istorical review 223; Clinical and experimental studies 226; Bibliography 235 : 248 Index 254 Errata 256

INTRODUCTION .

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V aranasi has always attracted patients to seek the diagnosis and treatm ent based on N adipariksha. Even to-day under emergency clinical conditions the m odern physician frequently records the pulse directly through an intraarterial catheter. the pulse has always been the subject of great learning in the field o f medicine. There is in clinical medicine no physical sigh m ore basic o r im portant than the arterial pulse. The early physicians paid great attention to the character of the pulse'in health and the changes which occurred in disease. the study o f pulse has got its lim ited scope in studying the diseases of heart and arteries. 1550 ) had been the earliest c o u n tr y of the world which invented the knowledge of pulse only to know the phys iological condition of the heart. A nd from there the rays o f knowledge of the same spread all over the world. To the ancient physician. Perhaps Egypt ( B.INTRODUCTION This m onograph entitled N A D l-V IJfiA N A ( Sphygmology ) is a hum ble attem pt to re-establish the principles and practice of N adipariksha on universal basis. G alen ( A. A brief account o f the current status o f N adi Pariksha in various systems of m edicine is presented herewith. and he wishes to gain as m uch inform ation a s possible from inspection o f pulse contour. 129 ) one o f the pioneers o f G reek system o f m edicine h a d w ritten several treatises on pulse . To the m odern physician. T he national and international reputa­ tion o f P andit Satya N a ra y an Shastri as an expert in N adi P ariksha diagnosis was too well know n for repetition here. It is hoped th at the w ork presented in this m onbgraph will pave the way and stim ulate systematic and scientific studies on pulse exam ination a h ith erto a less cared area for research in Ayurveda. irrespective o f civilizations of the world. The patients who visit Ayurvedic physicians for treatm ent are still inclined to be diagnosed by N adi Pariksha. D . F rom ancient tim es the pulse has been recognised as the m ost fundam ental sign o f life. Systematic and comprehensive training o f N adi Pariksha in Ayurvedic colleges could not be standardized due to lack of data based on scien­ tific research. o f course. Thus it.w as thought necessary to plan and con­ duct research on N adi Parikshai so th at an acceptable m odel m ay be constructed for universal application. C.

A nd th a t is why it is known as G reeko-A rabic system o f medicine. Still we find m any separare books written on sphygmology and available in various private as well as government libraries of India. T antrik source of N adi is also cited there. the physician of repute who by his own experience furthered the knowledge o f pulse exam ination. Paittika and K aphaja pulses. 980 ) had been. The V atika pulse possesses smallest percussion wave with its conical sum­ mit. from the period of Sharnga­ dhara onward the knowledge has constantly been added up. . After going through the various literatures of sphygmology of different civilizations of the w orld and seeing the recent con­ tribution of m odern haemo dynamics in this field. yet some anci­ ent races of India as Santhalas and Tantriks of India were aware of this knowledge. it has wealth of treatises on the pulse. a practical hypothesis has been proposed so th at this may have applied form also. P aittika pulse has longest percussion wave with its sharp conical summit. particularly to stan­ dardize them qualitatively and quantitatively• As regards studies in giving the practical form s to V atika. therefore. As regards Chinese system of medicine. A great knower of this system of medicine. volume and character etc. This m onograph consists of seven parts and eight chapters. D. rhythm . period o f Sharngadhara. N o prior standard scientific work was available on N adi Pariksha. Avicenna ( A. the present study on N adi P ariksha has been chosen. Though in India the knowled­ ge of pulse exam ination was not prevalent as a means of diag­ nosis till as late as the. I have lim ited the scope of study only to the qualitative and quantitative standardization of V atika. gradual and steady fall of dicrotic wave w ith small. rudim entary or no dicrotic notch. dicrotic notch. m arked dicrotism and highest pulse pre­ ssure. K aphaja pulse records medium percussion wave with well sustained rounded summ it.4 Nadi-Vijnana exam ination. In some of the treatises along with the pulse examina­ tion. Besides clinical study o f Vatika* Paittika and K aphaja pulses in terms of rate. P aittika and K aphaja pulses in this m onograph. pulses have been studied in their graphic forms. In Ayurveda. highest pulse rate and lowest pulse pressure in relation to Paittika and K aphaja pulses. The A rabic system of pulse-lore is totally basad u p o n the G reek system of medicine.

G reek. Sharngadhara-Sam hita. e. P a rt th ird of the m onograph is devoted for the description of m odern review on pulse. i. seventh and eighth. third and fourth. th at Indian physicians o f the time derived their conceptual knowledge of pulse from preva­ lent Indian T antrik pulse-lore. the condition of vessel wall etc. from 600 B. In addition. haemodynamics of pulsating stream and its general role in the form ation o f pulse. G hosh ( 1924 ) has been recorded. E. C. C hapter fifth descri­ bes about anatom y of radial artery and histology of medium sized arteries of which the radial is also one. Chinese. In clinical exam ination of the pulse. e. Second p a rt of the m onograph has also been divided into chapters namely. volume. The th ird chapter mentions a b o u t the first adaptation o f N adi Vijnana in the extant litera­ ture o f A yurveda from the thirteenth century onward. Like Ayurvedic review. D . N. B havaprakasha.I n chapter second an account of N adi Vijnana prevalent as a m eans o f diagnosis in different systems of medicine as Egyptian. sixth. other varieties of pulses have also been enum erated and explained. tension. force. The first chapter deals with the use of term ‘N ad i’ in various denotations except the pulse exam ination in ancient treatises o f Ayurveda. C hapter seventh o f third p art vividly describes about the law of Pbiseuille and its application in vivo. K an ad a’s N adi-V ijnana and R avana’s N adi-P ariksha have been mainly dealt with. Lastly. peripheral pulses and role of reflected waves and the form ation of radial pulse which is used commonly for the means of diag­ nosis. A rabic and T antrik literature has been given. various. factors affecting pulse pressure and the clinical examina­ tion o f the pulse. whereas they shaped the practi­ cal aspect o f pulse exam ination along with the contem porary Hakim s o f G reeko-A rabic system of medicine of the time. i. chapters fifth. In this sec­ tion.Introduction 5 P a rt one has been divided into two chapters. C hapter sixth discusses about the physiology of arteries and the general m echanism o f pulse form ation. In the fourth chapter o f this p a rt Ayurvedic pulse exam ination described in various other treatises of sphyg­ mology by D r. rhythm . this chapter also deals w ith diseases of arteries. besides describing its rate. the chapter eight deals with the recent advancem ent m ade in the . character. to 1200 A. this p a rt of m odern review has also been subdivided into four chapters. In concluding portion of this chapter it has been shown. Y ogaratnakara.

e. A nd it has been tried to establish correlation. whereas th e reason for th e selection o f thyrotoxicosis can be given th a t here there is an organised clinic for this particular disease.6 Nadi-VljM M field o f sphygmology i. ‘dicrotic notch’ etc. with the help o f frequency analysis. symptoms and pulse tracings and clinical pulse exam ination and pulse tracings in diseased cases. cardiac valvular lesions. Forty norm al volunteers have also been studied for standardization o f V atika. The sixth p a rt o f the m onograph deals with the conclusions draw n from the result o f this study. Thus. between symptoms and clinical ptilse exam ination. In these cases routine and specific laboratory investigations have also been conducted. e. To be precise* . P art fourth o f the m onograph consists of clinical and experi­ m ental studies on 120 cases o f cardiac valvular lesions. frequency analysis and the current status o f spygmology. seventh p a rt consists o f summ ary o f the work. jaundice and thyrotoxicosis. These diseases were sele­ cted only because cardiac valvular lesions and hypertension belong to cardiovascular system. e. In the fifth p a rt of the m onograph. jaundice and thyrotoxicosis. Recent criticism h iv e also been m ade on the use o f traditional term inology as ‘tiddl wave’. Jaundice is found to be a m ore common and prom inent disease.we have lim ited our study only to four diseases i. A nd thus the current status o f sphygmology can be judged in the light o f the above facts ju st m entioned. In these cases detailed clinical history has been taken and the pulse has been examined from Ayurvedic m etho­ dology and point o f view. From experimental point o f view pulse tracings on smoked papers by sphygmograph has also been done in norm al as well as diseased group. . A nd the last p a rt i. P aittika and K aphaja pulses. hyper­ tension. a complex periodic wave like pulse can be Woken down into its sim pler form s giving the num erical value of each. By definition frequency analysis is a m athem atical technique by which a complex periodic wave can be broken down into a series of sinusoidal waves having a fundam ental frequency of the original wave and harm onics having frequencies th a t are integral multiples o f the fundam etal frequency. P a ittik a and K ap h aja forms depending upon the predom inance o f D oshas. hyper­ tension. Pulses have been studied in their V atika. the observations obtained in the clinical and experim ental studies have been described in greater detail.

and its wide application as a m eans o f diagnosis and prognosis in different civilizations o f m edical world o f rem ote past.AYURVEDIC REVIEW T he purpose of reviewing A yurvedic literature available so far on sphygmology is to give a critical analysis o f pulse exami­ nation. the others o f abroad.*an endeavour has been m ade to search out the source o r sources o f origin o f Indian pulse-lore. In th is conne­ ction. So fa r indebtedness to the contribution o f the kno­ wledge o f the subject is concerned. it was the H akim s o f A rab o f the time who im parted the practical know ledge o f the subject to the then Indian Ayurvedic physicians. and (3) T he w ork o f S harngadhara and post S ham gadhara’s work upto Y ogaratnakara have been fully surveyed. i. The w hole review has been fram ed in the follow ing order : (1) A com plete survey o f E gyptian. after going th ro u g h the various historical literatures o f the subject. G reek. (2) Classics o f A yurveda—th e V rihatrayee and the later works before the period o f S harngadhara. G re e k o A rabian a n d T antrik literatures available on pulse-lore have been m ade. a good deal o f d a ta have been p u t fo rth -to 'fu rn ish the idea th a t before the introduction of knowledge b f pulse exam ination in A yurveda. fo r example Chinese. e. . G reek etc. were w ell versed in the knowledge o f pulse exam ination. thirteenth century have been reviewed thoroughly in order to search o u t the term ‘N a d i’ as used in various denotations b u t th e pulse. Also. Chinese.

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25 Su. N avinal N avinal Sushruta-Sam hita N adi Y antra N adi V rana N adi V rana N adi V rana N a d i Y antra N adi V rana Channel N adi V rana N adi Y antra Su. 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Term 2 Charaka-Sam hita D hu m rap an N alika N adi V rana N ad i Sweda N adi Shaka D h^m ani. 5 Su. N o. 6 Sha. table given below : S. 5. 33. 43. in which term ‘N adi’ has been used in the Ayurvedic texts. 45 . whole gam ut of Ayurvedic litera­ ture specially ancient ones chronologically in th« form of. 8 Verse/Prose passage 4 51 46 32.Chapter I The Use of Term Nadi in Classical Ayurvedic Literature A Survey o f the various denotations. 52 13 7 6 . Sira etc. 27 Vi. 22 Su.9 13 Section 3 Su. 27 4. 39. 13 Su. 16 Su. 11 Su. 12 Su. reveals th a t N adi Vijnana ( pulse science ) as the means of diagnosis was absent there­ from till as late as the thirteenth century. 14 Su. 5 Sha. 4^ 97 9 23 44. 7 Su. 7 Su. 12 11 4 9 49. 17 Su. N o doubt the term ‘N adi’ occurs abundently therein in m any other meanings apart from th e pulse. So it will be proper to give a complete history of the term by ransaking the.

5 Shwas Nalika Sha. 10 G arbha Nadi Sha. 8 N adi Vrana Chi. D ham ani etc. 6 Shrotas. 3 urinS i. 3 Navinal Sha. ureter Ni. 4 K ala Su. 56 7. 34 Nadi Y antra Nadi Vrana and Nadi Y antra Su. 7. 42 5. 34 K arna N adi Su. 7 Nadikailaya G ranthi N adi Su. 34 N adi Y antra Su. 22 D anta N adi U ttar. 5 118 12 39 40 41 42 43 44 45 46 47 48 49 50 10 4 8 9 10 13 4 3 77 50 69 23 75 . 25 A t two places in the sense of hollow wooden m aterial and Su. 2 structure ) N alika ( Tubular Ni. 23 N adi Y antra Ashtanga-Sangraha Su. e. 26 N adi Swedai Su. K antha N adi ( oesophagus ) Sha. 22 10 10 14 40 21. 16 D anta N adi Roga R asavaha Nadi. 2 MansavahS. 7 Larynx Ni. 39 Nadi Vrana Nadi Vrana and D anta Nadii SU. 10 N adi Roga Ni. 34 Su. 22 Nadi Sweda Chi. 1 N adi Vrana Chi. 34 N adi Y antra Su.12 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Nadi'Vijnana Nalika ( Tubular Ni. 9 Nadi Vrana Chi. 17 N adi Vrana Chi. 6 40 Whole chapter. Nadi 10 17 21. 28 5. 3 26. Sha. 10 Navinal Chi. 8 Navinal Ni. 10 4. 40 Sha. 6 Sha. 5 K antha Nadi ( Trachea ) Sha. 27. 31 8 1 41. 7 structure ) Tubular organs carrying Ni. 21 Nadi Sweda U ttar.

36 3 15.. it has been m entioned that tesides . 15 U ttar.The Use o f Term Nadi in Classical Ay. 25 Su. 29. available at present. there is any mentioning of ‘N adi’ as a means of diagnosis. 25 Su. it is quite evident th at no where from Charaka to Shodhal. 27 29 30 Whole chapter.28 17 17 23 4 26. Literature Ashtanga-Hridaya Nadikalaya Nalika like structure K arna Nadi Nadi Y antra and other utility. Vangasena 73 N adi ( Nostrils ) through ArishtaWhich air comes and goes dhikar 29 out. 30 Su. 25 Su. 28 U ttar. 25 Su. 4 Ni. Gadanigraha Prayogakhada 74 Nadi Vrana 1 75 Nadi Vrana 3rd chapter Whole chapter From the above table. 25 Su. 6 Su. 28 Su. 18 U ttar. The fourth chapter o f second section of Harit-Sam hita. 32. 25 Su. 77 10 10 10 13 14 15 20 23. 17 Su. Nadi Yantra N adi Y antra Nadi Y antra Nadi Y antra Nadi Vrana Nadi Y antra Nadi Vrana K antha Nadi Dham ani Nadi Vrana Nadi V rana Nadi Sweda Nadi Vrana Nadi Sweda Nadi Vrana Chikitsa-Kalika Siddhayogasangraha 71 Chakradatta 72 13 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Su. 20 U ttar. 28 U ttar.26. indicates prognosis cnl v n the symbolic form . 22 U ttar. 25 Su. In this.

purpose. the Charaka-Samhita is decidedly silent about N adi Vijnana as the means of diagnosis. i. It is also interesting to note that a misunderstanding pre­ vails about the inclusion of N adi Vijnana even in the Charaka Sam hita in Indriyasthana on the ground that non-pulsation of the always pulsating parts of the body and the cessation of the pulsation of carotid arteries ( M a n y a ) imply the said Vijnana in an axiom atic form. But we must also be aware o f the fact that the H arit-Sam hita available at present as such is not recognised by scholars o f Ayurveda to be an authe­ ntic one. when N adi be­ comes rapid the patient dies very soon.Nad i. ^Vnd it has been written quite later by some one. obviously. In the first place all descriptions in the Indriya section carried on in the third as well as other chapters are prognosticative and not diagnostic.of Nadi Vijnana. Secondly all the conditions enumerated in the third chapter are meant to serve as the measuring rock of the duration o f the patient’s survival and non-pulsation of the even pulsating organs such as ‘M anya’ is one of them and as such it can never be misdire­ cted so as to serve the intended purpose. it can be safely concluded that inspite of the use of word N adi a t several places in various denotations.Vijnana other symptoms such as rapid expiration etc.14 . But this solitary reference to pulsation in the context o f prognosis has. From all th at has been discussed above. But this is untenable for many reasons. no bearing on the examination of pulse for diagnostic purposes. . e. so far as it is related to life expectancy. T hat is why different parts of the body should be palpated with a view to ascertain the expectancy of life in a given patient and th at the absence of throbbing/pul­ sation in those parts of body where normally the throbbing is felt is to be taken to signify an unfavourable prognosis. T hat is why some give the nicname to it as pseudo Harit-Sam hita.

measuring in when you count anything with fingers ( is done ) to recognise the way of the heart goes. m utilated and presented special translation difficulties” . any swnw doctor.puts his. there is belief prevailing th at the knowledge of pulse-lore in Ayurveda has been derived from South Indian Siddhars’ work on pulse and not from the other sources. priest..Chapter II Pulse in Other Systems of Medicine of the World before its Introduction in Ayurveda In the cbntext'of origin of Indian pulse examination. to the examination of the pulse in th is. the refere­ nces.. The observation of the heart by means of the pulse 2500 years before the pulse appears in Greek medical treatise” .fingers to the head.. There are vessels in it leading to every part of the body. As observed by Sigerest. When discussing each point to highlight the present subject. The form er refers to “ the probing with the fingers ( palpation ) or m anipulation with the hand.“ are incomplete. The first instruction of Smith papyrus reads thus : “ .. to the .. we shall deal first with the Egyptian pulse-lore and the others one by one.. the deve­ lopment of the Indian pulse-lore. the possible source or sources from which the Indian pulse-lore developed or the source or sources which directly or indirectly influenced its developments.when a Sekhmet.to the two hands... * Egyptian Pulse-Lore It is im portant to note that there had been two authorita­ tive Egyptian papyrus. it is perhaps necessary to refer here to. the surgical papyrus of Edwin Smith and Eber’s papyrus. who had referred to the pulse examination. Also... whilst others like Jolly (1951) and Benjamin W alker ( 19 68 ) believe th at the Greek and contemporary Greeko-Arabian medicine m ight have contributed to. There are some scholars who believe th at Indian pulse examina­ tion ows for its knowledge to the Egyptian medicine and the Chinese medicine.

. any surgeon ( lit.. Now the acco­ unt of Greek pulse follows.” the following passage occurs : “There are vessels from it to every limb.in every vessel.. but only in those areas where the artery is close to the surface. On account of his experience he has mentioned to ‘slow’ and ‘fast’. sachwet ) priest or any exorcit applies the hands or the fingers to the head. Beyond the imperfect references to the pulse vis a vis the heart. to the place of the stomach.16 Nadi-Vtjnana place of the heart. every patt o f the body..” In the papyrus Ebers. by no meaqs indistinguishable. and others that do not lie deep. From discussion there appears to be no rvidence at all to support the view that the Egyptian pulse-lore may have influenced that of the Indian.. to the hahds. “ The heart and all the arteries pulsate with the s&ffle rhythm so that from one you can judge of all. its health and functioning as reflected is the arterial pulsation. the pulsations of the arteries in the soles of the feet and the wrists are easily felt. dicrotic and vibratory. when any physician.. because all the limbs possess its vessels. In addition he has also classified ‘unequal pulses according to their rate and m entioned again 27 varieties of them on the basis o f ‘axioms’. that is. But in all cases. But simply we can say that Egyptian pulse-lore centres round the heart. are pulsations of the arteries behind the ears and jn the arms. not that it is possible to feel the pulsations of all to the same extent.it speaks. Greek Pnlse-Lore In Greek system of medicine Galen is seen to have written several treatises on the pulse according to their length... then he examines the heart. ‘strong’ and ‘feeble’... knowledge of the heart’s secret and the heart. One measures the vessels of his heart to learn the information that is given to it. to the arms or to the feet. under the heading “ The beginnings of physician’s secret. it (the heart) speaks out of the vessels of every limb. N ot to distinct.. ‘wave like’. But you could .. As to this. ‘ant-like’ Caprezens. to the back of the head. pulse signs with reference to diag­ nosis and prognosis etc. breadth and depth and has described over 27 varieties of them . than he is measuring the heart.to the two legs. in the papy­ rus there is no information available in them about the proce­ dure of examining the pulse. A bout the palpation of the arteries during pulse examination G alen observes. ‘regular’ and ‘irregular’.

) of the Roman Empire and paul of Aegina were among the early European Savants who profoundly influenced the 2 N . the largeness or smallness and the length of the diastole. on the character o f pulsation. In other words. ) studied the pulsation of arteries and regarded the pulse as index of strength of the heart. D . length and depth respectively. F or pulse may be irregular in size. and it is not necessary to strip any p art o f the body of clothing. The pulse is termed to be ‘strong’ in strength when it repels the touch with force and the reverse is true for the weak pulse. and counted the pulse with Clephydra or water clock. 100 A. violence. ‘deep’. and the hectic pulses. In the view of Galen. . feebleness and frequency and so on. the ant-like ( formicans ).Greek Pulse-Lore 17 n o t find any artery more convenient or more suitable than those of the wrists. but in abnormal conditions sometimes the tension in too low. Galen says that they may be worm-like (vermifrom). Besides Galen. Similarly. you will find the artery quite moderately distended. Abnormality of pulse regarding rate or speed is described by considering the rate of movement. short and shallow pulses have also been described. He has described various types of abnormal pulses in the terms of ‘broad’. and they run in straight course and this is of no small help in the accu­ racy of diagnosis. The artery will seem to the touch to be dis­ tended in every dimension” . Describing normal and abnormal pulse Galen says “In an animal in a normal state of health. Ruphos ( Rufus ) of Ephesus ( C. Characterising the pulses. ‘small’ and ‘large’ pulses hav e also been described. an irregular pulse means an even and unbroken series. When the pulse appears flesh like to touch it is termed ‘soft’ arid when hard like leather it is termed ‘hard’ . Taking into account of diminution and augmentation in all these dimensions. Herophilos of Chalcedon ( 300 B. for they are easily visible. as is necessary with many others. However. too great in every dimension” . if the pulse is excessive in breadth. rate. the strength or fullness. sometimes. whereas irregularity means the destruction of even rhythm in whatever varieties of pulse. V. as there is little flesh over them. opposite of these narrow. according to Galen. the pulse examination was qualitative and not quantitative. ‘long’. It may be easily inferred here th a t the Galen’s description about the pulse and its examination does not make any refe­ rence to its counting. C.

N ow the account o f Chinese pulse follows. Jinabhadra. in the reign of the Emperor Ming Ti. which they translated into Chinese. the former does not appear to have made any significant impact on that of the latter. So. As Smith. Historically speaking. So far the im pact of Indian m edicine. Num erous Chinese monks such as F a Hien ( 500 A. D harm araksha accompanied him and. however. so many Chinese scholars also came here. According to professor Ralph. over Chinese medicine is concerned. Because there was two way traffic between In'Ha and China. ). as Buddhi­ sm spread in China. D. there began that long succession of piligrims and scholars who journeyed between India and China for 1000 years. says “ India has little affected the Chinese . Ruphos was the first m an who taught that the pulse was the result of the systole and not of the diastole of the heart. Indian medicine is seen to have travelled to Tibet and the medicine of -that country had adopted the form er us its basis. Hsuan Tsang ( 700 A. A bout Paul of Aegina R alph says. On the other hand. Sung Yun.Nadi-Vijnana A rabian medicine. culture except through Buddhism but by this means it has exerted a subtle influence which has perm eated the whole Chinese life and thought” . we can see how Chinese literature was enriched by the Indian travellers. specially as regards the pulsa. “ Paul o f Aegina devotes much attention to pulse and describes 62 varieties of pulse! His influence on Arabic medicine was very m uch” . but some of . Kum arjiva. Chinese Pulse-Lore The possibility of the influence of Chinese pulse-lore on that of the Indian appears to be even more remote and doubtful. These Indian scholars who went to China not only carried m any Sanskrit m anuscripts with them. Ashoka’s missionaries blazed the trail and. among the noted scholars who went were Buddhabhadra.them also wrote original book in the Chinese language. Parm artha. VII ) v isited . Vincet A. in later years. It was through Buddhism th at China and India came nearer to each other and developed many contacts. India to do reverence to the sacred spots of the faith and to improve their .. Pandit N ehru in his book ‘Discovery of India’ mentions that “ The first record of an Indian scholar’s visit to China is th a t of Kashyapa M atanga who reached China in 67 A . ) an I— Tsing ( A. D. Jinagupta and Bodhidharm a” . D. D. and probably at his invita­ tion.

Accor­ ding to the opinion of Wong and Wu “ Chinese physicians assert th at entire superstructure of medical practice is built upon the theory of the pulse. course and treatment of diseases depends upon this alone” .. According to Ralph. Deep I * LIVER. Deep H E A R T .Chinese Pulse-Lore 19 Knowledge of Sanskrit. IX . As regards the method o f feeling the pulse there is. VII ) claim that “ his country was never superceded by any other country in the skill of the feeling of the pulse” is. IV C IR C U L A T IO N . VII. Chinese have wealth of treatises on the pulse and they are considered to be ‘utterly disproportionate’ to other branches of medicine. X II. Fig. II. probably. I-T sing’s ( A. Superficial SPLE EN . D. not an exaggeration. “ The physician places his right hand on the right pulse. 1 : Chintse M ethod of Pulse Exam ination . location. During their journey m any Indians and Chinese perished on the way ( A. the inch pulse. each finger feeling a distinct pulse. however. D. V. the bar pulse and the cubit pulse” THE TWELVE RADIAL PULSES OF CHINESE ACUPUNCTURE THE TWELVE RADIAL PULSES OF CHINESE ACUPUNCTURE Superficial Superficial SM ALL IN TE STIN E. Deep ■ L A R G E IN T E ST IN E . some difference between one author and another. III. V III. [ I * K ID N EY S. The first three fingers are placed over the pulse on either side. VII ).the nature. I. Superficial LU N G S.. Superficial Deep | BLA D D E R . Deep T H R E E ~ H E A T £R ( VI. Deep STO M A CH . IX Superficial' * 1 j G A L L BLA D D E R . X.

‘Nan Ching’ or the ‘difficult classic’ realises th at the extent of the pulse is ‘one and nine-tenth of an inch’ which is divided into three parts called ‘taum ’*r>r inch.. and ‘Ch’ih’ or cubit. may perhaps. Li Shin Chen Inch M idiasti. his left hand for the right. As regards time of pulse examination according to most historians o f the Chinese medicihe.20 Nadi-Vijnana ( Fig.-Gall. ). Chinese system of medicine mentions about the pulse counting. Each of these divisions is stated to have ‘two different and distinct pulses’ viz. ‘Kwen’ or bar. The latter version from Chinese medical histo­ rians. W ang Shu-Ho 2.the normal or abnorm al conditi­ ons of which it reveals. In other words the pulse has been described in its quantitative term also. one inspiration and one expiration constitutes one cycle of respira­ tion. “ The examination is made upon both the right and left wrists. if should be examined at sunrise. whilst the thum b rests on the dorsum of the carpus” .viscera s tine. In the opinion of Chinese medicine. D IFFE R EN T CH IN ESE VIEW O N TH E CORRELATIO N O F TH E PULSE TO VARIOUS IN TER N A L ORGANS Pulse 3. 1. The normal ratio is four beats to one respiration. be considered relatively more authentic and reliable. Wong and Wu say that. On the o th er hand. Each of these twelve pulses is correlated to twelve different organs o f the body. then adding the index and ring fingers. his right hand for th$ left pulse. The middle finger is first laid on the head of the radius.H eart nal visceras H eart M ediastinal visceras D iaphragm Liver and Gfallbladder Liver Gall bladder Bar Internal. Nei Ching Cham ber LEFT W RIST E x te rn a l—H eart H eart Internal—Small M ediastinal intes..Diaphragm bladder . Golden I. E x te rn a l—Liver Liver 4. Unlike Greek and G reeko-A rabian system of medi­ cine. the internal and the external making altogether twelve pulses six on the right and equal num ber on the left hand.

and Shu or the quick pulse. four beats to one cycle o f respiration. According to Li Sbi-Chen these pulses are : ( 1 ) H ua —alippery. easily obliterated by pressure. large and long and slightly tense. In addition to these large num ber of ‘subsidiary pulses’ have also been m entioned. like scrapping a bam boo with a knife. The later two are good invidences for the description o f quantitative form o f the pulse in Chiaese system of medicine. slow. slow a n d short. like pebbles rolling in a basin. ( 6 ) T uan-short.tardy. (10) H uan . like a piece of wood floating on water. . ( 7 ) H ung .Chinese Pulse-Lore Cubit E x te rn a l—K idney Kidney 21 I n te r n a l—U rinary Belly bladder Inch Small intes.thready. felt on both light and heavy pressure. large and compressible. ‘a light flowering pulse. described as ‘a pulse with three beats to one cycle of respiration. fine. ( 5 ) Ch’ang . full.Kidney tine and urinary bladder Kidney Small intestine Lung Thoracic organ Stomach Spleen Kidney Large intestine Bar C ubit . hounding. R IG H T W RIST E x te rn a l—Lung Lung Thoracic organ I n te r n a l—Large Thoracic Lung intes­ organ tine Stomach E xternal-S pleen Stomach Internal-S tom ach Spleen Spleen E x te rn a l—G ate Kidney Largeof life intestine Kidney I n te r n a l—San Belly Chise Besides above types Chinese have mentioned four types as principal pulses. neither large nor Small . ( 3 ) H au —empty. strikes the finger sharply and leaves it quickly. and they a re : F u or the superficial pulse des­ cribed as. Cheng or deep pulse described as a deeply impressed pulse. forceful rising and gradual decline. ( 9 ) Chin . very fine and soft. Chi’ih or slow pulse. no volume.overflowing.the stroke markedly prolonged. like a stone thrown into water.tense. ( 2 ) Se — Small. described ‘as’ pulse with six beats to one cycle of respiration. hard and feels like a cord. (8) Wei . ( 4 ) Shih —full.long.

is said to indicate external diseases due to ‘seven passions’ viz. smaller than feeble but always perceptible. Likewise other examples may also be given. (17) San . grief. and also a variety of combination of these two may occur revealing disti­ nct diseases. like a tremulous musical string. deep. ( 22 ) Tai . tense. heat dryness and fire. (11) Koung —hollow. Thus we see iiiat a good deal of descriptions of qualitative form is also there in Chinese system of medicine. worry. H uan or tardy pulse is said to point to rheumatism. Numerous other examples of the significance attached to the various modes of combination of different kinds of subsidiary pulses can be enumerated. ( 1-6 ) Jo —feeble. ( 20 ) Tung —tremulous. ( 12 ) Hsein —taut. For example the Fu or the superficial puls e which is said to belong to Yang or the male principle is considered to indicate complaints contracted through sexual practices. auger.wiry. \ 18 ) Hsi —slender. ( 13 ) K e-hard. tremu­ lous. t° the pulse in the prognosis of diseases. the female principle. thin like silk thread. soft and'hollow like an onion stalk. irregular like willow flowers scattering with the wind. (15) J u soft. whereas a deep and hidden pulse is * stated to be symptomatic of vomiting and diarrho ea. pulsations cove­ ring a space no longer than a pea. A Ching or deep pulse. which is said to belong to Yin or female principle. fear and shock. anxiety. embedded in the muscles only' felt on strong press­ ure. very soft and deep. wind cold dampness. in case the pulse is deep and slow. a deep and sloppery pulse i3 said to signify indigestion. Few examples may be . joy. it indi­ cates weakness and cold. large.intermittent. superficial and Kung or hollow pulse is stated to indicate haemorrhage. A combination of superficial and Ju or soft is stated to denote sun-stroke.22 Nadi-Vijnana equal strength like willow branches swaying to a light breeze.. The pulse in Chinese medicine may either belong to Yang or the inale principle or Yin. strong . and hollow like the touching the surface of a drum. slow with occasional missing beat. it is considered to be indicative of latent heat.irregular. Chinese medicine attaches considerable importance . ( 19 ) F u . In addition. superficial and fine like a thread floating on water. beats occur at irregular intervals. (14) Lao . if it is deep and quick.hidden. superficial. ( 21 ) Chich .. felt on light touch and disappea­ ring on pressure.scattered. quick and jerky.and slightly taut.

fine and small it indicates bleeding in the intestine and the case is hopeless. a fat person’s pulse is usually deep and quick. A pulse seating like a fish or shrim p. superficial ^nd quick. “If the pulse resembles the peaking o f the bird. but in the women. In addition to these the character of pulses in pregnancy. ‘N ortherns often have strong and full pulses while the Southerns soft and weak pulses’. Chinese physicians have also observed the pulse variations under the influence of seasons. cessation of menstruation have been men­ . and in infants. In typical typhoid fever. From the point of view of Constitution. constitution. strong. darting about in the water. or the pulse like water com ing from a spring. “ In case of apoplexy. if the pulse is superficial.” . it is a sign of fatal kidney trouble and death may happen within four days if the pulse is like the anapping o f a cord or like the flipping of the finger against a' stone. the pulse on the left hand should be large to correspond with the Yang principle. the pulse is deep. but if it is thready. This system also observes differences and distinction in the pulse of the inhabitants of the N orth and the South. it is large. no anxiety need be felt. or feathers brushing against the skin. large. rapid and large.. According to sex ‘In man.. age. in the aged. In cases of diarr­ hoea. full and over-flowing. temperament and the sex of the subject. it is full and overflowing. extinction of the sleep-pulse and death may be expected within four days. Thus “ In spring the pulse is taut and trem ulous like a musical string in summer.Chinese Pulse-Lore 23 quoted here. in winter it is deep like a stone thrown into water” . small and soft it is serious. because the Yin ( the female ) principle predo­ minates on the right hand’. there is danger. it sho­ uld be opposite. the pulse should be super­ ficial and slow. Five beats to one cycle of respiration is normal in a hot tem perred person but four beats to one cycle o f respiration in a person o f slow temperament means sickness” . if. Equally im portant is the prediction of death by examining the pulse. it indicates serious diseases of the lungs and the end will come within three days. of water dripping from the crack. “ A thin per­ son’s pulse is generally superficial and full. it is rapid about seven beats to one cycle o f respiration. it is firm. is a fatal symptom” . in young people. on the other hand. the pulse is mostly empty. If the pulse resembles feathers blown by the wind. Agewise.

Vata. Next. But so far as impact of Chinese pulse-lore over Indian pulse-lore is concerned. and specially the wrist. From foregoing discussion it appears that Chinese pulselore is elaborate and complicated. Another point against the influence of Chinese medicine over Indian medicine is that the Chinese medicine refers. Pitta and Kapha. to the ratio between the pulse and the respiration and its diagnostic and prognostic implication. The pulse too was regarded as a link between cosmos and man. phlegm and mucous no doubt have been mentioned in the Chinese pulse-lore but there is no authenticity th at they convey the same idea as conveyed by the term Vata. And in this system of medi­ cine a vast literature. And these three pulses have been correlated to the various organs of the body instead of the ‘humors’ even though. e. But. from above downwards. cold. and also changes in cubit and Bar 'pulses in connection with distinguishing male and female child during pregnancy have also been enumerated. It may also be noted here th at not only Chinese system of medicine but the ancient Greek and the medieval Arabian medicine have also correlated the pulse to different organs of the body. Ayurveda and vice-versa. the ‘bar-pulse' and the ‘cubitpulse’. ‘spoke’ from the artery of the two ears” . As Jurgen thorwald observes “ The pulse was checked in the arteries of the head. whereas the Indian pulse-lore has not envisaged any such ratio or the correlation of the pulse with respiration. Pitta and K apha of Indian medicine. it appe­ ars after having gone through the literature of the form er that it leaves no influence over the later system of medicine. i. The heavens ‘spoke’ in the upper part of the hum an body by means of the arteries of the temples. The term wind. The description by Indian medi­ cine is after the three doshas viz. over 150 volumes of pulse examination have been identified and studied. the foot. there is a mention of accumulated humors in the context of th e description of prognosis. there is no such mentioning in Indian system of medicine. The m an himself. the ‘inch-pulse’. in its pulse-lore. heat. however. while the Chi­ .24 Nadi-Vijnana tioned. The points in the favour of this supposition may be that the Chinese medicine describes the pulse in terms of its ‘extent’ which is one and nine tenth on an inch in length. divided into three parts which are. The change in the character of Cubit pulse in relation to male and female.

Arabic Ptdse-Lore 25 nese system envisaged differences and variations between the male and female pulses in both the wrist. e. Arabic Pulse-Lore Arabic system of medicine i s of Greek origin which was rendered first into Arabi language and called U nani ( Ionian medicine ). This phase corresponds initially to the Omayid. leech etc. D. reptiles. e. 1000-A. So far as contact between Greeko-A rabian medicine and the Indian medicine is concerned. 1388 ). D. The first phase starts from the invasion o f Arabs ( A. the latter has specifi­ cally indicated that the pulse in the male should be felt in the right wrist and in female. D. 1351--A. D. regardless of the sex of the subjects. D. 1206-1210 ) to th at o f Firoz Tughalak ( A. On the other hand the Indian description will be seen to compare the pulsesigns with the movement of birds. baring some occasional ones such as ‘the “ pecking of a bird’. whereas the period of Turks in India i. The name Tibba ( physic ) which Avicenna ( A . This system of medicine is also known as U nani Tibba ( the Greeian system ). The last point which can be quoted th a t the Chinese classification of the pulse and description of the pulse-signs are functional. The second phase corresponds to the period extending from that of Qutabud-din Aibak ( A. first rendered in Arabic and again rendered in U rdu language. The Arabs were semitics and sha­ ped the islamic culture whereas the Turks gave it ruthlessness. 980--A. and the creatures as frog. During the period of Abbasids i. in the first phase the flow o f knowledge of Indian medicine was from India to Bagadad. it can be divided into two phases. D. D. 1036 ) gave to his medical system is derived from Tabijyata ( physics ) which denotes that it is based on no dogma or superstitions. 1026-7 ). A peculiar feature of the Chinese pulse-lore is the correlation of the pulse to the male and female principle respectively. Now the account of A rabic pulse follows. VI ) beginning with the incursion into Sind and ending with the invasion of India by M ahm ud of G hazani ( A. during the second phase witnessed the flow in the reverse direction of the Greeko- . D . and subsequently to the Abbasid Khaliphetes. The medicine under caption ‘U nani’ in India is the same Ionian or G reek medicine which was. in the left. and ‘the darting like fish or shrim p’.

distinctly mentions that under orders of Khalifas Harun and M ansur. medicine. In the result the Arabs. chemistry and other subjects of study” . standard Indian works on medicine. Nidan Sindhastaq etc. the Bramicide and appointed as the director of the Bramicide hospital. D . diagnosis of a given patient prevalent at. such as Ashtanga-Hridaya. As observed by Ishwari Prasad. He is also credited with having translated several Indian medical works into Arabic. it is quite evident that excepting other branches. Because from the period o f C haraka to the period of Shodhala ( A.26 Nadi-Vijnana Arabic medicine into India. and gave his commentary on the means of. Bajigar etc. M adhava-Nidana and Siddhayoga in the name of Ashtankan. toxicology etc. astronomy. were invited to Bagadad by Khalifas and abode in Bagadad and accepted Islamic reli­ gion. 1000 ) not only im ported these subjects to their country but also introduced them to Europe. Babal. M anak is credited with having translated several Sanskrit works in Arabic. mathematics. were translated into Arabic. Ibn-Dhan.of Indian system of medicine the knowledge of pulse examination of medicine must not have been migrated from India to the Arab country. “ The A rab scholars sat a t the feet 'of Buddhist monks and B rahm ans Pandit to learn phylosophy. in the first phase of their contaci ( A. He translated Charak-Sam hita into Persian. phar­ macology. th at time by . D. the classics of Indian system of medicine as available today were translated during that period. and Sushruta-Sam hita in the name o f Sushrud into Arabic. D. VI to A. who was invited to Bagadad by Khalifa H arun-al-Rasbid treated the Khalifa. another Indian physician a contemporary of M anak who is said to be a decendent of the Indian D hanapati was invited to Bagadad by Vahya. The Indian physician M anak. Ibn-D han. D. D. The author of Kitab-Fihirisit who wrote towards the middle of the tenth century A. And if the same Charaka-Samhita and Sushruta-Samhita etc. From the above discussions we can easily infer that during the first phase o f contact the Greeko-Arabian medicine was enriched mostly in all the fields to the greatest extent by the assets of Indian system of medicine. 1200 ) there is no where mentioning of pulse examination as a means of diagnosis. It is also im portant to note th at during this very phase most of the Indian physicians as M anaka. In the support of this view we can quote Itsing the Chinese traveller who visited India in VII century A.

In so far as medical science is concerned.Indians pre­ ferred to consult a diviner about their fate when there was no trouble at all in feeling the pulse. He also observed that. one of the five sciences (Vidyas) in India shows th a t a physician. Barni proceeds to observe further. The time bracket of A. Some of the rulers of the time allowed their physicians to trans­ late a few Indian medical works into Persian. One such work was Tibba-Ferozeshahi.Arabic Pulse-Lore 27 saying—“ The medical science. Negroes. 1281. the forcible conversion of Hindus under the threat of the sword. that not only M uslim s but also a large numbers o f Hindus the . China has never been superceded by any country in-Jam budwipa” . In Tia-ucf-Din Barnis’ well known work ‘Tarikhe-Firozshahi. “ During the Ala period. prescribed for the latter according to eight sections of medical sciences. There is indeed no . During this period Turkish invaders settled down in India. I t is seen from ‘An account of the physician of Alai period. the Turks in the second phase of contact brought with them their own physicians and m ateria medica a part of which was originally imbibed from Indian medicine. D. the annexa­ tion of the conqured territories to the expanding sultanate of Delhi. D. Now. It was dedicated to S ultan Ala-ud-din Khilji. there were such expert physicians that far exceeded Hippocrates and Galen in their skill' in . published in India in A. in contrast to the practice of this art in China which in his view—“ In healing arts of acupe ncture and cautery and the skill of feeling the pulse. having inspected the voice and countenance of the diseased. Brahmans and J o ts ’— took to the study and practiced o f the Greeko-Arabian medicine. This version of Itsing strongly strengthens the idea that Indians of the time were not aware of the knowledge of diag­ nosis by pulse examination.trou­ ble in feeling the pulse” . and this. let us see what happened during the second phase of contact. The royal physicians ( Hakims ) who were brought to India attracted increasingly large number of pupils not only from India but also from various parts of persia where Greek thought reigned supreme. The system of medicine which they followed in India was neither Indian nor Persian b u t an amalgam of the Arab version of Galen’s ( Greek ) medicine which later came to be know as the Tibbi medicine. and carried out their repeated compaigns against Hindu principalities. 1175— 1340 was of novel political upheavel and cultural upsurbes.

He was an Arabian authority on the pulse who is ranked with Avicenna as one of the foremost Arabian physicians and he is also regarded as probably the greatest and m ost original of all Muslim physi­ . Proceeding further Says Barni. Regarding pulse examination in Arabic literature. ‘Next to him ’ says Barani. Brahmans and Jats were in the city” . M any hospitals were established where regular training o f Greeko-Arabian medicine was given. Nagories. M aulana Aizuddin Badayuni and Badruddin Damasci were all physicians of the Ala period who had great proficiency in medicine and its • practice. ‘Rhazes’. it is im portant to note th a t Arabic medical literature assigned to the teacher particualr responsibility in training the student accurately to read the pulse. alm ost exclusively by the examination of the pulse ( nabs ) and the testing of the urine. M aulana Budruddin Damasci. he would a t a glance singly say that the urine has intermixed in the bottle ( italics anthor’s ). God blessed him with such a skill in m edicine' that only by feeling the pulse of the patient. He had such a prdficiency in medicine that if the urine of some animals was brought before him. In the second phase and the centuries th a t followed so as the practice of the Greeko-Arabian medicine by its Indian practitioners is concerned it is observed th at the diagnosis of the disease and the patient was made. Similarly. no body else in the city was equal (in Status) to M aulana Hameed M otarraz. Sushrud ( S u sh ru t). more or lesr academic* and they were left free to adopt w hat was ’ in them. he could correctly diagnose the cause o f the disease with the cure for it and gave a favourable prognosis of th e case.28 Nadi-Vijnand treating diseases. As Barni says further that “ D elhi soon became as im portant as Bagadad. liver between the ninth and tenth centuries. as he was named by the medieval Latinists. “ The Yaminy physician Ilmmuddin. A shtankar ( Ashtangahridaya ) and Nidan ( M adhavanidan ) were studied and admired but the interest of Indian Hakims in them appears to have been. The physicians of the city always learned the medical books from him. “ In diagnosing from the pulse and urine. Part of their medical circular was devoted to the study of the music so that the physician might appreciate the subtleties of the various tones of the pulse beats. the m aster physician occupied a high rank during the entire Ala period. There is evidence to show th at the Sharak (Gharak).

( 7 ) irregular. In addition to these A rabian medicine has observed differences in the pulse with age and sex. It was the text book o f the Arabic speaking world until the advent of Avicenna’s Quanun. The description of pulse-lore in Arabian medicine is quali­ tative and an asset o f details regarding different signs and symptoms have been furnished. in ease and disease. ( 8 ) strength. K hoon. He is famous for his alkitab al-Sinnah-al-Tibbiyah which is certainly one of the most.. concepts and principles of Greek medicine particularly Galen’s medicine inheriting the hum oral doctrine o f the Greek medicine. C hief points to be elicited during the examination of the pulse are : ( 1 ) length. Balgam. One should m ake a note o f it th at the A rabian medicine is found mostly on the philosophy. But these four hum ours in the case of examination of the pulse have neither been to the pulse-signs and symptoms nor is the interpretation of the pulse-signs and symptoms made in terms o f impairm ent of the one or the other of or all of the four humours. interprets the pulse in terms o f the functioning of the heart. so far as prognosis and diagno­ sis are concerned. ( 3 ) height. ( 2 ) breadth. ( 3 ) Ant-like pulse. place ( countries ). like the G reek medicine. ( 7 ) Dicrotic pulse. ( 4 ) the needs o f the body. and the l^ter in relation to the organs with which they are related. Instead. seasons. ( 2 ) Vermicular pulse. alcohol etc. the Arabian medicine. food and drinks. the tem peram ent or Mizaj and the vital force or Rooh. Safra and Sanda. ( 6 ) Spindle-shaped pulse. ( 5 ) D ecurtate pulse. Some among the types o f the pulses described by Arabian medicine are : ( 1 ) G azelle pulse. ( 9 ) Cord-like pulse. ( 4 ) Serratic pulse. among others. tem peram ent. He lived during second half of the tenth century. Besides. Another great physician was Haby Abbas or Ali Ibn Abbas Al-Majusi or Zoroastriap from South W estern Persia.Arabic Pulse-Lore 29 cians as well as one of the most prolific as an author. th e arteries. ( fc ) Supernumerany pulse. are seen to form the basis of th e study of the pulse. the four hum ours of A rabic medicine are fouring num ber viz. The another great authority o f Arabic medical world was Avicenna ( 980-1036 ) who not only syste­ matized the U nani system of medicine but made m any original contributions and m ore so in the field of pulse examination. ( 6 ) soft. A significant obser­ vation made by Avicenna who has quoted G alen about the . com­ plete and concise medical book irr the Arabic language. ( 5 ) hard.

a pulse which is large in breadth and height is known as a bounding pulse a n d that-w hich is small in this respect is called a thin pulse. i. and medium. a pulse which is large in length. The velo­ city of the pulse beat may be quick. and height is called a pulse of large volume and the one which is small. ( 4 ) Quality o f the vessel wall. Similarly. while honey-water benefits those with coldtemperaments. ( 6 ) Temperature. short. ( 8 ) Consiste­ ncy or inconsistency regarding the various features. The pulse may be hot. e. and breadth. He has mentioned in his book ‘Canon of medicine’ that “ the physicians have laid down ten features for examining the pulse although these should have been nine only. Similarly. the broad. breadth. The pulse may be rapid. ( 7 ) Rate i. slow or medium. feeble and medium. baths. The strength of the pulse may be strong. Rhythms of the pulse is time relation between two periods of movements and the two periods of rest. The pulse may be full. A pulse which is average between these two extremes is a medium pulse. hard or medium. Thus. frequ­ ency. “ the pomegranate juice is a tonic for those with hottemperament. On the character o f the pulse exercise. ) has described are of outstanding importance. This may be soft. alcohol is beneficial for people and injurious to others according to its hot and cold quality” . others have none. ( 3 ) Velocity of the pulse beat i. The pulse may thus be errhylhmic or dysrhythmic. pregnancy. swellings.'inflammations. cold or moderate in tem perature. e. speed. ( 2 ) strength of the pulse beat as felt by the fingers. The description o f m ain features of the pulse which Avice­ nna ( 10 A. pain. D. The vari­ ous compound varieties of pulse are worked out from combi­ nations of the simple varieties. length. The pulse has thus nine simple and a large number of compound varieties. The nine simple varieties of the pulse are the long. and the factors enimical to the body have also been described. In this way the pulse varies in respect of its ( 1 ) size. Dis- . Some of these varieties have special names. narrow and medium. is called the pulse of small volume.30 Nadi-Vijnana difference between the effects of alcohol and pomegranate juice is that. in these dimensions. The average pulse between these two is known as the pulse of medium volume. sluggish or medium. collapsing or medium. ( 5 ) Fullness or emptiness o f the artery. e. in the degree of expansion as estimated by its height. ( 9 ) Regu­ larity and ( 10 ) Rhythm.

that the pulse-lore o f Ayurveda has been derived from Tamil Siddhars. . ( b ) heterorhythmic in which the rhythm of a child’s pulse corresponds to that of an old m an’s pulse o r ( c ) erythmic in which the rhythm is so utterly abnorm al that it does not correspond to the rhythms of any age. He should also not be out of breath. In order to make a proper assessment o f the various chan­ ges it is im portant th a t the. M arked devi­ ations of rhythms indicate gross derangement in the body. nor excessively happy or under stress of exercise and emotions. He has given three possible reasons to be chosen this artery for the examination of the pulse.Pulse-Lore in Tantrik Literature 31 rhythmic pulse is of three varieties : ( a ) pararhythm ic in which the rhythm of a child’s pulse is like th at of the pulse of a young. regarding site of examination of the . Ramdevar. The subject should neither have given up any of his long standing habits nor should have adopted new ones. it is in direct continuation of the heart and quite close to it. while supination increases the height and length but decreases the width. Regarding the m ethod of examination he has said th at the forearm should be kept in the mid prone position because in thin and weak persons pronation increases the height and width of the pulse. it is more accessible. Secondly. but decreases the length. pulse Avicenna has mentioned that pulse is felt by palpating the ( radial ) artery at the wrist. m an. It is also im portant that the pulse should be felt when the subject is neither angry. Adinatha and M ulanatha. Firstly. it can be exami­ ned without embarrassment to the patient. Bogar and Patanjali. and thirdly. “ In so far as the Indian pulse-lore is concerned its origin and development may have to be treated to the only source which is that of the early Tamil Siddhars of the South” . D w arakanath observes.. Now the account of pulse in Tantrik literature follows. pulse should be com pared with that of a temperamentally well balanced person. His stomach should be neither over­ loaded nor altogether empty. F or usual practice. Shiva Vakkiar. Agastyar. Pulipari or Pulipasni Vyagrapadar. The pulselore o f the early Tamil Siddhars is seen to have taken its origin from the Shaiva-Agama Tantrism. Pulse-Lore in Tantrik Literature As regards fourth view. Very early Siddhars o f Yoga school o f Tantrism were Tirm ular also known as M ular.

K onganavar and others. C. Vaidyam ) the last mentioned included pulse-lore. Various dates fo r him have been assigned. The two great works of Tirm ular are. D. All of them had ‘already developed alchemy ( rasavada ). among which from 17-43 stanzas deal with the pulse-lore. the period of Tirm ular ranges from the second century B. The knowledge of the pulse became subsequently a part o f the medicine o f South Indian school o f Siddhars-also known as Ayurveda. Thus the pulse-lore is seen to be an outcome o f Yoga which deals among other things with the pulse (nadi) and the control of breath. According to the another source.32 N adi-V ijna n a Idaikawadar.a. The former is comprising o f 600 stan­ zas. belonged to X II century A. Agastiyar. ranging from. The Brihatsuchipatram ( Ayurveda ) issued by the Nepal Virra pustakalaya has listed Ramadey as the author o f the R asaratnapradipika on the basis o f the Colophons attached to this work. Theryar etc. Regardless of the difference o f opinion about the period it would appear that he might have flourished a few centuries before the Christian era. It may . Of these Siddhars. Shivavakyar. Tirm ular. the N adipariksha by Ravana o f X II century A. The number of Siddhacharyas grew to eighty-f our between the eight and tenth centuries. He is believed to have been among the ear­ liest exponents o f Shaivism in Tamil N ad o f his life. has been counted as one among the earliest and great Siddhars. the first to the ninth century A. D . as the peri od when he m ight have flourished. Vaidyakarukkadai and Tirm ular Vaidyam. Tirm ular. Tirm ular. N andi. who according to Dwarakanath. to the seventh century A. iatro-chemistry ( rasatantra/rasashastra ). Agastyar and Bogar are recognised as to be the most earliest.” . yet internal evidence points to six thousand B. He is said to have come down to the South from Him alayan region. D. “ The place o f T irm ular in the history of Tamil Shaivism is indeterminate. medicine ( Ayurved. The following are chronologically the more im portant Tamil Siddhars who authored works on alche­ my and pulse-lore. The pulse-lore in the later work is described from the stanzas 20-43... and N adichakra and Nadivijnana by an unidentified a u th o r belonging to the same period. D. The more im portant of N orth Indian works on the pulselore are Nadivijnana by K anada. He has also referred to the Tam il Siddhars and the pulse-lore in this work. Yugimuni. Says N ilkanth Shastry. C.

agni. Further giving his final remark. They are : idai ( ida ). visuddha. and three mandals viz. Again although the names o f several authors are known. For this reason idai has been con­ sidered as the Pitta nadi and suzimunai as the K apha nadi. pingalai ( pingala ). belonging of the early middle and late medi­ eval periods have been listed in the descriptive catalogues of oriental libraries in the South as well as N orth India. “ The place of the general Nadichakra and Nadi system in treatises on sphygmology can be best accounted for if we assure that the two subjects evolved together side by side in the hands of the same sages of by gone days” . One fact remains fairly constant th at once th e-tw o systems had p u t together by the earlier authors. In one o f the pieces of his articles ( Oct. their works are no longer available” . N. The first three which are mentioned in the beginning are known as the three Nadis from which the three D hatus as Vata from idai. both private and public. the authorship of some of which is unknown and that of very many not. Pitta from Pingalai and aiyyum ( K apha ) from the suzim unai. surya a n d chandra..■ ‘Sphygmology in Ayurveda’. m anipuraraka. Ghosh says. the six chakras viz. According to Tirm ular. many other works may have been lost for ever and some again are lying in obscurity and inay be discovered some day. yet the consideration of the same in works on sphyg­ mology has been considered imperative by most of the authors. are stated to arise. “ The Nadi system in Ayurvedic medicine. the practice continued.Pulse-Lore in Tantrik Literature 33 be recalled in this connection that many unpublished m anu­ scripts on th e pulse-lore of South Indian and N orth Indian schools. The one of reconciling such association is to consider their evolution side by side perhaps iii the hands of the same set of workers. V. swadhisthana. And also in his opinion. and is still extent amongst the present writers” . & ajna chakras. E. It has been further cited that the N adi through which the impulses 3 N . 1924 ). . he also arrives at the con­ clusion th at “ It is specially to be noted that although the gene­ ral ‘N adichakra’ system has nc real bearing on the pulse exa­ m ination. “ Although a large number of manuscripts are enlisted in the catalogue of various libraries. Upanishads and Tantrika literature. anahata. there are 72000 Nadis in the hum an body of which ten are encountered to be useful from the point o f view of medicine and the pulse-lore. buzumunai ( sushumna ). Ghosh ( 1924) had published many articles on the topic. m uladhara.

in the third place. In connection with the mode of feeling the pulse. ( 2 ) that of Pitta in the second place. ( 4 ) Bhute nadi-pulse felt between the thum b and the fore-finger. In addition the pulse movements both in terms o f animals as horses. birds. Few examples are : ( a ) Puzupelural-wormlike movement. fingers with which they should be felt. ( e ) A dnpotrullat-leaping and bounding like m ovements of goats. 3 & 4 ). a little above the wrist. and it proceeds to observe that “ the ojther three are open to physicians and are availed of in com­ mon practice” . (2) Pittana di-pulse showing Pitta dhatu. by the use of the index. Regarding sex the pulse in the male should be felt on the right wrist. it has been men­ tioned that they are more difficult and are not observed in practice from due to ‘great intricacy’. and in the female in the left.di-Yijn. And these impulses are to be felt below the thum b. below the fore­ finger. ( b ) Padariyodal-Hastening or very quickly. reptiles. below the middle finger. ( 5 ) G uru nad i-an intermediary pulse felt between fingers. the relative ratio of their beats etc. below the ring-finger. nadi-pulse exhibiting K apha dhatu. quick-decline due to pressure or low tension. like peacock. Pitta and K apha pulses.( in 1. ( 1 ) Vatanadi-pulse indicating Vata dhatu. 2. the school o f Siddhars has observed that the pulse should be examined by pressing the index. ( f ) Terinduvizal-sudden rebound which . middle and ring fingers respectively.ana of all the three Nadis are transm itted is the same. Regarding 4 and 5. ( 3 ) Aiyyum or the slettuma. the m iddle and the ring fingers of the phy­ sicians right hand at a place two fingers in length just below the root of the thum b. The natural order in which three D hatus are indicated are : ( 1 ) the pulse indica­ ting Vayu is to be palpated in the first place. e. nature o f their movements. W ith slight amendm ent the description from the Encyclopedic Dictionary of Indian medical science can be given which gives a broad idea o f the origin of the pulses.Na. ( d ) Odam. fowls etc. and ( 3 ) that of K apha. for Vata. It has also been m entioned that the pulse should be palpated three times by holding and letting loose the patients hand. amphibians creatures like frog. their regi­ ons. ( c ) K um urihodal-C rooked and shaky movement. bolodal-m oving like a boa: i. Encyclopedia further says “ This is a secret which can not be learnt without the aid of spiritual G uru or a Yogi” . as well in terms of physical signs hive also been mentioned.

( c ) Abalanadi— weak pulse. ( g ) Thadangunadi-slow pulse. ( 2 ) Ani and Adi corres­ ponding to mid-June m id..... ( f ) Idaividunadi-interupted pulse with missing beats. corresponding to mid M arch to mid April. action and other characteristics as : (a) Tivranadi-pulse which is faster in rate than the normal. the pulse should be examined in different times of the day and night in different months e.at Sunrise.a t Sun-set. in their works. N ot only this m uch.. Thai and Masi corresponding to mid December to mid M arch.. this work also envisages sex-wise difference in the pulse movements as it is evident from the following chart. ( 3. Frog Female Serpent Frog Swan ..A ugust/Aipari and Kanligi. when the body is wet with water. It is of interest to note that Saram has also mentioned that when the pulse should not be examined. will be misleading” .. Avani. when very hungry and when enjoying sexual pleasure.in m id day.. ( h ) Ozungunadi— Normal pulse etc. V annadi-hard or wiry-strong pulse.. about the time when the pulse is to be examined in different months of the year. at the time o f eating food. Thus foregoing apart. corresponding mid August to mid September and Purattabi corresponding to mid September to mid October. The remarkable point is tjiat they have mentioned ...Pulse-Lore in Tantrik Literature 35 is marked. ( 1 ) Chittiral-V aikasi corresponding to m id-A pril to mid June.. Besides. corres­ ponding to mid October and mid D ecem ber. ( d ) Nerungiyanadi-Tense and firm pulse-cordy pulse... a work conside­ red to be not only very authentic but also very old. Leech Serpent. the Siddhar pulse-lore has referred to pulse according to its nature.:. Likewise numerous other types can be quoted. As Noyin Saram says: “ Any diagnosis made by the examination of the pulse when the subject has anointed himself with oil. ( b ) Thallunadi-irregular and bounding pulse-goat leap pulse.in mid night.. D hatu Vata Pitta K apha Male Peacock Tortoise. ( 4 ) Panguni. diseasewise. the above types o f pulses Siddhars o f south have furnished numerous other details relating to pulse-variations Dhatuwise. (g) Talarvayodal-sluggish pulse.. prognosis etc. According to Nojin Saram by Agastyar. ( e ) Gatinadi-flowing and hard pulse..) Margazi. g..

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Nadi-Vijnana

So far we have discussed about some of the salient aspects of pulse-lore o f Tam il Siddhars and its Tantrik origin and deve­ lopment by them* and have also learned the various movements of pulse correlated with those o f certain animals, birds, reptiles, amphibions creattlres etc. along with highlighting the physical signs too. It is a point of rem ark that many of these movements vis a vis D hatus/D osas involved and abnorm al and normal states •have been mentioned in the works on pulse-lore o f the N orth such as the works o f K anad and Ravana ( Ravana Siddha ). It may be recalled in this connection that beginning w ith N agarjuna and the spread of M ahayanism' by about IV century on­ ward, the dividing line between the Buddha and Shakta cults became imperceptable” , and both “ Fe Haien and Y uan Chawang saw Buddhists wherever they saw. Tantrists” . It was also seen previously th at Tantrism reached its climax between the VIII and X centuries A. D . when the num ber o f Siddhacharyas grew to 84. Thus the period between the V III century and X III was one o f intense Tantrik activities and in the hands o f the same Tantrik sages alchemy ( Rasavada ). iatrochemistry (Rasa T antra Vijnana) reached, its apogee on one hand and the science of pulse ( N adi Tarttra/N adi Vijnana/Nadi Shastra ). on the other. That the both K anada and Ravana were Tantriks is proved by the fact th at K anada, one of the two has submitted himself to the devotion o f lord Shiva, who according to Tan­ triks, is regarded as the source o f knowledge o f ‘N adishastra’ and ‘Rasashastra’. As K anada in the very beginning of his work under the title ‘Vaidyaka Pracharaka’ has him self cited that it is the M ahesha only who knows the pulse science etc. and he ( K anada ) one of the descendent of remote past in the tradition learned this knowledge to second. Few verses cited by K anada in the beginning regarding origin of N adi from tartoise ( K urm a ) are such th at it appears that they are part and parcel of the knowledge o f Tantrism . But they convey no scientific meaning o f anatom y. M oreover, ambiguity o f the knowledge inherited in them does not make it clear that term ‘N adi’ used is restricted only to ‘artery or veins’ but in addition the term includes the sense nerve trunks and their branches etc. Similar, ■easoning can also be given for R avana who also has mentioned n his work the name o f ‘Nandin’, a great knower o f pulsecience and one o f the pioneers of South Indian Siddhars of emote past.

Pulse-Lore in Tantrik Literature

37

Extensive study o f Ghosh ( 1 9 2 4 ) on the subject “ The N adi system in Ayurvedic Medicine, U panishads and Tantrik L iterature” also reveals th at “ the Nadis and N adi-chakras are found elaborately described in m any Upanishads, Puranas, Samhitas, and Tantras and also in many works on sphygmo­ logy” . The site of the origin of Nadis has been variously stated in different works. The short accounts we find in nearly all the treatises mostly to nerves, although vessels m ight be referred to in some o f them. In the large num ber o f treatises on sphygmo­ logy we find the Nadis (the origin of the D ham anis as depicted in several treatises is also included in the origin o f Nadis) have been said to have had taken their origin from the region of the umbilicus. Giving rem ark on overwhelming importance attac­ hed to the umbilicus by Indian sages, Benjamin W alker (1968) says,“ ...th e whole physiological system is believed to centre around the region o f the navel and heart, which moistens the body as a stream moistens a garden” . Thfere is sprout like-lump a t the level o f the umbilicus, created by God. 72,000 Nadis take their origin from this lump. It is also said th a t the K undalini Shakti, placed in the navel, is shaped like coils o f snake. From this ( or from this place ) arise 10 upcoursing and 10 downcoursing Nadis where reside the 10 Vayus. Two on each side are lateral coursing. These are th e 24 main Nadis which are concerned in the 10 vital forces ( Vayu ). A nd also the navel is placed in the M adhya C hakra in the body. All the D ham a” lc spreading in the body, arise from it. They are" 24 in num ber. In others are descriptions that those Siras which are distributed in the body o f a m an are all bound to the navel and extend on all sides. Arising from below the navel 10 pass upwards and 10 downwards, 2 pass lateral-wise on each side; these are 24 Siras of the body and also, the Siras and D ham ani are placed in, the navel; they lie in the body by spreading in all directions. The treatises on sphygmology in which 72,000 Nadis are mentioned are.: ( 1 ) N adyutpatti, ( 2 ) N adipariksha, ( 3 ) N adishastra'samgraha, ( 4 ) Nadinidanam , ( 5 ) N adichakrabhedi and ( 6 ) Nadivijnaniya. In Nadivijnaniya the Nadis have been classified into male, female and neuter. There are 30,000 jnale and 30,000 female Nadis and 12,000 neuter Nadis. The Nadis on the left side are called female, those on th e right side are called male and those in t he middle are called neuter. Thus there are altogether 72,000 Nadis. T h e re a re 14

38

Nadi-Vijnana

Nadis enumerated in Shiva-Samhita, Nadishastrasamgraha and Nadinidanam. These are as followes r ( 1 ) Sushumna, ( 2 ) Ida, ( 3 ) Pingala, ( 4 ) Gandhari, ( 5 ) Hastijhwa, ( 6 ) K uhu, ( 7 ) Saraswati, ( 8 ) Pusha, ( 9 ) Sankhini, ( 10 ) Payaswini, ( 11 ) Varuni, ( 12 ) Alam busha, ( 13 ) Viswodari, and (1 4 ) Yashaswini. Tn Shiva Samhita, it is distinctly noted that, of these, Pingala, Ida and Sushumna are the principal Nadis; again of these three, Sushumna is the principal Nadi. All the Nadis o f the body arise from this ( Sushumna ). In both Nadi Shastra Samgraha, Nadi Vijnana and N adi Chakrabhedi, we have the same note regarding the Sushumna, Ida and Pingala, the first one being referred to as a Brahma Nadi. Similar sets of Nadis are also mentioned with some change in numbers in Nadi Vijnana, N adi Pariksha and N adyutpatti etc. Though, we find that anatom ical classification and functions of Nadis are amalgama­ ted, yet in many treatises on sphygmology and general Sanskrit works, we find the Nadis differentiated into Siras and Dhamanis, different characters ( including functions ) being assigned to them. The Nadis are divided like the veins of a leaf are fine, are distributed in the body, are provided with various colours and are placed in 7 Dhatus. They are carriers of derangements, are holders of functions and are running like creepers. They are stout, cylindrical and knotted; they are gradually narrowed down from a broad base, and are apparently scattered, provided with a calibre are fine at the terminals and extended to all parts o f the body in a downward, lateral and upward course and are continued to all the joints. Such a definition can only be applied to a vessel. And also the Pran Vayu travels in the calibre of all the Nadis. They indicate health, if free from any derangement, but are carriers of diseases, if affected w ith derangements. Of these 5 are the principal ones, and are placed in the body trunk. Of these 3 are eminent owing to being carriers of 3 types of derangements and being capable of giving an idea of the deran­ gement. Those which are directed upwards and downwards are connected with the wrist and are known as ‘Sutrapanchaka’ 5 cords. There is undoubted confusion between a pulsatile vessel and a nerve cord in this passage. The first five lines indicate an artery, whereas the last line points to a cord, a solid structure. Elsewhere, these ‘Sutrapanchaka’ have been

Pulse-Lore in Tantrik Literature

39

used namely for Ida, Pingala, Sushumna, Subla and Bala. But above all, one thing we can derive is the idea inherited in few lines that derangement of Doshas are carried by Nadis and if they are examined they are capable of giving an idea of deran­ gement of Vayu, Pitta and K apha. Ghosh in his articles has quoted pulsatile Nadis as studied by the authors of the various treatises on sphygmology and they are : ( 1 ) There is a Nadi in the Brahm arandhra to be found pulsating in the infant. The pulsatile anterior fontanallae is evidently m eant by this; ( 2 ) There is a Nadi on each temple. This refers to some large, bra­ nches of the tem poral artery; ( 3 ) The nasal arch of the two angular arteries of the facial artery is referred to as a N adi b e t­ ween the two eyes brows capable of being examined iq, young persons; ( 4 ) There is a Nadi infront of the ear. It occupies two fingers breadth. It corresponds to superficial tem poral arte­ ry; ( 5 ) There is a Nadi on the undersurface of the tongue on each side. The pulsation can be easily felt behind a fingers breadth from the tip; ( 6 ) There is a N adi in the neck on each side, two fingers breadth above the root-of the neck. It is com ­ mon carotid artery; ( 7 ) There is a Nadi in the middle o f the hand on each side. It refers no doubt to the brachial artery at the bend of the elbow; ( 8 ) There is a Nadi at the wrist which is considered as the most suitable one for clinical examination. It occupies three fingers breadth on the wrist at the base of the thumb; ( 9 ) The pulsation can be felt over the heart; ( 10 ) There are two Nadis in the neighbourhood of the navel; ( 1 1 ) There is pulsation which can be felt over each Kukshi; ( 12 ) There is a pulsation which can be felt on the sides. It i s ' very difficult to locate the actual position from the vague note as Paraswadesa; ( 13 ) There is Nadi on either side of the geni­ tals. It evidently corresponds to the femoral artery; ( 14 ) There is a Nadi on the back of the thigh. Perhaps it refers to the popliteal artery; ( 1 5 ) There is N adi in the ankle. It occupies 2 fingers breadth below the ankle. It refers to the posterior fibial artery as it lies behind the inner melleolus. Considering the importance of manuscripts related to sphy­ gmology and their classification, G hosh may be referred again. According to him, works on sphygmology with short notes on each can be divided into three main groups, namely, (a) works finding a place in the general treatises on Ayurvedic medicine such as Nadipariksha by Sharngadhara and Nadipariksha by

40

Nadi-Vijnana

Bhavaprakash etc; ( b ) works forming independent treatises on sphygmology and ( c ) compilation works of the present time in printed form. In the present context we mainly restrict ourselves to the works finding a place in the second group of classification. This group contains treatises which treat of the general ‘N adichakra’ system ( nerve and nerve plexus ) fully, in. addition to the study of pulse from clinical standpoint. The works are enumerated in an alphabetical order for convenience and they are : ( 1 ) N ad ibh ed a : A small manuscript of 34 shlokas, depo­ sited in the library of His Highness the M aharaja of Aiwa. The manuscript is interesting from the fact that the pulse characte­ ristics in various conditions have mostly been named after ani­ mals, the movements of which the pulses resemble. A short note is given in the beginning on the general Nadi system. ( 2 ) N adivijnana : A small treatise said to have been com­ posed by sage Kanada. There are three printed editions of the work, one from Bombay and the others from Calcutta. The Bombay edition contains explanatory notes in Hindi. The two Calcutta editions were published by Kaviraja Devendra N ath Sen and Gangadhar Kaviraja respectively. The first was in Bengali character. A manuscript was also available from east Bengal. The edition by Gangadhar Kaviraja is very valuable, due to exhaustive explanatory notes and quotations from vari­ ous authors. The names of Gautam and Vasishtha occur in the notes. ( 3 ) Nadivijnana or N adichakra : A m anuscript deposi­ ted in Tanjore state library. A copy has also been deposited in the Bangiya Sahitya Parishad. It is a large treatise of twelve chapters and is ascribed to Shiva explaining to Parvati. The data of original script is Sambut 1417. The whole script has been divided into 12 chapters. In the first chapter the means of diagnosis as by touching, asking question and by sight have been mentioned. Second chapter deals mainly with origin of Nadis division into male and female Nadis, description of vital force ( Pran Vayu ), five main nerve cords and different kinds of respiration. Third chapter deals with longevity of man; number of years ascribed to Vayu, Pitta and K apha ( 33 years 4 m onths of each ); position of pulsatile arteries to be felt in several domestic mammals and 3 kinds of bodily derange­ ments. Fourth chapter deals with diagnosis of bodily derange­

. in different seasons. ( 6 ) N ad ip arik sh a : There are two works both ascribed to Ravana. M ost of the verses are identical with these in the Nadipariksha of Sharngadhara Sangraha. His name is also found mentioned by Ravana. . The copy is not available. One has been printed in Bombay a n d several m anu­ scripts are available. The name of the author and many passages from his work are seen in many treatises on pulse examination. The second work consists of about 25 verses and is also deposited in the same library. ( 8 ) N ad ip arik sh a : A m anuscript by N andina. The first work gives the name of its author Nandini. after partaking of food of different testes ( Swad Rasa Sevya K alah ) etc.Pulse-Lore in Tantrik Literature 41 ments by pulse examinations. ( 9 ) N ad ipariksha : A m anuscript o f 15 verses without authors name and deposited in the Tanjore state library. One has been deposited in the library of Asiatic Society of Bengal. position o f pulsatile Nadis for diagnosis of diseases and according to the age of the patient. It was deposited in some private library in the Bombay Presidency. W. Fifth chapter describes pulse character in different parts of the day. The work is available. There are section of which the first section consists of 47 Shlokas and deals with pulse examination. deposited in the private library in N . ( 7 ) N ad ip arik sh a : A m anuscript ascribed to D attatraya. It is not available. The author mentions the names of Nadin. These passages are practically identical with those in Nadivijnana of K anada. The name of the author is referred to Nadiprabodha. ( 4 ) N adigrantha • A m anuscript deposited in private . province. library in the M adras Presidency. The second work gives detailed notes on the time of death as ascribed by the pulse characteristics. A few passages frem his work are seen quoted in Nadivijnana. The section on pulse examination is characterised by detailed notes on pulse conditions in relation to unfavourable prognosis and in conne­ ction with prediction of death tim e (passage derived from Ravana ). Sixth chapter deals with pulsatile vessels ( Jivanadi ) their position and their relation to some bodily conditions. The author of Nadiprabodha quotes the same passages from Ravana with recognition. The copy is not available. It is a large m anuscript on clinical methods deposited in the library of Asiatic Society o f Bengal. Trimalla and Ravana. ( 5 ) N adivijnana .

(11) N ad ip arik sh a : A small m anuscript of about 28 Shlokas. ( 14 ) N adiprakarana : A m anuscript of about 30 verses. It is a common treatise used by the students of Ayurvedic medicine in Bengal. The work is available. M andanya. various sources. ( 15 ) N ad ip rak ash a : A treatise by Sankarsen. The treatise is ascribed to 8 days who derived the subject as revealed by Shiva to Parvati. It has been quoted by Sankersen and Kapil Mishra. D attatreya. w ithout authors name and deposited in the Benaras Sanskrit College library. Ram araja and Sankarsen. without authors name and deposited in the Asiatic Society of Bengal. The first chapter con­ tains 9 verses and is a sort of introduction. The second chapter consists of 75 verses dealing with ‘N adichakra’ system. deposited in the M GOM L. It is a comprehensive treatise with an excellent arrangem ent of the subject m atter alnd very useful explanatory notes. The work is not available. It is deposited in some private libraries at Ahm edabad. Vasishtha. It is deposited in the library of the Asiatic Society of Bengal and Bangiya Sahitya Parishad. It is the only work of its kind. The printed book has got expla­ natory notes in Sanskrit by the author himself. ( 13 ) N adiprabodhan : A large manuscript by Kapil M ishra dating back to Sam bat 1807. The work is available. Bombay.42 Nodi-Vijnana ( IQ. Ravana. A m anuscript by Karkandeya. The a u th o r refers to K anada and quotes a few passages from his work. We get names of Yajnavalka. The au­ thor quotes m any passages from. The treatise consists of pulse condition in various diseases. M anuscript has been deposited in various parts of India.) N ad ip arik sh a . The manuscript is available. Agneya. The copy is n o t available. Sankarsen refers Ram araja. ( 16 ) N ad ipariksha : A m anuscript by R am araja. The author quotes passages from Ravana without recognition. Gautam . without author’s name. nearly all having gained at the recognition. It has been printed in Calcutta. The third" chapter consists of 34 verses dealing with pulse exami­ . ( 17 ) N a d ish a stra sa n g ra h a : A large m anuscript with three chapters. ( 12 ) N ad ip arik sh a N idana : A manuscript of about 57 verses without authors name and deposited in the Bangiya Sahitya Parishad.

if towards the ring or little finger a spirit of the field or of the village out Kirts is at work. the knowledge of pulse examination is quite prevalent. N ot only pulse examination. Then he sits down beside the patient and feels the pulse a t his wrist. Kaushika. the Ojha treats the patient with incantations. . but also they were and still are acquainted with the knowledge of urine examination to diagnose the diseases. Certainly this knowledge is p art and parcel of their culture. if the medicine man ( Deonwa ) finds any difficulty in . Vasishtha. or the index finger. uncertain and feared Bonga ) is ‘hungry’. Moreover. And also “ Among the HOS. K um bhasam bhava. ( 18 ) N ad yutp atti : A manuscript in Telgu script. or poison. Jaggi in his book “ Folk Medicine” has stated that among Santhala. Interpretation of the pulse tells him the cause of the disease. It consists of 57 verses ( Shlokas ) and deals with the ‘Nadi­ chakra’ system more elaborately than the pulse. but rather. and so on. the Orak Dongas ( that is the house Bongas ) or some other Bongas are at work. If the pulse comes towards the thum b. Other nume­ rous manuscripts are also available but are not being quoted here. The pulse is further supposed to reveal whether the complaint is due to “ sudden fright” . Jhar ( cleansing) etc. inflammation. On the basis of his diagnosis. A good Santhal Ojha is said to be able to distinguish as many as 23 different types o f pulse in each of the arms. They mostly believe in devils and damons for the cau­ ses of diseases. and by examination of pulse they ascertain which type of devil is responsible for the particular type of disease in a particular person. deposi­ ted in Tanjore state library. If the pulse comes towards the middle finger the Abge ( a kind of tutelary. A copy has been deposited in the Bangiya Sahitya Parishad. after the preliminary enquiry > the medicine-man ( Ojha ) looks at the face of the patient and asks him to put on his tongue in order to examine it. it would not be out of place if we quote here the view of Jaggi ( 1973 ) to show the oldness of the knowledge of pulse-lore as was practiced and is still being practiced in barbarians-the Santhals. Bharadwaja and Markandey from whose work the present work was compiled. it is a sign th a t Bongas. The name of the author is Shreeram.Pulse-Lore in Tantrik Literature 43 nation. one of the oldest race of India and still barbarian. As Jaggi observes “ Among the Santhals. The last verse gives the name of Kashyapa.

a” . he resorts to Dukidamal. ( 4 ) In the available works of K anada and Ravana they have often quoted. ( 6 ) The work of Kaviraja G angadhara on “ Nadivijnana” o f K anada is available with exhaustive explanatory notes with enumeration o f the names of G autam and Vasishtha. utterance th at the konwledge should be preserved with great care and not be given to those who are unfit for it. Further. one of the Siddhars o f ancient time is available and deposited in the private library of Bombay Presidency. “ M anisina” . In foregoing pages we have tried to emphasize th at the pulse-lore of Ayurveda found its source of origin in the other works of Sanskrit literature and particularly in Tantrik one. is not only sufficient to prove the oldness of the knowledge of the subject perhaps only known to the sages of India. “ Janiyacchavichakshant” . Karnik. contributing th e knowledge o f the subject to others. “ Nadinatatw avedina” . ( 5 ) The work. following points may be noted down : ( 1 ) Abundence of independent existance o f treatises on sphygmology. but also indicates th at the knowledge was completely confined to the hands of same sages. not merely dealing with the pulse-lore. It is from the nature of this reaction that he makes the diagnosis whether the disease is caused by Najom ( a sort of poison ).44 Nadi-Vijnana coming to a diagnosis.. Ravana. A small quantity of Dukida or urine is brought in a leaf-cup early in the morning by the patient or any of his rela­ tions . “ Vaidy. "Purvacaryaihi” . The deonwa puts a drop o f m ustard oil on it and sfudies the reaction carefully. “ Muneyoh Nadigati Jnaninah” . After summerising the whole discussion to support the above view. but also ‘N adichakra’ along with the source o f origin o f N adis'from the structure like tartoise and the others as cited in Tantrika literature. G autam etc. ( 3 ) Moreover citation by K anada in the verse forty nine o f his work th at the pulse indicating death within certain limited period is only known by certain intellectuals and the knowledge of it is obtained w ith great difficulty even in the heaven. ( 7 ) The work is available in the name of ‘Nandivijnana or N adichakra’ and was written in Sambut . ( 2 ) Repea­ ted enum eration of the names of same sages as K anada. of by gone days in some of the treatises on sphygmology leaves no doubt about orientalism o f the subject. but no where they have mentioned the word like. examination of urine. “ N adipariksha” of Nandin. Yajnavalkya.

D ..the knowledge according to their own tradition. F urther. D . ( 9 ) The derivation of the idea th at in case of male the pulse should be examined of right wrist while in cases o f female th a t of left wrist has been totally derived from idea of T a n ­ trism.Pulse-Lore in Tantrik Literature 45 1417 or roughly we may say in A. Nadi Pariksha Among the existing opinion between East and West regar­ ding the source o f origin of Indian pulse science. following synthetic views can be offered about the fact. And they hesitated to add anything new from without. ( 8 ) In this conne­ ction the independent opinion of Ghosh. Though according to Jolly ( 1951 ). Virslmha ( 1383 ) m en­ tions in his work-Virasim havaloka. the name o f Tisatacharya th at he has mentioned about pulse exam ination in his work Chikitsakalika which was composed in 10th century A. ( 2 ) M ost o f . it is also clear from the saying of I-tsing ( 7 A. ) during his journey in India th at the Indian physicians were not able to diagnose the diseases by m eans o f feeling the pulse by th a t tim e. but some barbarian races of the time were aware o f the knowle­ dge. why the Indian physicians before the period of Sharngadhara could not inclu­ de examination o f pulse to their literature : ( 1 ) The Indian physicians a little anterior to Sharangadhara were mostly over­ whelmed with the idea of greatness and validity of classics of Ayurveda. M oreover. D . yet in available Chikitsakalika at present there is no such m entioning. Jolly and Benjamin W alker giving their own rem ark say th at the pulse feeling perhaps originated among the A rabeans or Persians. ( 10 ) Diagnosis made by pulse exam ination as prevalent am ong Santhals is also convincing th a t though the feeling of pulse was not adopted by the scientific world of Ayurveda. And they were so stuck to the idea with firm con­ viction that what had'been told therein is the final. derived after vast study of the subject scattered in the other works o f Sanskrit as Upanishadas and Tantras. 1359 which corresponds to the period a bit later to Sharngadhara. that the “ N adichakra and Nadi system in treatises o f sphygmology evolved together side by side in the hands o f same sages o f by-gone days” can be quo­ ted. And they were utilising.

concluded on. the diagnosis of diseases could be revealed. T hat is why the description of Sharngadhara is elementary in knowledge and depicts only the introductory portion of th e subject. ( 3 ) D ue to absence of knowledge of pulse examination in the literature. but their conscience was also shaked. among others are seen to form the basis of the study o f the pulse in ease and disease. the pulse should be examined in the morning hours on empty stomach. This period corresponds more or less to the period of Sharngadhara ( b ) In Greeko-Arabian system of medipine pulse has not been correlated with the derangement of hum our like Sofra and Sauda etc. the ground th at ( a ) A ma­ nuscript— Nadivijnana or Nadichakra has been found written in Sambut 1417 i. mere exami­ nation o f the pulse. And they found th at in Tantrik literature there was also mentioning of pulse. about 1360.46 Nadi-Vijnana chem were com m entator and redactors. during examination o f the pulse the stomach should be neither overloaded nor altogether empty. { 4 ) D uring M oham m adan Sultanat. This fact can be. e. They saw that the Hakim s were well versed in the knowledge and art of pulse examination. the phy­ sicians o f she tim e perhaps had no faith th at by. According to Sharngadhara from this much knowledge of pulse the physician o f a meagre knowledge can assess the deranged conditions of Vayu.. . This was not only challenge for Indian physicians. amphibians etc. M oreover. Pitta and Kapha. In contrary in Ayurveda. Because the knowledge of pulse was first introduced by Sharngadhara a n d 'th a t was too for the physicians of meagre knowledge. the temperament or Mizaz and the vital force or Rooh. instead. the Indian physicians realised ii* inevitable to change themselves with the m arch of the time. Thus they derived their conceptual knowledge from Tantrik literature} whereas they learned the practical knowledge and art of pulse examination from Hakims of Greeko-Arabian medicine. (c)'\The pecularity of Indian pulse is th at its various characters have been correlated with the movements of birds.

P art Two Ayurvedic Review : Applied Literature .

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Sharngadhara’s contribution to medicine may be aptly described as the reaction o f the classical Indian medicine to internal developments that were slowly taking place between the tenth and the thirteenth century. it sepms improbable to assert the exact period as to when Sharngadhara was at the height o f fame. R ay ( 1956 ) “ Its popularity is th at it is based upon the Ayurvedas ( the C haraka etc. The work gained considerable autho­ rity and a great popularity. 1260 to A. In the words of P. was well acquainted with the famous minister Hemadri. In the present context it has been consulted for explanatory notes given on various movements of the pulse. However. Adham ala has written commentary on this work which is considered to be very authentic. In the opinion of Jolly he m ust have flourished a t the latest in the thirteenth century B. so much so. .D . V. Sharngadhara Samhita Sharngadhara wrote his work on medicine. But this m uch is definite that his period may be considered as the post classical period o f Indian medicine. And the period o f Hemadri as Jolly has decided is between A . C.Chapter III Pulse from Sharngadhara Onwards Sharngadhara History does not reveal the clue as regards the determina­ tion of the period when Sharngadhara flourished exactly. Sartan believes that Sharngadhara flourished not later than the thirteenth century. it found a place as the number two in “light-triad” or “ laghutrayi” . among controversies prevailing. D. Ray dajes him in A. and it corresponds to the Muslim period o f India. 4 N. Whole of Sam hita has been divided into three m ain parts-which comprise o f thirty two chapters and 2600 verses. C. Beca­ use Vopadeva. D. one of the comm entators of Sharngadhara Samhita. This work may be consi­ dered as the first standard work of iatro-chemical reforms in India. ) on the one hand and the T an­ trik chemical treatises on the other” . known as Sharngadhara-Samhita. 1363. 1309. The only compromising way appears to be to assure’ that he flourished in the terminal phase of thirteenth century.

cold preparations ( Him ). As regards pulse examination. medical and sur­ gical aspects of treatm ent. eye fomentation. As regards anatomical position. qualities of medical stuffs. effects of seasons. As regards mental states. pow­ ders. tremulous ( Chapala ) and fast. First verse of the beginning deals with anatom ical position o f the artery showing its clinical significance as the pulse. The second part of Samhita has been framed by the union of twelve chapters and deals with the pastes ( A w aleha). liquors ( Asava and Arishta ). Pulse Examination Sharngadhara’s description to pulse examination is conde­ nsed only in eight verses (Shlokas). and scholars ascertain the healthy state or diseased condition of the body by feeling the movement of it. various food prepara­ tions like Yawagu etc. in .50 Nadi-Vijnana The first p art comprising of seven chapters. deals with wei­ ghts and measures under two separate standards of units-K alinga and Magadha. and after the satisfaction of hunger ( Triptavastha ). surgical procedures for blood leting and m ethod of cure like snuffing. oil gargalling. ( b ) pulse in certain mental states. the abnorm al spread and normalization o f Doshas in the body. it has been described in the third chapter of th 6 first part o f Samhita. medicated ghees. electuaries (Paka). and it is for the first time in the history o f Ayurveda that Sharngadhara has included pulse examination in his work as a means of diagnosis. smoking. merits and demerits of dream s etc. the artery found at the root of the thumb ( Fig. 2 ) is evidence of life. As regards physiological conditions * in a person. it becomes steady (Stiiira) and in a healthy person the pulse is steady and strong. who has good hunger and appetite ( Diptagni. different times for drug administration. Kshudha ) the pulse is light ( Laghwi ) to touch. ( c ) pulse in certain pathological states of the body. pills. instillation of eye drops etc. The points mentioned above can be read in following passages. physio­ logy. anatomy. Rest verses deal with fifteen types of pulses which can be categorised as below : ( a ) pulse in certain physiological states of the body. The third part is composed of thirteen chapter's and deals with practical methodology of Panchakarma. M ost of the portion o f the chapter is comprising of description on pulse examina­ tion.

reptiles and amphibians. 4 ). the movements of the pulse in these conditions are correlated with those of the birds. it assumes the curvilinear motion like them. In case. 2 : Radial Artery. in case of anxiety ( Chinta ) and fear ( Bhaya ) it is feeble. As regards pathological states. . it is heavy ( Gurvi ) to touch. its movement resembles to those of the sparrow ( Kulinga ). when the one or the other of the three Doshas and all of them are involved. crow ( Kaka ) and the frog ( M anduka ) ( Fig. in the case when there is excitement of the Vayu. In case of profound intoxication ( Amadosha ). i. the move­ m ent of the pulse is slow. Fig. 3 ) and the leech ( Jalauka ) i. Thus. e. In case of fever it is very hot and fast. and when full of blood ( Raktapurna ) it is heavy and hard to touch and mode­ rately warm ( Koshna ). In the case of excitement of the Pitta. e. in the condition of ppor appetite ( M andagni ) and cachexia ( K shinadhatu ). pulse resembles to the movements of serpent ( Sarpa ) ( Fig.Sharngadhara-Samhita 51 case of lust ( K am a ) and anger ( K rodha ) the pulse is repid.

4 : Frog. In case in which any two o f the three Doshas are invol­ ved the movements o f the pulse is alternately slow and fast. when the K apha is excited the movements o f the pulse resemble to those o f the swan ( H ansa ) Fig. e. the pulse moves slowly. Fig. i. 5 ). 3 : Snake. and the pigeon ( Paraw ata ) ( Fig.52 Nadi-Vijnana the pulse becomes jum ping. In case in which all the three Doshas are equally involved .

Fig. the pulse becomes speedy ( Sottalagati ). indicates death. 5 : Pigeon When the pulse slips from its norm al position (Sthan Vichyuta ) or moves slowly and slowly. indicates death. Healthy pulse 2. when it becomes very thin like lotus fibre ( B isatantuvata com­ mentary on Atikshiria ) and cold to touch. tremulous and fast. Sthira Simile of animals — — — . Various characteristics of pulses described above are given be­ low in table form. e. Light to touch. C hapala and Vegawati.Sharngadkara-Samhita 53 ( Sannipata ) the movement of the pulse resemble to those of the lark ( Lava ). Laghwi. Satisfaction after hunger Characteristics of the pulse Steady and strong. Steady Ayurvedic terms Sthira and Balawati. Good hunger and appetite 3. And also. quail ( Varti ) and the patridge ( Titter ) i. Types of pulse in different conditions 1.

— Snake and leech. Poor appetite and cachexia 7.54 4. Sparrow. W hen summarising th s discussion o f foregoing pages on pulse examination and comparing it with those written in the later period. Full of blood 9. we find that the description in Sharngadhara Sam hita is elementary. Lust and R apid Feeble Slow Nadi-Vijnana. quail and patridge. slow and thready. In other words it does not seek to diagnose the specific diseases. D eath Slow Alternately slow and fast. Anxiety and fear 6 . When any two Doshas are in combi­ nation ( D w a n d aja ) 13. V atika 10. — Lark. Bhavaprakasha Bhavamishra. His work is popularly known as Bhavaprakash. He was a famous physician of his time. Intoxication 8. K aphaja 12. G rahani etc. and it was an im portant attem pt in the direction of introducing the knowledge of pulse examination. D . like Atisara. Vegavaha K shina M andatara Gurvi hunger 5. pigeon — 1 Speedy Very hot and fast Slips from its norm al position.Fever 15. crow and frog. heavy and tepid to touch Curvilinear Jumping Tiryakagati 11. . Swan. according to Jolly flourished in the sixteenth century A. Paittika Heavy Full. Sannipatika 1 4 .

first and the second. ( d ) pulse in mental states. Middle part has been further subdivided into four sub-divisions and deals with the special pathology and the therapy. cosmology ( Srishti U tpatti ). phar­ macology etc. middle part ( M adhya K handa ) and terminal part ( U ttar Khanda ). when the patient has taken his bath immediately or is thirsty or has come ju st from the Sun or is tired due to exercise. (b) rela­ tion between the fingers and different positions of Doshas. The pulse should not be examined. pediatrics (Kaum arbhritya). Fifteen types of pulses have been described.Bhavaprakasha 55 Bhavaprakasha One of the authentic work o f Ayurvedic literature. the examination of the patient. dietetics. So far as pulse examination is concerned. namely. The whole of the verses can be read under the follo­ wing heads : ( a ) specification of sides for pulse examination in male and female. The terminal part of the book of only eleven pages deals with aphrodisiacs ( Vajikarana ) and elixirs. tongue and urine has also been mentioned. and unfavourable conditions when it is not examined. first part ( Pratham Khanda ). embryology. By applying three fingers over the pulse during examination. Vata when vitiated becomes prominent under the ring finger. it has been descri­ bed in the sixth specified subdivision of the first part under the heading “ Rogipariksha” . occu­ pying a place in “ lighter-triad” is divided mainly in three parts ( K handa ). ana­ tomy. indication of three fingers to examine it. Pulse Examination Bhavamishra has condensed his work related to pulse exa­ m ination in twelve verses. First sub-part ( Bhaga ) is composed of six specified sub-divisions ( Prakhandas ). First part is again divided into two sub-parts ( Bhagas ). ( e ) pulse in pathological states. examination of eyes. Alongwith the pulse. the physician can ascertain the ease and diseased condition of the patient. th e Pi tta under the middle finger and the . ( c ) pulse in physiological conditions of the body. These sub-divisions deal with the origin of medicine. T he points mentioned above are hereby explained below : The physician should examine the pulse at the root of the thum b in the left hand in case of female and that of right hand in case of male. As regards relation between different fingers and the positi­ ons o f the Doshas.

In case of appetite it is stremulous and is steady after its satisfaction. In the case when K apha deviates -from its normal position. W hen Vata and Pitta are at fault together the pulse is appreciated in between index and -middle finger. it becomes slow. Various characteristics of pulse are given below in table form : Types of pulse 1. When Vata and Pitta are at fault together its movement be­ comes curvilinear and jumping. The pulse becomes jum ping and slow when there is vitia­ tion of Pitta and K apha. And when all of three are equally involved. the pulse is appreciated under all the three fingers. As regards the pathological conditions. Appetite 3. It assumes curvilinear motion when Vata is deranged and is jumping when Pitta is at fault. In case of loss of appetite and cachexia it is slow. the pulse in fever is very hot and fast. Satisfaction after appetite 4. and when all the three Doshas are at fault the pulse becomes speedy. the pulse of healthy person is steady and strong. it indicates death. its movement becomes curvilinear and slow. In the case when Vata and K apha are at fault. Paittika Characteristics of the pulse Steady and strong Tremulous Steady Fast Feeble Curvilinear motion Jumping Ayurvedic terms Sthira and Balawati Chapal Sthira Vegavaha Kshina Vakragati U tplutya Simile — — — — — -— . Vatika 7. As regards mental states. In case of vitiation of Pitta and K apha the pulse is felt in between middle and ring fingers. As regards the physiological conditions. while it is feeble in anxiety and fear. In health 2.56 Nadi-Vijnana K apha under the ring finger. while it is felt in between ring and index finger when Vata and K apha are deranged. Anxiety and fear 6 . it is rapid in lust and anger. Lust and anger 5. When the pulse slips from its normal position and becomes slow and extremely feeble and cold to touch.

Pitta and K apha respectively. fever ( Jvvara ). Poor appetite Slow — and cachexia 15. slips from — its position extre­ mely feeble and cold to touch 8. In describing qualitative forms of pulses in the conditions of poor appetite ( M andagni ). anger ( K rodha ). K aphaja — — — — — While summarising the discussion of foregoing pages. auto-intoxication ( Amadosha ) and good hunger ( Diptagni ). satisfaction after appetite ( Triptawastha ). we can say that Bhavamishra has added the knowledge after Sha­ rngadhara and they are : ( 1 ) Bhavamishra indicates clearly about the use of three fingers namely. ( 2 ) There is a clear cut indication for specific sites for the examination of pulse in case of female and male. appetite ( Kshudha ).Bhavaprakasha 57 — — Slow M andagati 9. experienced directly under the fingers. V ata Paittika Curvilinear — and jum ping 11. fear ( Bhaya ) and healthy condition (Swasthawastha). but has only mentioned *the different types o f movements such as Vegawati. anxiety ( Chinta). reptiles and amphibians. Vata K aphaja Curvilinear and — slow 12. ( 3 ) Bhavamishra has not correlated various movements of pulse with those of birds. middle ( M adhyama ) and the ring ( Anam ika ) for pulse examination. ( 4 ) Bhavamishra has analysed different characteristics o f pulse produced by combination of any two of the three Doshas. index ( Tarjani ). ( 5 ) He has omitted out certain types of pulses as full of blood. lust ( Kam a ). And thus he has made the subject more objective and practicable. Fever Very hot and — fast 14. cachexia ( Kshinadhatu ). D eath pulse SloW. M andagati etc. Bhava­ mishra has practically followed Sharngadhara. Pitta K aphaja Jumping and — slow 13. . Sannipatika Speedy A tidrata 10. These fingers indicate the condition of Vata.

it has been described in the first chapter of the book under the heading “ Rogipariksha” examination of the patient. there is description of drug preparations like liquors. its period is 1676. Among the existing works related to Ayurvedic medicine. eye etc. So far as description about pulse examination as means of diagnosis is concerned. are also indicated. night and seasons. Thirty three varieties o f pulses are of clinical importance. One type indicates good prognosis. The per­ iod when it was composed. and the second p a rt ( U ttarkhanda ). ( d ) Pulse indi- . Besides. D. K. paste. And on the ground oj the above date. therefore it is cer­ tain that the work must have been composed after Bhavapra­ kash. faces various controversies. The work can bro­ adly be divided into two m ajor parts namely. ( b ) Pulse in physiological conditions and mental states. The work deals with four necessary elements ( Padchatushtaya ).58 JYadi-Vijnana Yogaratnakara The name o f the author of this work is unknown. D . drugs. The whole piilse-lore can be considered under the following heads : ( a ) Indication sides and the method of pulse examination. However. ( c ) Pulse* in pathological conditions. its period can pre­ sumably be placed about in the middle part of the eighteenth century. as phy­ sician. Eighteen varieties deal with the characteristics of pulses in some physiological and other general pathological conditions. nursing staffs and the patient. Gode its period lies between 1650 A. urine. among which fourteen types are completely devo­ ted to described bad prognosis and death. the first part ( Purvardha ). And also there is enumeration of different metals and the process of their calcification. According to Jolly this work should have been com posed'not later than 1746. Accor­ ding to P. and 1725 A. There is description also about dietetics. Pulse Examination Description of pulse in Y ogaratnakara is condensed within forty eight verses. since the work quotes Nirnayasindhu ( 1611 ) and Bhavaprakash ( 16th century ). medica­ ted ghees etc. different regimens to be followed up in the day. Y ogaratnakar occupies one of its position. In the opinion of Singh. Other means of diagnosis such as stool.

6 ). Physician after attaining concentration of mind should examine himself the pulse repeatedly for three times by giving and releasing the pressure alternately over it. Fig. Particularly in case of female. o f soul and mind. In this position the physician should examine the pulse in the first three hours ( Aik P rahar ) of the morning. first the elbow ( K urpar ) of patient should be slightly flexed to the left and the wrist slightly bent to the left with the fingers distended and dispersed ( Fig. tradition and self experience. the physician is advised to examine also the pulse of left leg by applying the knowledge gained from the classical literature. The pulse bel 6 w the thumb detects the ease and diseased conditions o f the patient. should examine by his right hand the pulse below the left thumb in case of female and that below the right thum b in case of male.Yogaratnakara 59 eating bad prognosis. By this procedure he should decide the condition of Doshas in . ( A ) Indication of Sites and M ethods of Pulse Examination : Physician after attaining himself the state of m ental stability and peace. As regards methodology and allied aspects of pulse exami­ nation. 6 . Ayurvedic M ethod of Pulse Examination. ( e ) Miscellaneous descriptions related to pulse.

Sannipatika Snake and Index fin­ ger. —Chapala — Sthira -Kshina -Kshina ( C ) Pulse irt General Pathological States : Various characteristics of pulse in these conditions can be given in the table form : Types of pulse 1. ( B ) Pulse in Physiological Conditions and M ental States : Good hunger Appetite Satisfaction after appetite Lust ( K am a ) Anger ( K rodha ) Anxiety ( Chinta ) Fear ( Bhaya ) —Fast and light —Tremulous —Steady —Fast —Fast —Feeble —Feeble —Vegavati and Laghwi. Crow. and frog Swan. Repeated practice of pulse examination makes the physician perfect in the art and science of it. Ring finger. medium or fast.60 N adi-V ijnana their respective places and the conditions of the pulse whether the pulse is slow. Pitta-K aphaja Characteristics Simile to move­ of pulse ment of animals Relation to fingers 7. pigeon. Snake and frog Snake and swan Monkey and swan Moves very fast with intermi­ ttent pause. lark Middle fin­ ger. Vatika 2. leech. K aphaja 4. The pulse Should not be examined just after the bath. or in combination o f the two or all of the three are at fault together. Vata-Paittika 5. and also whether they are involved singly. cock. Paittika 3. like . in hungry or thirsty states or during sleep and just after awakening and the patient has anointed with oil. This way the physician may be able to know the good and the bad prognosis of the patient. Vata-K aphaja 6 .

fever 18. steady. Fever 61 9.' long and fever simple 16. Vata Paittika Curvilinear. Full o f blood. 8. fever cold and slimy ( Picchila ) 15. W hen carry­ ing flesh ( M ansyaha ) 10. 2. (R aktapurna) 12 . Vatika fever Curvilinear and trem ulous and cold. ( D ) Pulse Indicating Bad Prognosis : Periods indicating death.Yogaratnakara the acts o f wood­ pecker ( K asthakutta ) when cutting the wood. Pittakaphaja W eak. 17. Death within three hours. Heavy . Heavy and hot. a fever bit tremulous and hard. 1. 14. Vata Kaphaj Slow and slightly. Auto-intoHeavy xication 13. coinci­ ding with respiration. Very hot and fast. K aphaja Slow. steady fever and cold. Poor appetite Slow and cachexia 11. and cold. K apha Pitta Fast. Pulse appears and disappears alternately and moves like drum Which is shaped like an hour glass ( D am aru ). D eath withi n a day Characteristics of the pulse Pulse moves like fringe o f shawl.

bad prognosis.it has been cited that as the . The pulse which is amalgum of the three Doshas. 9. Pulse is hot. indicates death. Pulse indicating The pulse moves like swan aod elephant good prognosis. and assumes the circular move­ ment and horrible. Pulse not felt at the proximal end. Pulse. Death within sometimes cold and sweaty and slimy seven days skin. weak. then Paittika and then K aphaja. Pillse with intermittent pause indicates. and disappers from its place. and the patient is happy. visible sometimes in the finger. Death within two days. tremulous with intermittent pause. Patient nearly cold. Sudden death. too much jum ping appearing beneath the fingers indi­ cates bad prognosis. Slow. ( E ) Miscellaneous Descriptions Related to Pulse : In hyperbolic language ju st to give emphasis on the impor­ tance of the pulse exam ination. moves Zigzag ( Tiryaka ) and also like snake. dead. Pulse excessively tremulous. indicates bad prognosis. cold in the middle and appears tired at the term i­ nal part. indicates death within seven days. Pulse becomes speedy at the proximal end. indicates death. weak. runs very fast and 7. fast and the body is cold and 6 . indicates bad prognosis. of lightning and alternately appears and disappears. D eath within three days Pulse carrying excessive amount of m eta­ bolites and cold to touch indicates death within two days. hot and fast and the throat of the patient is full of cough. Pulse extremely weak.62 N adi-V ijnana 3. Pulse first -Vatika. 4. If the pulse beats 30 times in its place in one “ M an” the patient shall survive other­ wise not. Pulse adopts curvilinear motion like that 8. 5. fifteen days. It is a Sannipatika pulse. D eath within patient takes mouth breath.

there is enumeration of greater numbers of pulses indicating bad prog­ nosis and death. And the physician is also advised to examine the pulse first.Nadivijnana by Kanada 63 instrument made of by the union of fine wires ( Sitar ) emits out the various melodic tunes when it is striked. In the end there is instruction to the physician to wash his hand after examining the patient. D hara. Hinsra. This is indicative of that the knowledge of pulse examination can only be achieved by cons­ tant practice and applying one’s own thinking. Different synonyms of ‘N adi’ have also been enumerated in the work e. Dhamini. kills the patient and gains bad reputation. Ofcourse. Y ogaratnakar enume­ rates certain more points of importance than its previous works as Sharngadhara-Samhita and Bhavaprakash. tongue and urine. Eighth. and subsequently eyes. as Vata fof Brahma. But on the ground . there is mentioning of detailed anatomi­ cal position of the forearm including wrist during pulse exami­ nation. Pitta for Shankar and K apha for Vishnu. Snayu. In pulse specific places for gods have been alloted. there is indication that besides examining left hand in case of female. there is indication of the fixed time when pulse should only be examined. Secondly. there is indication to examine the pulse repeatedly for three tim es in the same period. Fourth. Thus in describing pulse examination. Nadivijnana by Kanada No data is available as to decide when K anada came into existance. the pulse should be examined by the physician to know the condition of deranged Doshas in beginning and the end. similarly the pulse of the hand is sufficiently able to tell the various diseases o f the body. Ninth. The physician who does not follow this rule. Therefore. Sixth. the work does not mention about the pulse of a healthy person. stress has also been given to examine the pulse of the left leg in this case. Seventh. and then treat the diseases accordingly. there is clear cut indication of acquiring the knowledge by self experience. the work advocates for the practige of pulse examination as much as it can be to get the mastery over the science. Jivitajna. there is description of quantita­ tive form of the pulse as thirty times. he has clearly mentioned the importance of mental peace to reach at the diagnosis accurately by exmi­ ning the pulse. g. Tantuki. First. Fifth. The period is buried in oblivion. Thirdly.

Regarding pulse examination it has been described that among seven hundred veins. seventy two thousands of them are thick and are attributed to convey the essential elements of five sense organs. ( c ) Characteristics of pu-lse in physiological condition. ( f ) Pulse in general pathological conditions and diseases. ( g ) Pulse indicating bad prognosis. out of these twenty four only one. In addition to pulse examina­ . His mouth. And also. the left hand arid the left leg above. and the tail to the right side of the body. ( h ) Pulse characteristics though appearing apparently of bad prognosis but really not so. which are hollow inside and Contain countless microscopic pores which poure out the essential constituents of food required to the body. From this structure the whole Nadis take their origin. thick and thin in nature lying in the body. Among these arteries again there are seven hundred veins (Sira). These are known as arteries ( Dham ani ). which spreads in the right hand and the right leg. In the morning after being free from his daily routine. the phy­ sician should examine the pulse. Again. ( e ) Pulse as a prodro­ mal symptoms. K anada’s whole pulse-lore is ascribed to one hundred and six­ teen verses. And again. The other description for the origin o f Nadis is. down­ wards and the upwards. And they can broadly be divided into the followings : ( a ) General consideration of origin of ‘N adi’ and examination of pulse ( £ ) Characteristics of pulse after taking different kinds of foodstuffs. should be examined. hands and feet are also the seats of origin of Nadis. the right hand and the right leg down­ wards. Thus they form twenty four in total num ber. these veins having been spread in every directions in the body tie the whole body like a drum ( M ridanga )—a musical instrum ent. only twenty four are quite prom i­ nent. ( d ) Pulse in m ental states. ( i ) Pulse of good prognosis. They are tied in the region of umbili­ cus ( N abhi Pradesh ) from where they spread obliquely. tail. one can dare to say that he was a Tantrik. Two from his m outh. that in the region of umbilicus there lies structure like tortoise whose head is to the left. two from his tail and five from his hands and feet separately take their origin.64 Nadi-Vijnana of internal evidences. ( A ) General Consideration of Origin of Nadi and Examina­ tion of Pulse : There are three and half crores of Nadis.

flattened rice. D uring examination. Sweet food Jumping like frog. There is also mentioning that Pitta occupies the middle position while the Vata lies in the end. 5 N.Nadivijnana by Kanada 65 tion of right hand and left hand. where the artery lies and becomes prominent. Oil. under the index finger and th at of Pitta and K apha is felt in the middle and the end i.77 cake prepared times jumping. e.Molasses Sometimes curvilinear. Parched grain. and substances like molasses. M eat . Molasses. e. 62 Lika rod steady ( Lagudakriti. milk. there is clear-cut indication th at particularly just to ascertain the expectancy of life of the patient. 4. Normally. Green leaves pulse filled with blood. the pulse is smooth in the morning. some­ 63. The pulse of Vata is felt at the proximal end. V. Gourd (Kushmanda) Radi­ sh ( Muli ). resembles the from pulses etc. pulse of Vata Pitta but main­ dry foods & meat tain no order. Banana. molasses Characteristics of pulse Strong ( Pushta ) Verse No. Again. cakes. putting the three fingers o f his right hand at the root of the thumb of the patient. the physician should rub slowly with his left hand the portion of the elbow of the patient. M andatar ) Slow ( M and ) 75 6 . 62. ( B ) Characteristics of Poise After Taking Different Foodstuffs : Different foods 1 . under the middle finger and ring finger respectively. i. 2 . stems roots 76 ^Steady and slow (Sthir and M and) 8. m ust also be examined. The pulse at the root of the thum b is evidence of life. The'pulse should not be examined when the patient has taken his meals or has anointed with oil or is slee­ ping.76 Sthir ) 62 3. the pulse of right leg and in case of female of left leg. examine the pulse of Vata and the other Doshas. 74 Steady and slow ( Sthira and 5. 75 Resembles the movement o f the 7. hot in the noon and the fast in the evening.

. Sthira and M anda ). M ixture o f ail M ultiple movem ents 65 { C ) Characteristics of Pulse in Physiological Conditions : Types of pulse 1. Moves like pigeon Verse No. Lust Anger Anxiety Fear Agitated con­ dition. 7. 5. Salt Straight ( Sarala ) and rapid 65 18. Bitter taste Moves like earthworm 64 14. Liquids 10. 2. 5. Acid taste Slightly hot and jum ping. anger. In Bravery 114 ( D ) Pulse in M ental States : Types of pulse 1. 3.74 15. cold 64. 4. anxiety and giddiness. Astringent H ard and tight ( Jada ) 65 17. 3. fear. 8. Healthy pulse G ood hunger Appetite After sexual enjoyment In the morning In the noon In the evening In the night In normal con­ dition of Vata Characteristics of pulse Steady (S th ir ) Light and fast Tremulous H ot like flame of a candle Smooth ( Snigdha ) H ot Fast Less prom inant than day tiine Uniform. 104 106 104 84 79 79 79 79 85 10. Solids 11. Pungent (K atu) Resembles the movement of 64 sparrow 16. 2. 6. Frozen 12. 4. Sweet taste H ard ( K a th in ) 73 Soft 73 Sometimes hard and sometimes soft 73 Resembles the m ovem ent of 64 peacock 13. 9. 93 93 93 93 97 . Sukshma.66 Nadi-Vijnana 9. steady and slow ( Samya. Characteristics of pulse Fast ( Vegawati Fast ( Vegawati Feeble ( Kshina Feeble ( Kshina Feeble ( K shina ) ) ) ) ) Verse No. fine.

Curvilinear inotion 22 Tremulous 22 Slow 23 Moves sometimes like snake 24 and sometimes like frog. Sannipata Characteristics o f pulse Slow and jumping Verse No. 25 5. I f fever is about to increase 3.Nadivijnana by Kanada 67 { E ) Pulse as Prodromal Symptom : Types of pulse 1. hard ( Kathin j 85 10. 4. 87 14. cold and steady Slow and fast alternately 29 7. 3. Vata K aphaja Sometimes like swan and sometimes like snake 26. K aphaja fever Very fine to touch like thread and slow. Fever Curvilinear 83 9. Paittika fever Light and beats rapidly. 27 6 . Paittika fever Hard. excess metabo­ lites 86 13. 2. 80 Jumping forcibly Miscellaneous movements 80 81 ( F ) Pulse in General Pathological Conditions and Disease : Types of pulse 1. . 2. 86 12. long ( Dirgh ). dominating. beating rapidly. when metabo­ lites are redu­ cing gradually. Paittika fever Straight ( Saral ). Vatika Paittika K aphaja Vata Paittika Characteristics of pulse Verse No. 86 11. Vatika fever Thick ( Sthul ). P itta K aphaja Weak. Lassitude and slight pain in the body when fever is to occur. When Vata is excessively pre­ and very fast. as if the pulse come out associated with of the skin.' Sannipatika Very hot and fast 82 8.

The pulse is very hot and fast. 24. fever due to evil spirit. moving to and fro. moves along with the other Nadis. Pitta K aphaja fever. Vatika fever due to dry feeding 19. during fever. As if. the pulse whirls and is hot. H ot and slow Always dry and harsh 88 15. Moves forcibly like flooded river in rainy season. Desire o f sex F ast and tremulous.W eak and slow. 27. Sexual enjoy. Sometimes beats in its normal position and sometimes in dis­ placed position. when Vata predomi­ nates 18.68 Nadi-Vijnana Tremulous. 20. e. e. Excess fever due to anger and lust. 25. Vishamajwara i. thick and hard. Fever due to anger. 28. 90 91 92 94 95 23. When fever comes on alternate days or on every third or fourth day. Pulse full of blood and excess metabolites in fever. i. Vata Kaphaja. 96 96 96 98 98 99 . Bhuta fever. m ent during fever. the pulse moves in association with the other Nadis. 22. 26. 89 89 D ry harsh and knotted ( Pindasannibha ) Fine. As if. Fever due to lust. 21. fever. P atient of H otter and moves irregularly* fever when takes curd ( Dadhi ). Vata Paittika fever 16. Vata K aphaja fever 17. steady and cold Appears hot beneath the middle finger. intermittent fever.

Patient of fever when takes Kanjee and sour subs­ tances. Am atisar > Thick ( Prithula ) and tight ( D y sentry ) or rigid ( Jada ). 31. 42. When the sto. G rahani (Mai. e. 101 102 103 103 103 104 104 105 107 108 108 108 108 109 . soft and fast. 10^ from indiges. 33. Exercise.W eak. moves like swan 37. but in the hand like frog i. Voluntarily The D osha which predominates retention of during this stage. Cachexia Slow. A fter recovery Slow and light ( Pushtihina ). Poor appetite Slow 36. Indiges tion Slow and h o t 100 Pulse assumes miscellaneous movements. Full of blood Tepid and heavy 34. absorption) slow. e. tion. 40. grief and ju st after reco­ very from fever. In more adva. very slow felt beneath need stage of the fingers with great difficulty G rahani. 43.Nadivijnana by Kanada 69 H ard and tight ( K athin and Jada ) 32.Feeble. 39. Autointoxica.Heavy tion ( Sam ) 35.In the leg moves like swan i.light. 30. A tisar ( chro. jumping. 29. stool.Moves like hood of a snake m ach loaded excessively with good qualities of food. feeble and slow nic diarrhoea ) 41. anxiety. leads the moveurine and ment of the pulse. 38. Bilambika M ostly weak but sometimes jumping.

51. Pulse in poison Curvilinear Pulse assumes curvilinear motion and appears as if it is displaced from its original place.70 44. 112 112 Paittika i. Fistula 55. jumping 115 H ot and curvilinear Slow like swan’s movement. 48. Abscess when not filled with pus etc. Vishtambha 47. e. Cholera and Nadi-Vijnana Jumping like frog. 54. A naha (abdo­ minal disten­ tion) and ure­ thritis (M utrakrichha). Diabetes asso­ ciated with autointoxica­ tion. 56. 52. Always curvilinear H ot Strong ( Pushtirupa ) 113 113 111 111 111 Beaded A bit hot. 46. Diabetic con­ ditions. After vomiting beaten with stone or after extrac­ tion of spear etc. Heavy 109 110 gastro-interitis. 45. When Vata predominates in Vishtambha and Gulma. Pain associa­ ted with the distention of abdomen ( Adhman ). 115 116 Jumping 113 . Pain due to Vata 49. 53. Pain due to Pitta 50.

Nadivijnana by Kanada 71 ( G ) Pulse Indicating Bad Prognosis : Types of pulse 1. 30 2. The pulse appears beneath the index finger like flash of lightning after intervals. very feeble ( imperceptible ). D eath in one day. trem ulous. D eath within 43 . 32 34 4. sometimes beneath the middle finger and sometimes beneath the ring finger. assumes the circular motion. The pulse impinges two finger’s Verse No. Pulse looking quite prominent very slow. W hen all the three Doshas are at fault at the same time. i. the death is certain. causes death wi­ thin a day. steady. When the body is too hot and the pulse is cold and vioe versa. Sometimes jum ping like Paittika pulse. When all the three Doshas are at fault at the same time. disappering form its place and reappearing is due to derange­ ment of all the three Doshas at a time and indicates unfavourable condition of the patient. W hen all the three Doshas are a t fault at the same time. Beats very rapidly and stops suddenly. feeble. the pulse indi­ cates unfavourable condition. e. Characteristics of pulse Slow. thick like rod. like the movement o f large black bee. sometimes curvilinear like Vatika pulse and sometimes slow like K aphaja pulse and when sometimes beneath the index fin­ ger. and the pulse assumes the miscella­ neous movements. moves obliquely is due to deran­ gement of all the three Doshas at a time and is indicative of unfavourable condition. 31 3. 39 41 5.

11. of the thum b and sometimes har ) appears feeble and sometimes strong is indicative th at the pati­ ent will die within 36 hours. when for the most period 36 hours in most does not appear at the ( Twelve Pra­ root. The pulse runs in straight line one finger’s breadth below from the thumb. 9. Death within The pulse beats rapidly for a pe­ seven days. Death within The pulses of both the legs and four days. D eath within I f the pulse appears 1J finger’s three days. breadth below the root of the thumb. 8. When the patient suffering from derangement of the three Doshas at a time and is restless due to temperature and the pulse’is cold. Death within Pulse. he will die within 3 days. Death within four and half an hour (Dedh Prahar) 7. riod and suddenly disappears and . 6.72 half and an hour ( Ardha Prahar ). Death within eighteen hour ( Six Prahar ) Nadi-Vijnana breadth below from the root of the thumb. 12. Death within The pulse moves very slowly 15 five days. indicates death within three days. The pulse runs with temperature l £ finger’s breadth below the root of the thumb. The pulse runs in straight line one finger’s bfeadth below from the thum b. 13. The pulse appears merely like a streak two finger’s breadth below the rest of the thumb and more often disappears. 10. D eath within four and half an hour (Dedh Prahar). the wrist are felt beneath the index finger only. finger’s breadth below the root of the thumb.

is does not Indicate that the patient will die. if the pulse does not beat it indicate that the m an will survive. 73 35 ( H ) Pulse Characteristics though Appearing Apparently of Bad Prognosis but Really not so : Types of pulse Pulse apparently of bad prognosis Characteristics of pulse Always‘due to habit of carrying load. if the pulse becomes fin e or appears after every long pause. D eath within If chronically ill patient becomes one month. and the pulse mimic the picture of derangement of the three Doshas at a time. 13. Verse No. plastering of fractured bone. extremely cachexic or fatty and if his pulse is thin and smooth like earthworm moves slowly in Zigzagway and in case when the pulse is thick and hard like snake and becomes imperceptible after its fast and curvilinear motion. it the pulse does not appear.Nadivijnana by Kanada if there is no swelling in the body. In grief. When the man is captured by evil spirit etc. the patient will die within seven days. 50 51 52 54 . if does not indicate death. fainting. diarrhoea and maximum loss of semen. Due to fall injury. the patient will die wi­ thin one month. fear and grief. being victim of severe cold or in case when one falls from the height or jum ps to a height. the m an still survives.

being neither fast nor excessively slow. e.. the . beats in its 58 normal position. Giving concluding rem ark about the work of K anada. In sucK condition one should not be mislead that all the three D oshas are at fault at a time. soft. and treat the case for excessive derangement of Pitta. ( I ) Pulse of Good Prognosis : Types of pulse Good prognosis Characteristics of pulse 56 Varse No. it can be said that it is independent work on sphygmology which has the following characteristics : ( I ) There is indication that be­ fore the examination of pulse at the root of the thumb.74 Nadi-Yijnana In case when Pitta is deranged maximum in comparison to 75 ¥ a ta and Kapha. W hen the pulse resumes its normal 60 position in relation to its time etc. W hen the characters of the prise 61 coincide with the orders of accu­ m ulation. vitiation and norm ali­ zation of Doshas. it indicates good prognosis. th e'pati­ ent will survive inspite of all the grave symptoms whatsoever may be. If the pulse is quite thin appea57 ring like thread but does not leave its original position i. As long as the pulse impinges at the root of the thumb. the disease is durable and it is indication of good prognosis. it indicates good prognosis. the pulse of Pitta appears first and runs more vigorously than that of Vata ^nd K apha. Pulse is clear. if the patient is treated properly. it beats just below the thumb.

( 4 ) Similarly various types of pulses have also been mentiohed to assess the prognosis of the patient. And all the descriptions related to pulse examination are condensed within ninety six verses. For example. which for convenience can be studied in the following heads : ( a ) Gene­ ral description. ( c ) Pulse in certain physiological conditions. when he flourished.Nadipariksha by Ravana 75 pulse found at the elbow joint should be rubbed lightly. Pitta and Kapha. but really are not so have also been cited. Nadi-Pariksha The whole treatise is attributed to pulse examination. ( 3 ) A good number of diseases to be diagnosed by means of pulse have been enumerated. It is proved by his some verses and the style in which these verses have been cited. . Ravana was a Tantrik. verse eighteen about the traditional change regarding location of Vata. And yet. the period of Ravana is also in dark. after taking certain diets. it is one of. ( d ) Pulse in certain mental states. there is description also that when the patient does only breath through the left side o f the nose.. ( b ) Pulse. “ Nadi-Pariksha” . ( 7 ) The im portant thing to be worth recording is that work mentions differently in.the patient is nearly died. ( e ) Pulse in general pathological conditions and diseases ( f ) Pulse in prognosis. no data are available. and the “ Vayan Swara” . the K apha in the middle whilst the V ata is felt in the terminal part from about downwards respectively. (5) Different types of pulses which apparently appears clinically to be of serious type may be misleading. Ravana in his treatise “ Nadi-Pariksha” has mentioned the name of ‘Nandin’ the one o f the oldest Siddhars of the South. ( 6 ) Four different types of pulses indicating good prognosis are also found in the work. the indica­ tives that. ( 2 ) Varieties o f pulses have been described after taking of food­ stuffs of different qualities. in the verse eighty nine besides other things. The Pitta occupies the uppermost position. and does breath through the right one. and who was well versed in the knowledge of pulse examination. Nadi-Pariksha by Ravana1 Like K anada. In Yogik language or so to say in Tantrik language two sides of the nose through which one inhales are known as “ D ahina Swara” .

supporting with his left hand to the elbow of the patient’s hand to be examined. The artery a t the root o f the thum b is evidence of life and by examining it. the' positions of the Doshas. can be elicited out. in describing the anatom ical position of the pulse ( N adi ) name of N andin and the reference of the veterans of the subject of remote past have been given.76 Nadi-Vijnana ( A ) General Description : It includes the enumeration of other means of diagnosis in addition to pulse. likewise with the help of the pulse. various conditions of Doshas. R avana says that according'to him among other N adis at the wrist. the pulse should be examined. In case of female the pulse of the left hand and that of the left leg. have been mentioned to examine the giVen . Quo­ ting N andin. As regards the relation between the positions of Doshas to that qf the fingers. and their relations to the fingers. the condition of the Vata is detected under . stool. these can be read in the following passages. there exists a N adi a t the root of the thum b which is evidence of life. pati­ ent. And in the leg one finger below the great toe and' also below the malleoli towards the side of the great toe. tradition and his self -experience. pulse is concerned. and in case of male that of the right hand and the right leg should be exa­ mined. in the next verse emphasis has been laid upon its importance. the anatom ical description of the arteiy to be examined as pulse selection of sites related to both sexes and the method of examination. other than pulse examination. the pulse lying one finger in breadth below from the root of the thum b should be examined carefully. In the very beginning in the verse second. Further. and has been cited th a t as the light of a candle helps in recognising the materials lying in the dark. sound. whether they are deranged singly or in combination of any two-'or all of the three are involved a t the same time. In the next verse. They are urine. eyes and countenence. the physician can know the ease and diseased conditions of the body. the physician should press the artery lightly with his three fingers and exa­ mine it by applying his knowledge gained from the classical literature of the subject. So far as. As regards m ethod of pulse examination. touch. tongue. and particularly it should be exami­ ned to know the conditions of the body.

5. Tremulous 27 27 28 . W hen Pitta and K apha are in combination and in normal condition. Healthy pulse 9. 39 39 39 42 normal place 2. 7. Good hunger 10. Other varieties of physiological pulse are given in the table form. tremulous. ( B ) Pulse in Physiological Conditions : The pulse indicating no abnormality moves towards the thum b and appears to be equally moving. Vayu in its Characteristics of the pulse Slightly tremulous. W hen Vata and Pitta in norm al condi­ tion 6 . In Sannipatika condition the pulse is felt under all the three fingers. 43 Steady and strong. Types o f pulse 1 . P itta in its norm al place 3. 43 Feeble. In Vata Paittika condition the . And in the condition of P itta K aphaja the pulse is felt under middle a n d the* ring fingers. steady and slow.pulse is felt under the index and the middle fin­ gers. W hen K apha and Vata are in combination and in norm al condition. K apha in its norm al place 4. cold to touch and steady. straight ( Saral ) and trem ulous. 8. feeble. Appetite A bit trem ulous. In V ata K aphaja condition the pulse is felt under index and the ring fingers.Nadipariksha by Ravana 77 the index finger and that of Pitta and K apha under the middle and the ring fingers of the physician respectively.( Sthula ). 42 T h ic k . \ Verse No. Light and fast. curvilinear and hard. Strong. cold to touch and slow. Soft. Feeble but prom inent and cold to touch. When Vayu is in normal condition.

26.78 Nadi-Vijnana 11. Agitated con­ H ot and fast dition . Satisfaction Steady after hunger and appetite Heavy and Vatika pulse 12. Pulse of a Slow. 47 47 Verse No. Due to volun­ Pulse resembles the character of tary control Paittika pulse. 47 46. In winter Pulse moves like a leech 21.'. After exer­ Pulse does not become prominent cise 19. 17. 22. course 23. Dead foetus Paittika pulse and light 15. prominent and slow 16. 24.. 47 46. ( C ) Pulse in M ental States : Types of pulse Characteristics of pulse 28 34 34 34 38. o f urges of micturition etc. During sleep Strong. Getting a Paittika in nature thorn pierced. dition. Lust 2. Pregnancy The light and heavy conditions of 13. 47 38 35 35 I'.46. M atured pregnancy Vatika and Paittika pulse 14. In Wet con­ Feeble and slow. 24 24 H ot and fast 1. ’ 49 61 46 46 . N octurnal Fine like thread and moves fast emission ( loss o f semen ) 20. K aphaja in nature fatty person and after meals. Forceful Pulse does not become prominent laughing 18. Pulse of in­ Paittika in nature fants 25. After descri­ Curvilinear motion like Vatika bing certain pulse. Desire for sex Curvilinear motion like vatika and after its pulse satisfaction.

and Pitta Kaphaja. Vata Paittika Sometimes fast and — 58 Vata K apha. 40 3. Vatika 2. and Vata and excess of K apha. In reduced Beats after every — 41 ratio of Pitta pause. Pungent and bitter 3. 5. 36 44 44 ( E ) Pulse in General Pathological Conditions and Diseases : Types of pulse 1. fine pigeon 40.Crow and frog 15. ing vigorously. Paittika Characteristics of pulse Simile of the movements of Verse No. 4. | Verse No. K aphaja Steady and slow. stra. Anxiety 4. Sannipatika Combining movement Patridge and 16. lark 6 . In reduced Moves like Vatika — 41 ratio of pulse. the animals Assumes curvelinear Snake and leech Tremulous and jum p. K apha 7.45 like thread and moves slowly and cold to tough. Flesh 2.sometimes slow. .17. Dry foods causing vitia­ tion of Vata Characteristics of pulse Heavy to touch Tremulous due to excess of Pitta. 16 ight ( Sarala ). ja .Swan and 15.Nadipariksha by Ravana 3. Fear Feeble Feeble 24 24 79 ( D ) Effect of Diet on Pulse : Types of pulse 1. Rough ( Ruksha ) and beaded. 18 of all the three Doshas.

noctu-. Indigestion 16.80 8 . Vata paittika pulse when light food is taken. Excess of flesh (Mansvriddhi) 22. Rasajirna 17. Uniform and feeble 50 51 25 25 26 29 29 31 48 Irregular. Cachexia 13. 20. Full of K apha Nadi-Vijnana Fine ( Sukshma ) 50 but without auto-intoxi­ cation (Niram) 9. vomiting. Improper metabolism of Rasa 18. Pulse appears like thread and feeble. Auto-intoxi­ cation (Sama) 15. Pulse with cold. H ot blooded pulse. Incomplete metabolism of metabolites ( M alajirna ) 19. Kathin and Sthula ) 48 H ot and heavy Assurties the character o f fever and chronic diarrhoea. Jumping Very slow ( M andatar ) Very slow Heavy ( Gurvee ) H ard and tight ( K athina and Jada ) Tremulous. 10. 26 49 . Slow ( M anda ) 51 Very fine like thread. Poor appetite 14. slow and cold to touch. Full of blood 21. dia­ rrhoea. causing fain­ ting. hard and heavy (Visham. 11. 12. Full of blood indigestion. long ( Chapala and Dirgh ) Smooth. Residue left after incom ­ plete m etabo­ lism of m eta­ bolites (Malashesha).

35. Grahani Like a dead snake ( M alabsorp. Fever of sud­ First slow becoming den onset and gradually forceful. under all the three fingers and fast. When exce. 2 4 .( quote slow and tion ) feeble ). Susthir and Picchil ). 28. V. 33. perceptible disorder. and cKill. Paittika Fast.Fever H ot and fast 25.Fast bolites are reduced in Paittika fever. 6 N . W hen meta. K aphaja Slow. poor appetite. 81 — 52 — — 56 — — 56 53 —. mulous. 31. Steady and slow and sometimes curvili­ near and straight. and cold ( M and. Diabetes. slimmy fever. loss of blood. 32'. straight and long ( D ruta.Nadipariksha by Ravana rnal emission. 26. indicates sudden fever intermittent fever. 29. Beats rapidly. Piles. and K athin ). Fever due to N ot detected by pulse evil spirit. Vatika Curvilinear and tre­ fever. dizzines s. steady. 23. relatively cold to touch ( Vakra and C h a p a l). Piles and excess m eta­ bolites. 53 54 — — 54 55 95 33 61 62 .Thick and hard ( Sthul ssive Vata. 27. 30. In blood Long. and Dirgh ). 34. Saral fever. Internal fever Pulse is too hot but body is cold.

R akta Pitta Nadi-Vijnana Pulse assumes the character of fever and 62 chronic diarrhoea. Diabetes ( Prameha ) increases repeatedly ( Sukshma & Jad ). 39. Like Pitta etc. Excess depo­ sition of flesh ( M ansa Vrid d h i) 37. 59 Slow. sometimes visi­ 46. Asthma Fast ( Tibra ) ( Shwasa ) Elephant 40. hard and tight 41. K aphaja K asa ( cough ( Sthir and M anda ). 42. K athin and Jad ). predom inated by K apha ).82 36. M adatyaya ( Sukshma. rrhoea ( A tisara ) 43. Steady and slow 38. Fine and fast ( Suk­ 51. hands appears hard and hot ( K athin & Soshna ) 49. hard and strai­ ght ( M and. Fast. K athin and Riju ). D iarrhoea Fine. the 50. In K aphaja diseases shma and D r u t ) 59 59 60 60 61 63 63 63 64 64 67 65 65 65 . 48 Disease rela­ Pulse in both the ted to blood. Vata when pulse is associated covered by with all the symptoms. ( Pandu ) H ard and steady 47. Tuberculosis Moves slowly Fine. Leprosy ( K athin and Sthir ). Vatika dis­ Steady ( Sthir ) eases. Driblling of Jumping urine (M utraghata) Jumping 44. tight and beats 45. Chronic dia­ Slow. Anaemia ble sometimes not. Pitta.

Moves like an hour-glass like ins­ trum ent ( Dam aru ). sometimes jerky. 20 21 68 68 69 69 71 72 . 66 ( F ) Pulse Indicating Bad Prognosis : Types of pulse Bad prognosis Characteristics of pulse Sometimes slow. Jerky movement indicates bad prognosis. If the pulse is distinctly visible on the surface and very fast and is clammy indicates bad prognosis.Nadipariksha by Ravana 52. Diseases of hand and neck. If the pulse appears quite promi­ nent and looking and resembles in character like the pulse of after taking the meat i. and towards. Sannipatik diseases. The disease should be diagnosed with the help o f pulse by kee­ ping into the mind the Doshas involved and their intensity. clammy and fast. Extremely feeble and cold. upper side-the pulse is quite fine and slow and towards lower side it is curvilinear. Pulse sometimes cold. indicates bad prognosis. hard and thick moves slowly and is feeble and Verse No. sometimes fine and sometimes quite slow indicates bad prognosis. e. sometimes h ot and sometimes quite feeble and again fast. sometimes fast. Wood peaker 83 76 53. Cold. Moving very fast for certain beatings and stops suddenly and repeats the same process again and again.

. curvilinear and again like K apha • i. indi­ cates bad prognosis. again occupies its original position. Characteristics of pulse When the force of the pulse is gone but still it is beating and is hardly perceptible it indicates death within one day. i. 84 86 74 75 . e. i. e. comes down slow is indi­ cative of death due to Sannipata. when the order is not m aintai­ ned in its movement. D eath within one day. If the pulse moves slowly and slowly and is tremulous and steadily disappears for a while and is displa­ ced from its normal position. If the pulse of Sannipata first moves like Paittika pulse. it indicates bad prognosis. fastness. 77 Verse No. sometimes slow and gradually be­ comes very fine. W hen the pulse passes through the various stages of extremely feeble­ ness ( Hardly palpable ). e. wet and heavy to touch is indi­ cative of bad prognosis. and sometimes appears beneath the middle finger. sometimes beneath the index finger. First day fast next day after beco­ ming cold. ( G ) Pulse Indicating Death Within Limited Period : Types of pulse 1. ju m ­ ping and again like Vatika pulse. I f the pulse is trembling and is fine like thread and feeble and touches the finger repeatedly.84 Jfadi-Vijnana curvilinear indicates bad prognosis due to derangement of all the three D oshas a t a time. it indicates bad prognosis.

If the pulse impinges beneath the middle finger and tremulous. death of the patient is sure within two days or the patient shall die within 2 days. the patient survives only one day.day. . 3. If the pulse o f a healthy individual 87. If the patient is victim o f severe 82 fever ju s t a day before and his pulse constantly appears like flame only beneath the middle finger. kills the pati­ ent in a. the patient will die within seven days.Nadipariksha by Ravana 85 2. D eath within three days. 88 comes down from the ro o t of the thum b when the patient does not extend his palm. If the pulse suddenly impinges like 73 lightning flash underneath the index finger. it indicates death within three days. the pati­ ent will die within four days. 5. D eath within seven days. If the pulse does beat beneath the 80 index finger and is cold beneath the middle finger and is fine and slow. I f the pulse moves beneath the index 85 finger like hour-glass instrum ent trem ulous in nature. I f the pulse appears like a flash of 88 lightning when the hand is raised up. D eath within four days. the patient will die within a day. and again reappe­ ars a t the root of the thum b when the hand is extended it indicates death within three days. D eath within two days. 4. If the pulse impinges fast beneath 78 the index finger and sometimes becomes cold and there is sweating the patient will die within seven days. If the pulse suddenly being interr83 upted does n ot appear a t all bene­ ath the index finger.

R avana’s Nadipariksha is also an independent work on sphygmology. Like K anada’s work. 79 ( H ) Pulse Indicating Good Prognosis : Types of pulse Good prognosis Characteristics of pulse I f the pulse beats thirty times at its norm al place.86 6. after Lathi charge. grief. Verse No. And almost covers the same range as the later in describing diseases and prognosis to be diagno­ sed and assessed by means of feeling the pulse. the patient will survive. patient will survive and will not dizziness and die. fear. Nadi-Vijnana I f the pulse is quite . 94 ( I ) Pulse Apparently of Bad Prognosis but Really not So : Types of pulse Characteristics of pulse Verse No. The work of R avana also describes the character o f pulse in infants. 12 D ue to heavy If the pulse stops its beating. It is written in the same form as the work of K anada. the pati­ ent will die within 15 days. . the load. Death within fifteen days.hot and runs very fast and the body is cold and there is m outh breathing.

Pulse beats like the progression of a goose. Pulse beats like the progression of an aquate anim al ( evidently fish ). I f the pulse is n ot displaced from its own site and seems to be slender. ( A ) Pulse Conditions Indicating a Favourable Prognosis : Types of pulse Good prognosis Characteristicis of pulse Pulse beats uniformly at the root of the thum b. ( b ) Pulse conditions indicating a favourable prognosis ( here may also be considered a group of cases where the pulse condition. Bhavaprakash etc. Pulse in Prognosis Pulse in prognosis as described in other books of sphygmo­ logy may be dealt with under three headings : ( a ) Pulse con­ ditions indicating a favourable prognosis.Chapter IV Pulse in Other Treatises of Sphygmology G hosh ( 1929 ) after his extensive research have had publi­ shed a good series o f articles on the subject “ The*Nadi system in Ayurvedic medicine. The curve produ­ ced by the movement of fish in water is more or less wavy and may be likened to a normal pulse. Among the various aspects o f the subject a good deal of description has also been given about the importance of pulse in assessing the expectancy of life of the patient. . various other books on sphygmology have also been consulted. seemingly unfavo­ urable do not indicate any unfavourable prognosis and ( c ) Pulse conditions revealing the time of death.away. Besides Sharngadhara. peafowl ( M or or M orani ) a t the site of K apha indicates good health. there is fear o f his death and the disease will also go. Upanishads and Tantrik literature”. Pulse beats like the progression of a quail at the site of Pitta indicates good health. it indicates no defects.

Unfavourable prognosis. Extreme slowness of th e pulse. e. In most cases the condition is produced as incurable. Extreme smallness. The pulse which is very soft ( nearly imperceptible ) indicates death. I f the pulse be deep-seated ( th at is scarcely perceptible ) indicates death. Unfavourable prognosis indi­ cated by single sign. Extreme slowness of the pulse.88 Nadi-Vijnana ( B ) Pulse Conditions with Unfavourable Prognosis : A large number of pulse characters have been recorded in various treatises. The following pulse conditions are indicative of bad prognosis. Crookedness of the pulse. Types of pulse 1. Displacement of the pulse. Imperceptibility of pulse. A number of pulse conditions have been mentioned severally so as to give a general idea of the bad conditions. Hardness ( this indicates that the pulse is felt between the beats ). the pulse becomes imperceptible a t the time of death. Extreme softness of the pulse. This evidently refers to a “running pulse” . . Displacement o f the pulse f rom its normal state. In case when three Doshas a t fault a t the same tim e. Characteristics of pulse Rapidity. the condition of the patient should be con­ sidered hopeless. The pulse which beats slowly indicates death. The pulse beating like the progression of a sparrow ( i. The pulse which gradually leaves its normal position means death. which beats quickly and by 2. If the pulse beats in the wrist and then again has no movement beneath th e (examining) fingers. The arrhythmia o f the pulse. The pulse dis­ placed from its normal position indicates death. Irregularity of the rhythm.

jt indicates death. 3. scarcely perceptible ) then the physician should know that the patient will die. e. I f there is no pulse. If the pulse beats with extreme rapidity. this indicates a hdpeless condition. the p atient will not live for a moment. If the pulse is very fine and is very soft ( nearly im perceptible). it indicates death. it prognosis indi­ indicates death. noses. e . If the chest. . cated by two If a pulse is tranquil ( i. e. the life exists long as the pain is there. and the pulse is very quick and fine ( thre­ ady ). If the pulse beats very slowly and becomes displaced from the norm al site.Pulse in Prognosis 89 jum ps for a num ber of times and then stops beating for while ) indicates at condition curable with difficulty. The running pulse. tible-perhaps indicating extreme slowness ) a n d is very soft ( low ). the beats are minute ) and is very quick or very soft ( i. The pulse. beating in the moderate rate a t the base of the thum b. The disappearance of the pulse. If the pulse is slow and soft it soon kills the patient. If the pulse is very fine ( i. which is fine ( i. If the pulse. scarcely perceptible ) then th e physician should know th at the patient will die. nearly impercepsigns. there is a great doubt for the life. thigh and legs are cold. e. Unfavourable If the pulse is very weak and very 'soft. e. unfortunately leaves the site and slowly becomes forcible. it indicates death. be felt or n ot and if there is severe pain in the heart. beats are minute ) and is very quick or very soft ( i . it indicates death. I f the pulse displaced from its site.

Unfavourable If the pulse is very rapid ( running ) or is Prognosis by very deep-seated ( i. If the pulse is very soft in patient with high fever. it means death. If the pulse gradually becomes very slender ( very small ) and feeble ( forceless ). there is no hope for the life of the patient. The extremely soft ( i. strong like In d ra-h ard and feeble). e. . run­ ning ) or -very deep-seated in the flash ( i. e. e. and if the pulse'is dis­ placed from its normal place. If the pulse is slow at one time and quick at another. rded by signs. forcible in a cold body and if the pulse beats irregularly. e. very slender ( fine ) and quick ( run­ ning ) pulse is for rapid death. it indicates that the three Doshas are at fault together. e. nearly imperceptible > and is fine ( thready ) and curved. indicates death. If the pulse is felt in the leg. If the pulse is trembling ( tremulous ) and beats very quick ( or thread like ) and again strikes the finger. Unfavourable prognosis reco­ tible ). the death is to be considered to take place soon. nearly impercepti­ 4 or 5 signs. there is little hope of his life. ble ) and it is fine ( thready ) and curved. the patient does not live. it indicates that three Doshas are at fault. If the pulse becomes soft in high fever and it becomes hard. If the left pulse ( pulse on the left hand ) beats really in a curved manner and if it is like Sakra ( i. but not in the wrist and there is an anxious look. 5. The pulse which is very quick ( i.jo e s down like a flash of light­ ning and is felt-at one moment and not at another the patient dies as if s t uck by light­ ning. it indicates death. there is no doubt of his death.90 Nadi-Vijnana If the pulse. nearly impercep­ 4.

e. the patient will die in 15 minutes. the beats are i repeated by long gaps and if the pulse gra­ dually leaves it normal site. If the pulse beats with a sharp rise. is very slow and deep-seated and if it is fine and crooked ( with low rise ). Indicating death in 18 hours. If the pulse is seen rising up from beneath the skin. e. the patient will die in 15 minutes. frequent at another and is missed at times and if it is fine at one time and large at one another. If pulse is agitated ( i. If the pulse beats crookedly beyond the first examining finger ( or beyond one finger’s bread th ). if it is very slippery ( i. it means death in 18 hours. very soft and slow. it indicates death. If the pulse is displaced to the width of one finger and a quarter from the wrist and is curved. ( G ) Pulse Conditions Revealing the Time of Death : Types of pulse 1. Indicating death in 21 hours . there is no hope of life. slips be­ neath the examining fingers ) it indicates un­ favourable prognosis.Pulse in Prognosis 91 If the pulse is rising obliquely and if it is frequent like the progression of a snake and if K apha collects in the throat. Characteristics of pulse If the pulse is displaced to a quarter of a finger’s breadth and rem ains imperceptible. the patient will die in 21 hours.. If the pulse is displaced to the breadth of one finger a n d a half from the -wrist and if it is crooked. there is no hope of life. beats are not unifrom ). there is no hope of life. 2. the patient will die in 18 hours. If the puls-e becomes imperceptible Upto the middle examining finger. I f the pulse is slow at one time.

92 3. Indicating death in 24 hours ( one day)

Nadi-Vtjtuma

4. Indicating death on the second day.

5. Indicating death in 27 hours.

The pulse beats slowly on the inner side of the space of one finger’s breadth from the wrist, the patient will die in 24 hours. If the pulse beats rapidly for 4 days, the patient will die in 24 hours. If the soft or sl6 w pulse is felt at one time and not a t another, the patient will die in one day. If the pulse at wrist beats like an hour-glass, drum (that is the pulse becomes thready and running), the patient will die in one day. If the pulse beats like the progression of a hornet that is the pulse becomes very small and thready, the patient will live for one day. The pulse beating like the progression of a leech in a patient with bodily pain, indicates death in one day. Very slow, sometimes displaced from its position, very small and soft. If the pulse becomes irregular at the base of the thumb, it is felt upto the place o f the middle examining finger, then becomes very small for a little while and then beats, as before the same num ber of fingers, the pati­ ent lives for the day and night and die on the next day. I f the extremely slow pulse appears like the flashes of lightning, the patient will live for one day and will die on the second day. If the pulse remaining a t the wrist strikes the examining finger like a flash of lightning the patient will live for one day and will die next day. I f the rapid pulse at the end of delirium is attended with very high fever, the patient will live for a single and will die on the second day. If the pulse remains very soft (nearly imper­ ceptible) beyond one finger’s breadth from the wrist, the man will die in the course of 27 hours.

Pulse in Prognosis
6 . Indicating

93

death in 30 hours. 7. Indicating death in 33 hours.

8. Indicating

death in 36 hours.

9. Indicating death in 39 hours. 10. Indicating death in 42 hours.

If the pulse beats rapidly beyond less than ^ of a finger’s breadth from the wrist, the patient will die in 30 hours. If the pulse remains jerky within less than J the finger’s breadth from the wrist, the man will die in 33 hours. If the pulse remains soft within less than \ finger’s breadth from the wrist, the m an will die in 33 hours. If the pulse remains soft and curved ( that is of very low ascent ) within less than 1/4 ( i. e. 3/4 ) the finger’s breadth from the wrist the patient will die in 36 hours. If the pulse often rem ains imperceptible in the wrist and then strikes the finger’s breadth from the wrist, the patient will die in 36 hours. If the pulse remains very soft within quarter of a finger’s breadth from the wrist, th e patient will die in 36 hours. If the pulse becomes very quick, with the beats distinct from one another and if it is accompanied by high fever a t the end o f the day, the patient will die in 36 hours. If the pulse rem ains very soft and crooked within 3/4th of the finger’s breadth from the wrist, the death will occur in 36 hours. If the pulse rem ains within 3/4th the finger’s breadth from the wrist, the death will occur in 36 hours. If the pulse of Pitta character is not found in the right leg ( ankle ), then death will occur in 36 hours. If the pulse is very soft and is felt a t half the breadth o f a finger from the wrist, the patient will die in 39 hours. If the pulse is displaced to half the width of a finger from the wrist and if it is jerky and rapid, the patient will die in 42 hours.

94

N adi-V ijndna

11. Indicating death in 45

hours.

12. Indicating death in 48 hours.

13. Indicating death in 3 days.

I f the pulse is displaced to half the breadth of a finger from the wrist and if it is very rapid, the patient will die in 45 hours. If the pulse is displaced to a quarter o f a finger’s breadth from the wrist and if it beats very rapidly, the patient will die in 45 hours. If the pulse beats frequently at one and half a finger’s breadth from the wrist, it means death in 45 hours. If the pulse is simple and is displaced to a quarter of a finger’s breadth from the wrist, the patient will die in 48 hours. If the quick and low pulse be accompanied by high fever in the middle of the day, and it becomes imperceptible, the death occurs on the second day. If the pulse is very slow at the wrist and is sometimes not felt at all, the patient will die on the second day. If the pulse is having the characteristics of Pitta, Vayu and K apha successively, remains in its place, sometimes leaves it is attended w ith high fever and then becomes very quick and soft, it indicates death on the second day. If the three Doshas are deranged the same time, the pulse becomes very soft and indi­ cates death in 3 days. I f the pulse is imperceptible at the wrist ( beneath the first examining finger ), and is very feeble on the other side ( beneath the last examining finger ), and if the pulse is thready, the patient will not even live for 3 nights. If the pulse which was originally slow in the natural position, becomes fine ( thready ) and very quick it indicates death in 3 days. If the pulse is very soft ( nearly imperce­ ptible ) is attended with high fever, has the individual beats indistinct due to derange­

Pulse in Prognosis

95

14. Indicating death in 4 days.

15. Indicating death in 5 days.

16. Indicating death in 7 days.

m ent of the three Doshas at a time, it indi­ cates death in 3 days. If the pulse is displaced to a quarter of fin­ ger’s breadth from the wrist and if it be­ comes quick and curved, it indicates death. If the pulse is not felt in the right leg but is uniformly beating in the wrist, it indicates death in 3 days. If the pulse leaves its site by half the length of a barley grain, the patient will die in 3 days. If the pulse is displaced to a quarter of a finger’s breadth from the wrist and if it becomes jerky and quick, it indicates death in 4 days. If there was high fever on the last day and if the pulse beats continuously like the pro­ gression of a quail at the wrist patient, he will die in 4 days. If the pulse is not full in right leg ( ankle ) and in the hand, but it beats continuously at the wrist, the patient will live for 4 days. If the Pitta becomes snake like, the Vayu becomes crooked and if the beats are disti­ nct at night the death will occur in 4 days. If the pulse beats very slowly after having been displaced to a quarter of a finger’s from the wrist, it indicates death in 5 days. If the pulse in the leg is displaced for half the width of a barley grain from the wrist, the patient lives for 5 days. If the pulse becomes frequent at one mo­ ment and infrequent at another, it indicates death in 7 days. It the pulse beats forcibly at the wrist at one time, becomes very soft ( nearly imper­ ceptible ) at another and if it is attended with clammy sweet, the patient will not live for 7 days. If increased rhythm ic movement of the novel, death occurs in a week.

96

N adi-V ijnana

17. Indicating death in 8 days. 18. Indicating death in 15 days. 19. Indicating death in 1 month. 20. Indicating death in 5 weeks. 21. Indicating death in 6 weeks. 22. Indicating death in 3 months. 23. Indicating survival more than 5 years.

If the pulse is frequent at one moment and infrequent a t another and if tfyere is no dro­ psy, the patient dies in 7 days. If the pulse in the raised hand resembles a flash of lightning, the patient dies in 7 days (the pulse suddenly appears and disappears). If the pulse is not a t the root of the hand, the patient lives for two weeks only. If there is perspiration in fever and breath­ ing by the m outh, the patient will die in 8 days. If the pulse is very frequent, the body is cold and the respiration is hurried, the pati­ ent lives for half a m onth. If the pulse heats like the progression of an earthworm and again like that of snake, if it is slender and fine ( that is thready ), the patient dies at the end o f a month. If the pulse is infrequent and crooked ( cur­ ved ), the patient will die in 5 weeks. If there is no pulse between the brows and a fine pulse at the root of the neck, the p a­ tient will live for 6 weeks. I f there is no pulsation in the cardiac region or the pulse is fine in the armpit, the life is for 3 months. If the pulse at the root of the hand ( a t the bend of the elbow) is felt as a short slender, the m an will live for more than 5 years. I f the artery in the left axilla is felt as a long slender cord, the man will live more than 50 years.

In several old treatises most of which are now lost and are only known by passages quoted from them by later authors, we find the pulse conditions mentioned in connection with longevity as is mentioned in 22 and 23 in last two passages.

Last portion deals with the clinical section o f the review. the discussion about the pathology of arterial diseases has been made. Regar­ ding the mechanism. ( b ) to mention the common arterial diseases. This is followed by the description of physiology in which the histology of radial artery and the principles of haemodynamics etc. effort has been made to explain the mech­ anism of pulse formation on the fundamental principles of haemodynamics. 7 N.MODERN REVIEW The aims of furnishing the modem review . Next. and ( c ) to discuss the clinical importance of pulse examination. V. First of all the antoitty of radial artery has been described. of literature on sphygmology are ( a ) to describe the mechanism of pulse for­ m ation with the description of anatom y and histology of radial artery. have been mentioned. .

L j A .

7 : Radial Artery the radial side of the forearm to the wrist. The pa»i of the radial artery which lies infront o f the lower . where its pulsation can readily be felt in the interval between flexor carpi radialis tendon medially and the salient lower p a rt o f th e anterior bor­ der of the radius laterally. because it is easily accessible and lies against 'th e bone. a second a t the wrist. 7 ). one in the forearm. I t begins a t the division of the brachial. G ray ( 1973 ) describes th at the radial artery than its contem­ porary ulnar artery is the more direct continuation o f the bra­ chial trunk.Chapter V Anatom y and Histology of Radial Artery Anatomy of Radial Artery F o r clinical examination o f the pulse the radial artery is chosen. below the bend of the elbow ( Fig. and a third in the hand. about 1 cm. The radial artery is divisible into three p arts. and passes along .Fig.

In the forearm it is sometimes super­ ficial to the deep fascia instead of beneath it. have one structural component in common. and ( 3 ) tunica adventitia ( Fig. arranged longitudinally the outer surfaces of which are covered with a typical basal lamina clo­ sely abbuting upon the internal elastic lamina. th e .102 Nadi-Vijnana end of the radius and on the lateral side of th e tendon of the flexor carpi radialis is used clinically for observation o f the pulse. 8 : Histology of M edium Sized A rtery The arteries have three main coats from within outwards ( 1 ) the tunica intima. The internal . Som etim es'the origin of the radial artery is higher than usual. In th at circumstance it then branches more often from lower p art of the latter. This inner lining is continuous from the arteries through the capillaries to the veins and to the inter­ nal lining of the heart. ( 2 ) tunica media. the innermost lining. Histology of Arteries Bel et al ( 1967 ) mention that all the blood vessels of w hat­ ever size have smooth inner lining of flattened endothelial cells joined edge to edge. The tunica intima or inner coat consist of a single layer of elongate endothelial cells. The following description refers mainly to a medium sized and small arteries.whole blood vascular system. Therefore. a smooth lining throughout of a single layer of endothelial cells which in the heart from the endocardium. namely. of which the radial is also one. from the finest vessels up to and including the heart. Fig. In turning round the wrist. it is occasionally superficial instead of deep to the ex­ tensor tendons of the thumb. 8 ).

The tunica adventitia consists of collagenous and elastin fibres which run predominantly in a longitudinal direction. and particularly the aorta. They ramify in the loose areolar tissue connecting the arte­ ry w ith its sheath. The larger arteries. That i s why medium and smaller sized arteries are mostly muscular in their structure and in this way they differ from the larger artery such as aorta. Since tunica media or middle coat is having less elastic tissue than the lar­ ger vessels as aorta. So far as large arteries of the elastic type such as aorta and its main branches are concerned they differ a bit in their histo­ logical appearances and so in their construction. so far as tu ­ nica intima. They arise from the branches of artery itself or of neighbouring ves­ sel. and its m ain branches. and after forming a dense capillary network in the adventitia.architectural differences between aorta and its branches and the medium and smaller arteries are quite analo­ gous to their function. contain a relati­ vely greater proportion of elastic tissue in their walls than do the smaller arteries. Imm­ ediately adjacent to the smooth muscle of the tunica media the adventitia contains m uch elastic tissue which here constitutes thfe fenestrated external elastic lamina. Because the latter are mostly of elastic type and also they differ a bit in their histological appearances and so in their construction so far as tunica intima. tunica media is concerned. the internal elastic lamina stands out in sharp contract. The nutri­ tional requirements for the remainder of the vessel wall are . the arterioles. The arteries are supplied with blood vessels called Vasa vasorum. are almost entirely muscular. The tunica media in medium and smaller arteries consists mostly of smooth muscle cells with scattered elastic membranes and a few collagen fibres. is thrown into characteristic wavy fold as shown in the figures. supply the outerpart o f the media. The walls of the smallest arteries o f all. We should remember here that the.Histology o f Arteries 103 elastic lamina is a fenestrated elastic membrane which appears in the transverse section as a high refractile zone which due to agonal contraction of the muscular media. These are also known as nutrient arteries. tunica media and tunica adventitia is concerned. merging into the surrounding areolar tissue and so allows considerable move­ ment between the artery and the neighbouring structures. The outer portion is somewhat loosely arranged.

but some may mediate pain impulses under certain pathological and traum atic states. Thus summarising. receive their sup­ ply in peripheral nerves coming of in a series of small bran­ ches. However.( 3 ) in the skin following afferent nerve stimulation. The significance of afferent nerve fibres in the general systemic arterial tree is uncertain. nervemediated vasodilator action is seen ( 1 ) in skeletal muscle vessels which secure a cholenergic sympathetic innervation. we can say that the vasodilatation of parts of the vascular system can be achieved in mainly two ways : ( 1 ) nervous and ( 2 ) chemical and further nervous mechanisms of vasodilatation can be : ( a ) reduction of sympathetic constrictor tone. They imply themselves into the vein or veins accompanying the artery. The majority of nerves supplying the arteries are non-myelinated but some are myelinated.104 JVadi-Vynana obtained by diffusion from the blood in the lumen of the ves­ sel. Besides nervous control of vasodilatation there are also chemical substances produced in increasing amount due to increased metabolic activity of the tissue. .. M inute veins return the blood from these vessels. the collaterals of which ramify on neighbouring blood vessels and form the stru­ ctural basis for the so-called‘axon reflex’. and it is thought that the fenestrations in the elastic lamina are im portant in this regard. Unlike the largest trunks which receive branches direct from the sympathetic gan­ glia. The non-myelinated fibres are most ly efferent and constitute the vasoconstrictor nerves to the vessels along which passes the continuous flow of impulses responsible for the variable ‘Vasomotor tone’ o f the vessels. The nerve fibres ramify in the adventitia and then approach the outer layer o f the medial smopth muscle cells through the fenestrations in the external elastic lamina. ( b ) speci­ fic activation of vasodilator nerves. the smaller arteries such as brachial etc. The majority of blood vessels do not receive a vasodilator innervation and in these. (2) in various exocrine glands following secretomotor activity with the secondary release of the vasodilator bradykinin. neurogenic Vasodilations follow a reduction of sympathetic vasoconstrictor tone. The myelinated fibres are believed to afferent and are distributed to the outer and inner coats where they terminate in expanded and varicose endinge. Lymph vessels are also present in the outer coat. The terminal area o f non-myelinated nerve fibre is extensive.

Potential energy thus stored during cardiac contraction by the elastic tissue of the aorta and its branches. The peripheral vessels like radial.. traum a and many other physiological events and thus may affect the pressure-volume curves. cold. distensibility o f the ve­ ssels is governed by their content of elastic and collagen tissue and smooth muscles. The elastic recoil o f the vessels sus­ tains the pressure head better and renders the blood flow to the periphery steadier that it would otherwise be. which by virtue of their shortening can reduce the lumen of these vessels considerably. . changes in their radius more­ over. as we know.Chapter V I Physiology of Arteries and Mechanism of Pulse Formation Physiology of Arteries As regards functions o f the vessels. femoral etc. The arterioles which are almost muscular provide the great majority o f peripheral resistance. 'Systolic ejec­ tion distends aorta and its large branches. Such a set-up permits adaptation to accomodate changing volumes o f circulating blood. This is initiated by heat. We have seen in the previous discussion that larger. is reconverted into kinetic energy for the circulation during the diastolic phase. have predominance of smooth muscle fibres arranged circularly. aorta and its large branches are termed as windkessel vessels. determine the blood supply of the different regional circuits. Samson Wright ( 1971 ) says that due to high elastic property. subsequent to the closure of the aortic valve at the term ination of the systole of left ventricle of the heart. Degenerative changes in the media o f large vessels cause a loss of arterial elasticity and a high pulse pressure ( systolic pressure minus diastolic pressure ) results owing to the lack of the windkessel effect. medium and smaller vessels have a prominent component of elastic tissue with special reference made to aorta that it is endowed with highly elastic tissue.

Mechanism of Pulse Formation The mechanism responsible for the generation of pulse can be better explained through the interpretation of diagrams. 9 : M echanism of Pulse Formation the piston and tied into an artery. Bel et al ( 1970) mention that in a cylindrical blood vessel the intravascular pressure ( P ) tending to increase the size of the vessel is opposed by the tissue pressure ('P T ) tending to limit dilatation. This occurs simply because the blood is incompressible. The difference bet­ ween the two is the transm ural pressure ( P T M ) the total force tending to expand the vessel. If. 9 ). The transm ural pressure at which critical closure takes place is known as critical closing pressure ( C C P ) or flow cessation pressure. This immediate incompressible column of blood producesa . Alteration in the calibre of the vessels are automatically adjusted by variations in elastic tension over a wide range of transmural -pressure. and active tension (T R) due to the state of the smooth muscle in the vessel walls and independent of stretch. then they can contribute no elastic tension and the system becomes unstable.. depen­ dent mainly on elastin and collagen fibres. namely elastic tension (T E). Should the transm ural pressure fall any further then Tc/r ^ vis the radius of the vessel) be­ comes greater than P T M and the vessel closes ( critical clo­ sure ). however. there is a tube fastened with Fig. Suppose.106 Nadi-Vijnana Considering about various pressures and their role in a cylindrical blood vessel. if piston is pushed forward towards the right into the tube the vessel distends loca­ lly. As shown in the diagram ( Fig. the transmural pressure is reduced to the level at which the elastic fibres are no longer stretched at all. This expanding force is encountered by the tension in the vessel wall ( T C ) which itself has two components.

the expelled blood is really accomodated in them. the vessel wall at point B continues to distend and the pressure continues to rise while the vessel at point A continues to shrink and the pressure continues to fall. Consequently. This causes the vessel wall to distend at point B. distending the vessel a t point C and relaxing the vessel wall at point B. Instead the next sectioii of the artery is stretched so th at a wave of pressure travels along the vessel wall w ithout involving actual transmission o f blood. innominate and subclarian arteries are highly dis­ tensible and so. such a t point A causes bulging of the tube a t the point of ejection. A B C 0 Fig. This wave o f distension is transm itted along the arteries and w hat we feel as the pulse. Similarly the largest arteries. In the figure 10. which is in fact a mass of incompressible blood. This means that the pulse is actually a wave set-up in th e walls of the vessels by the"systole of the ventricle and it is not due to the passage of blood along the arteries ( Fig. im m ediately after the vessel wall is distended at point A the elevated pressure a t this point forces a small am ount of fluid along the vessel. So it is very clear that the elastic property of the arterial wall takes the part in the generation and transmission of the pressure wave of the pulse. and the pressure in the area of the tube rises. 10 ). such as the aortic arch. A fter point B is well distended. . it has been shown th at sudden ejection of large quantity of fluid into a distensible tube.Mechanism o f Pulse Format ion 107 local increase of pressure that has little effect on the advancing piston. as illus­ trated by the arrows. 10 : M echanism of Transmission of Pulse Wave. while-at the same time the vessel begins shrinking at point A. the elevated pressure at this point causes fluid to flow to point C. This process is repeated by small increments along the entire length of the vessel until the pressure wave reaches the end of the vessel.

In his article first published. and further stated that after initial delay between vertical and ascending aorta. In the same year Hickson McSwiney showed that the pulse wave velocity varied with respiration. 7 meters per second the movement o f the red cells or plasma is m uch slower a t 10 to 20 cm. Bazette and Dreyer ( 1923 ) demonstrated that pulse wave yelocity was slower in larger vessels—4 m eter per second . it would be appreciable here to throw light on the velocity of the pulse wave. viscosity and cross sectional area o f the blood vessel. This is to be natu­ rally expected since the latter occasions the former. per second. if there would be an appreci­ able lag time between the pressure pulse and the f aid displace­ m ent or movement of pulse wave from segment to segmeqjt. And as the sum o f the cross sectional area is con­ cerned. This is because the speed of the blood depends on such factors as the blood pressure gradient. Thus although the pressure wave or pulse may reach the vessel o f the foot in 0.’ Spencer ( 1958 ) stated that in the upper a irta pressure and flow start together. e. it varies inversely as the total cross section o f the vascular bed.8-1. However. Bramwell and Hill ( 1922 ) demon­ strated that the velocity o f the pulse increases with the age clo­ sely following the rise in blood pressure. but it was not supported by any figure.0 m eter per second and about 0. So far as rate o f flow Versus cross section is concerned. it requires several heart beats for the blood which enters the ascending aorta to reach the foot vessel. the pressure pulse seems to be proppgated at a steady rate through the aorta. he introduced the idea of ‘large lag. it increases progressively as the arterial system divides and redivides. Also. Bramwell et al ( 1923 ) pointed out th at pulse wave velocity varied with the pressure within the artery and with the extensibility of the arte­ rial wall. which occurs as one grows older.108 Nadi-Vijnana Peterson ( 1952 and 1954 ). As regards velocity of the'pulse it is de­ termined almost entirely by the elasticity of the wall. whereas the pressure wave travels in the term of meters per second i.0 millimeter per second in capillaries. the first scientist who raised the question against the problem that. Again Remington ( 1963 ) hypothesized and supported the view of Peterson that there appears to be a true lag of about 5 msec. So naturally the velocity of blood in aorta is 0.2 second.5-1. Gregg (1967) states that almost simultaneously the acceleration of blood occurs with the rise of pressure pulse in the aorta and arterial tree.

Starling ( 1968 ) says that the pulse wave velocity is independent of the output of the heart with each stroke and so is a better indication of the elastic behaviour of the arteries than is the pulse wave. Here one should be very clear in his mind as also foregoing discussion under the head ‘mechanism of pulse form ation’ pro­ ves th at the phenomena taking part in the formation of pulse chiefly concern with the mechanism of haemodynamics of car­ diovascular system.Mechanism o f Pulse Formation 109 in artery as brachial com pared with 8. and this mechanism can be explained in the light o f Poiseuille’s law—a physical law concerns with the branch of hydrodynamics which shows the interrelation bet­ ween the pressure. flow and the resistance in a rigid tube. .5 meters per second or more between the elbow and the wrist.

The iT is im portant in the formula because we are dea­ ling with a cylindrical tube. While applying Poiseuille’s law to the circulating blood in vivo. Here F stands for the flow p e r unit in the tube.) (— ). In other words the resistance to flow is increased sixteen times.. Periphe­ ral Pulses. if other things such as viscosity and pressure remain unchanged. Diseases of Arteries.1416. and decreases with resistance (R) to flow as indicated by the equation which after extension can be written in the form of F=( Px—P 2 ). So. flow and resi­ stance have definite relation to each. Haemodynamics. we should bear in our mind that it is mostly applicable in vitro to the Newtonian fluid flow through a rigid tube under steady pressure head. And flow varies inversely and resistance directly with the visco­ sity of the fluid.Chapter VII Poiseuille's Law. a decrease to half a radius will actually decrease the flow to a sixteenth of the original value. ( . Thus considering only the fourth power of the radius. Factors Affec­ ting the Pulse Pressure and Clini­ cal Examination of Pulse Poiseuille’s Law and Its Application in Vivo In the branch o f heamodynamics it was the Poiseuille (1884) and Hagen ( 1939 ) who invented th at pressure. Finally. T hus Pj—P 2 represents the pressure head or pressure gradient. after further dilatation of the above form ula it was established that flow varies directly and resistance inversely with the fourth power of the radius. .^ . The 8 arose in the process of Hagen’s integration. is 3. 8L v Pa is the pressure at a down stream point in the tube.other and showed in vitro that volume ( F ) o f a jluid flowing through a capillary tube increase with the pressure head ( P ). By definition Newtonian fluid means a simple viscous fluid which viscosity is unaffected by flow rates and remains constant at different rates of streamlined flow. Formation of Radial Pulse. V is fluid viscosity.

And its application to the circulation depends on whether resistance is independent of pressure and flow. Thus we see th at in vivo the criteria such as ‘steady p re­ ssure head’ and ‘Newtonian fluid’ of Poiseuille experiment is mostly satisfied at the normal physiologic range. In the living subject.Poiseuille’s Law and Its Application in Vivo 111 in vivo Poiseuille’s law have but restricted application. Considering about Newtonian fluid in relation to blood we know that it is made of both liquid and.hyperglycaemia. There are other certain metabolic conditions which increases the viscosity o f blood and they a r e : ( 1 ) large am ount o f fat in the blood. And when measurements are m ade at very low shear rates the viscosity is greatly increased. blood behaves as if it were a Newtonian fluid. And thus the pulsatile ejection of the heart is converted into a steady outflow. ( 2 ) polycythemia. and ( 5 ) hypercalcaemia. Haynes ( 1957 ) also proved by his experiment that in the physiologic range of blood flow. visco­ sity does nqt change appreciably With flow. In the vitro the resistance would be constant . because variation o f tem perature affects the viscosity. ( 3 ) acidosis. blood in vivo is lower and in capillaries unaffected by tem perature changes. From foregoing discussion it is now evident th at Poiseuille’s law may also be applicable in vivo. so far as steady head of the pressure. cells and has anom a­ lous viscosity as observed in vitro. visco­ sity o f . Y et there are some factors which would seem to be immediately complicating to help in . blood shows a relative viscosity o f 4-5. is concerned it is achieved approximately by the combined effect o f elasticity of larger vessels and resistance offered by the arte­ rioles. ( 4 ) . Cooling raises the viscosity o f blood. A nd the blood behaves approximately as a Newtonian fluid. Thus we m ay say that the physical principles are of value only when used as an aid to understanding what goes on in the body rather than as an aid in themselves. But the condition in vivo is rather different. In vitro when measured at moderate or high shear rates. it is similar to th at of plasm a. In general. The reason-is th a t in living body the hfeart beats rhythmically and ejects blood phasically into a system of elastic tubes and more­ over the blood is not a perfect fluid but a two phase system of liquid and cells. achieving this goal. But it is to be noted here that in normal condi­ tions throughout most of the physiological range of flow. which fulfills one of the criteria o f Poiseuille observation.

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because both the viscosity and the geometry of the tube were unchanged and did not change with the rate of flow of pressure. But in circulating system peripheral resistance is a measure of the totality o f the factors affecting blood flow. These include change in* apparent viscosity ( which is known to occur with increase in perfusion pressure, occasioned by the movement o f the red cells to form a central axi^l rod. Also, perfusion pressure in relation to blood flow numerically means the mean intralu­ m inal pressure at the arterial end minus the mean pressure at the venous end ). Besides viscosity other factors are the existance o f stream-lined versus turbulent flow, the length of the vessels and the cross sectional area of the blood vessels which is determined by the extravascular pressure provided by surro­ unding tissue; by mechanical dilatation with perfusing pressure; by opening o f new capillaries and vessels with change in m eta­ bolism and with rising perfusion pressure; and by active change in the state o f contraction of the muscular walls through vaso­ m otor nerves, hum oral substances and metabolic products. We know that in the body arterioles play m ajor role in cau­ sing the peripheral resistance and the smooth muscle in their media having the quality o f distensibility also reacts actively to stretch by contracting. In the case o f vessels such as arteries and veins which are having smaller resistance, a given pressure head would increase their internal radius and would correspon-

Fig. 11 : Flow-Pressure Curve Relation in Rigid Tube and in Blood Vessels.

Poiseuille’s Law and Its Application in Vivo

113

dingly cause a raised flow at that pressure. This is not the situ­ ation in arterioles due to their myogenic property. So the pre­ ssure flow relationship in distensible vessels and the vessels having myogenic element will be different. And therefore, flowpressure curves obtained with blood in vascular beds are quite different from those obtained in the artificial system used in Poiseuille’s experiment. These differences are described diagramatically ( Fig. 11 ). In ( A ) when the tube is rigid and the viscosity and the length changes are ignored the relation between pressure and flow is linear as would be defined by Poiseuille’s formula in vitro. But in ( B ) where the tube is elastic such as arteries the increase in flow as a result o f a rising pressure head is. greater than in A. In it the initially collapsed vessels are distensible. In B it is obvious that the vessels can not be ultimately distensible because the adventitia etc. contain enextensible fibro-collagenous element. So at high pressure the flow would again be linear. In ( C ) the myogenic contractile response to stretch is depicted as affecting the ‘elastic’ effects exerted by the pressure rise. The curve is concave to the pressure axis. Curve ( D ) shows the result when the myogenic elements of the wall even exceed the ‘elastic’ effects of a raised pressure. Superimposed cJn the phy­ sical features are the additional effects caused by an increased sympathetic vasoconstrictor discharge to the resistant vessels. Such discharge constricts the lumen o f the innervated vessels mainly the arterioles and thereby decreases the flow o f a given pressure head. Wright ( 1971 ) says that two possible explanations may be given for the deviations o f the curves and they m ay be ( 1 ) the geometric factor of Poiseuille’s law is not constant but varies with distensibility o f the blood vessels, and ( 2 ) blood has anomalous viscosity. As far as role of anomalous viscosity in pressure-flow rela­ tionship is concerned, apparently it is a m inor factor in large '( non-capillary ) blood vessels. As it has also been pointed out already that throughout most of the physiological range of flow blood behaves as if it were Newtonian fluid. Now the only remaining factor in consideration to curve deviation is the dis­ tensibility of the blood vessels. In this context it can be said that while experimental evaluation is difficult, it does appear that vessel distensibility is the m ajor factor responsible for the devi8 N. V.

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ation of in vivo pressure-flow curves from Poiseuille’s law. This in mrn is related to the active tension or contraction of smooth muscle in the vessel walls and collagenous fibres in the archite­ cture of the vessels. In summarising the entire discussion, we can say th a t the resistance and distensibility of the vessels have definite relations to the flow of the blood throughout the body; and as it has been shown in the diagram of pressure-flow relationship that the factor of overwhelming importance is the distensibility of the blood vessels for the shape of aptual flow-pressure curve in vascular bed.

Haemodynamics of Pulsating Stream and Its General Role in the Pulse Formation
After a brief survey of pressure, flow, resistance and the significant role of elasticity in effecting the flow of blood through an elastic tube, we shall now explain their applied aspect in causing the pulse. The factors responsible for the production of pressure wave or pulse are three in numbers, nam ely: ( 1 ) the interm ittent inflow of blood from the heart i. e. stroke volume output, ( 2 ) the resistance to outflow of blood from the arteri­ oles into the capillaries, and ( 3 ) the elasticity of the arterial walls. The role of these factors will be explained in a better way through the medium of curve ( Fig. 12 ) which represents the pressure and flow relationship during systolic ejection.

Fig. 12 .- Haemodynamics of Pulsating Stream and its General Role in the Pulse Formation. During each ventricular contraction or systole, a definite quantity o f blood is ejected into the aorta; and in man this

Haemodynamics o f Pulse Formation

115

quantity averages about 62 cc. The interval o f ejection is short, about 0.25 second in man. M oreover, the output is by no means constant over this period. Fully two third of systolic discharge volume is displaced into the aorta in less than 0.1 second, and very little is ejected during the last 0.05 second. Because the arteries are already comfortably distended with bipod at the m om ent o f maximum ejection, additional room m ust be m ade quickly. T he creation o f additional room is accomplished by two ways—by moving the column o f blood, and by distending the arterial walls and increasing the capacity o f the vessels. In moving the column of blood only 1 per cent, or less of the total energy developed by the left ventricle acting as the source of pressure head is utilized. Hence, fraction o f the total energy is utilized as kinetic energy. The rest energy developed by left ventricle contraction is stored in the form o f potential pressure by causing distension and increasing the capacity o f arteries. W hen left ventricle pumps, it increases the radius and length of the aorta and its large branches to store potential energy as ten­ sion in the arterial walls. H ere, it is worth recording th a t the arterial tubes, because o f its elasticity and distensibility of their walls, are better adopted for an efficient utilization o f cardiac energy than for the faithful transmission of small pressure oscillations. And in doing so the arterial tubes subserve four
PRESSURE GRADIENT

i. conduit
Z PRESSURE R ES ER VO IR

S OAM RINO O S C IL L A T IO N S

- 4. C N R L OTO or rcow
D IS T R IB U T IO N

Fig. 13 : A rterial Tube Acting as Conduits, Dam pers of Oscillation, Pressure Reservoir and Flow Regulating Valves.

11 6

Nadi-Vtjnana

distinct functions namely; ( 1 ) conduits, ( 2 ) dampers of osci­ llations, ( 3 ) pressure reservoir and ( 4 ) 'flow regulating valves as shown in the diagram ( Fig. 13 ). Again coming to the original pressure and flow curve ( Fig. 12 > we find that there occurs a great forward movement of blood together with steep increase in pressure about 0.04 second after the onset of ejection ( a - b ). During the next period ( b— ) which occupies nearly 0.04 or 0.05 second, the c pressure mounts with a slower gradient to a summit but the velocity of flow gradually decreases. During remainder of systole ( c-d ), both pressure and flow decreases. The latter approa­ ching that during previous diastole. The time of closure of semilunar valves demarcates the beginning of diastole as shown at d-e. It is accompanied by a sharp drop in pressure and a transient reversed flow which is indicated by a fall of the velo­ city curve below the zero line. Here, we can safely infer that the pressure energy represented at this moment by the pressure curve is gradully used to move the blood stored in the distended arteries through the arterioles into the capillaries. This accounts for the slow decline o f the pressure curve during diastole and the constant velocity indicated by the straight trend of the velo­ city curve during the same period. Therefore, it is quite obvious that the conversion of potential energy stored during systole into kinetic energy of flow during diastole increases reasonably continued flow through the capillaries. By dilating upon the above facts, we can say in other words that during each stroke of the ventricular systole all am ount of fluid forced into the arteries does not escape at once owing to peripheral resistance. Instead, part o f the force of the pum p is spent in distending the walls of arteries, and part of the fluid that was forced in remains for a time into the arteries. The distended artery tends to empty itself and force out the fluid which over-distends it before the next stroke of pump occurs. , So. now the output may be divided into two parts. One part which is forced out by the immediate effect of the stroke of the pump. And another part which is forced out by the elastic recoil of the artery between the strokes L e . during the period of diastole. If the strokes be rapidly repeated before the artery has time to empty itself thoroughly, it will get more and more distended. Greater distension means stronger elastic reaction, ,#nd therefore a larger output of the fluid between the beats. This

it should be noted that with a pressure below from 30 to 40 mm. And fjelow this level of pressure there would be little stretching of the walls of the arteries which would then behave like a system of rigid tubes. flow. of mercury elasticity does not come into play. And this flow becomes continuous.Haemodynamics of Pulse Formation 117 distension goes on increasing till the fluid forced out between the strokes by the elastic reaction of the wall of the artery is exactly equal to th at entering at each strokes. From the above statement it is quite evident that resistance mainly offered by arterioles and elasticity of the arterial walls inspite o f producing pressure wave or the pulse. And it is also evident that the flow close to the heart rises very rapidly to a peak velocity and then falls to zero at the end of the systole and remains very low throughout . A t the usual diastolic pressure. 12. otherwise the pressure would fall to zero after each stroke. It is also interesting to. However. 14 ) that beside the production of pressure wave.'note here from the pressure flow curve ( Fig. waves are also produced due to flow of blood. the walls of the arteries are stretched and by virtue of their elasticity they tend to recoil against the disten­ ding force driving the blood onwards in a continuous stream between the heart beats. that exists. are responsible side by side also for maintenance of the continuity of flow of blood and thereby diastolic pressure.

we also get from pressure and flow curve th at the pressure in the aortic arch reaches a maximum during midsys­ tole and minimum of the end of diastole. femoral and pedis etc.118 Nadi-Vijnana diastole. These are referred to as systolic and diastolic pressure respectively and the. Where we find that the systolic peak velocity is reduced and a secondary period of forw ard flow develops in diastole. where behaviour o f pressure and flow pulses has been shown. Fig. the total distensibility ( the total quan­ tity of blood that can be stored in a given portion of the circu­ lation for each mm. This fact is quite clear from the diagram ( Fig. shows that the numerical values fo r systolic pressure increase in larger vessels causing greater pulse pressure as shown in diagram ( Fig. 15 : Num erical Values fo r Systolic Pressure Increase in Larger Vessel Causing G reater Pulse Pressure. 15 ). numerical difference between the two is known as the pulse pressure. The registration of pressure in radial. 14 ). high pressure rise ) o f m ore distal portion . Regarding explanations of increased numerical values for systolic pressure and decrease values for diastolic one in larger vessels there is controversy among different physiologists. Finally..It is also clear from the 'diagram that the pulse pressure in still smaller vessels diminishes progressively due to rapid fall o f systolic pressure than diastolic. e. How­ ever. But we find a change in the pattern when flow is recorded a t greater distance from the heart. possible explanations are given as : ( 1 ) progressive de­ crease of compliance i.

20 and 30 cm. 16 : Peaking o f Pressure Pulse. much of the kinetic energy of this momentum is changed into pressure. ( 2 ) the transmission of certain parts of the pulse wave at more rapid rates than other parts. downward from the root.Haemodynamics of Putse Formation 119 of the large arteries. When this wave'suddenly reaches the less compli­ ant areas of the arterial tree. ( 3 ) role of reflected and standing waves produced as a result of reflection of pulse wave at the points where arteries bifurcate.certain portions of the wave and therefore. “ peaking” of the pressure pulse as illustrated in the diagram ( Fig. Fig. . the high pressure portion is transmitted more rapidly than the low pressure portion. As for exam­ ple. These changes can be seen well in the superimpo­ sed records in this diagram taken from the root of the aorta and from sites 10. resulting in augmen­ tation of pressure. This causes crow­ ding of. Characteristically there are delay in upstroke due to transmi­ ssion time. 16 ). The arterial pulse wave becomes distored as it moves along the arteries. The refle­ cted and standing waves will be dealt with further under the separate head. W hat happens actually in this th at during transmission the pressure pulse is characterized by a high level o f momentum of the blood in the advancing edge of the pre­ ssure wave. and a more rapid rise of pressure to a higher and sharper peak followed by oscillations in pressure. because the arterial distensibility is less at high pressure than a t low pressure.

Owing to architectural characteristics o f the aorta and its branches and different distensibilities of various portions. intermediate pulses are recorded from the distal p a rt of the carotid or the brachial artery. One should be very clear with the fact th at the peripheral pulses are nothing b u t the mere continuation of central and intermediate pulses with a bit changes. Like peripheral pulses. Buj. having pressure sensi­ tive capsule when applied to an artery records only the general shape of the pulse wave without in any way measuring the pressure involved. Now we shall deal with the greater details of the qualitative form o f periphe­ ral pulses o f which the radial is also one. The instrument was further refined by Wigger. the recent recordings . the haemodynamic factors which determine the form o f pulses in vessels arising from the aortic arch and abdominal aorta are somewhat different. The instrument. These older cur­ ves are quite familiar in text books.120 N adi-V ijnana Peripheral Pulses and Role of Reflected Waves As the nam e itself reveals th at th e pulses which are recor­ ded from the peripheral arteries than the aorta are known as peripheral pulses. Lilly and others and used in man by Cournand and Ranges. interm ediate pulses and then switching over to the peri­ pheral pulses. So a t the outset it is necessary to give an account of the qualitative form of central pulse. Contour differences between a central and a peripheral pulse were recognized before the time o f F rank by low frequency manometer. The im portant peripheral arteries which are usually used in clinical practice are the radial.. 17 ) shows that the shape of arterial pulse wave change when it. passes progressively from centre to periphery. whereas the central pulses are recorded from central aorta. though the pulse tracing is usually done from the radial artery in hum an being. Older curves ( Fig. So far we dealt with the general role of haemodynamics in the pulse formation* mainly in the aorta and the descriptions were centred to the central pulse for the sake to give an elabo­ rate idea of pressure wave—the pulse form ation. Now-a-days more exact information is being achi­ eved by using an electronic m anom eter communicating through a needle with the inside of the artery. F rank ( 1903 ) developed high fedelity manometer to establish the difference between a central and a peripheral pulse in precise terms. Ham ilton. femoral etc.

The time from the foot of first rise to incisura is a measure of the length of systole. Laszt and M uller ( 1952 ) recorded pressure waves in the dog and they are very similar to those recorded in m an. The rising limit is usually known as the anacrotic phase and any superimposed oscillations on it are .Reflected Waves and Pulse Formation 121 (F ig . reveals that the curves are smoother than many o f the older ones. then a dome like top terminated by a short sharp trough called the incisura. 17 : Tracings of Older Curves The main features of central pulse recorded from the proxi­ m al aorta ( curve 1. Fig. 17 ) shows a sharp initial rise. This short dip is due to the momentary reflux of blood through the aortic valves as they close a t the end of systole. M odern recordings as shown in the diagram. 1 8 ) show that the curves are smoother than many of the older ones. Fig. Laszt and M uller were the first m an who made the revolution in modern tracings of pressure wave in the dog and they are very similar to those recorded in man.

Ramington ( 1963 ) giving his argum ent for the change in the shape of peripheral pulses states that the central pulse propagated is not intact and the pulse contour during its propa­ gation is modified from damping or from poor matching bet­ ween the frequencies of the volume input curve and those set . the dicrotic phase drops during diastole. In the figure typical representative of peri­ pheral pulses is the recording taken from femoral artery. As the waves are recorded further and further away from the heart. In the second curve ( Fig. the sharp discontinuity of the incisura has been damped out and we now find that the falling limb of pressure i. it is seen that not only they are shifted because of the time taken up in transmission but the form of the wave is altered markedly. 18 : R ecent Tracings of Pulse Waves.m Nadi-Vijnana called anacrotic waves. Here the rise in pressure is due to systole is now peaked in shape and the total rise is considerably greater causing a steeper curve. These damped incisura and dicrotic phase are called dicrotic wave respecti­ vely. 17 ) there is a slight dip in the systolic plateau which is termed as anacrotic notch. Also. e. Fig. Following the incisura a small rebound i$ usually seen and thereafter the pressure falls fairly steadly during diastole.

Such type of positive and nega­ tive pressure waves also occur. e. the pulse will return in the same sense. ( b ) Arterial Pulse Composed of M any Frequencies. the wave will still be totally reflected but will be inverted i . a positive pulse will return DISTORTION OF ARTERIAL PULSE WAVES F n u rie r A n a ly m o f R « d u l P re ssu re P u h e 3 H ig h e r T fic n m itiio o V ^jocrty o f H igher F f« q u e n c iei Fig. e. The simplest demonstration o f a reflected wave can be made in a rubber tube filled with water. reflected and standing waves upon the incident wave. b u t only p art of the wave will be reflected and part will pass through the constriction. If instead o f clamping the end of the tube. Very close to the point o f reflection at a closed end the reflected wave will . e. If the rem ote end is clamped. it runs into a large reservoir. Starling ( 1968 ) also accepts the view th a t the cause o f these changes may be attributed to the effects Of damping and the reflection o f waves in the arterial tree. Suppose if a syringe is attached to one end and a sudden push on the plunger will cause a pulse to travel along the tube. The role of reflection in determining the form of the pulse wave is more complex and has been the subject o f much con­ troversy. 19 : { a ) Reflected Waves from A rterial Branches.Reflected Waves and Pulse Format ion 123 by the distensibilities and flow resistance of each arterial seg­ m ent or from an augmentation o f “ m atched” frequencies or even from super position of a wave reflected from the periphery i. in the arterial system. The same effect will occur if the end is constricted w ithout being totally blocked. as a pulse o f negative pressure. a positive pressure pulse is positive after reflection. i.

we can say that these waves are responsible to the greatest extent in bringing out the real architecture of peripheral pulses which are nothing but are mere modified form of central and peripheral pulses being distorted by reflected waves. M cDonald ( 1960 ) and Attinger and M c­ Donald ( 1967 ) suggested that normally some 60-70% of the incident wave is reflected at the arteriolar beds of the pelvis and hind limbs. 19 ). In previous section much has been discussed about the peripheral pulses. At slow heart rates the oscillations set up by one systolic ejection have almost completely died away before the next heart beat. The main site of reflection appears to be in the arteriolar bed because its effects are greatly increased by vasoconstriction and diminished by vasodilatation. interpretation of the form of the wave is difficult. it is essential at this moment to deal with separately in a greater detail of the radial pulse. Looking into the complexities of role played by reflected waves etc. Formation of Radial Pulse Among the peripheral pulses. a reflection will be created. Therefore. the radial pulse is most com­ monly used in clinical diagnosis. every time an artery branches. the oncoming pressure wave distorted.Nadi-Vijnana fuse with the incident wave and the added waves will give a total of double the samplitude. However. it appears that even with an ideal recording device. This is known as the summa­ tion effect. No sign of any reflected wave of any significant size can be detected in the ascending aorta or a short distance away from it. The fact that small terminal branches are acting like a partially obstructed end due to the much greater viscous drag of the blood. If the press­ ure wave travels with increasing velocity tow ard the periphery and reflected back from regions where many branches occur over a short distance. we get more exact information by using an . in the construction of peripheral pulses so to the radial pulse. attaining a high peak pressure and wide fluctuations following the peak ( Fig. but it appears that for the larger branches the dimensions are such that reflection is minimal. Theoretically. In summarising the phenomena played by reflected waves. In the fore part of the body it is probably the same. By the same reasoning the incident 'and reflected waves will cancel each Other out at an open end.

) which Was used more prevalently before the invention of latest instruments is now out of date. even in normal person. The initial rise which causes expansion of the artery not .Formation of Radial Pulse 125 electronic manometer communicating through 3 needle inside the artery. D ud­ geon’s sphygmograph is the only means to record the pulse tracings Fig. 21. 21. As it appears from the diagram (Fig.) that there are two waves P and D which can be easily distinguished. The percussion wave first rises due to rapidly transmitted shock of left ventricular contraction and then fells towards the end of systole. Tracings of normal radial pulse have been illustrated diagramatically ( Fig. 20. To the trained fingers normal pulse wave appears to rise fairly sharply but not abruptly. W here this type of facility is not available. Dudgeon’s sphygmograph ( Fig. 22 ). But where there is ex­ treme lack of facilities in using the advanced technique. It is sustained for a moment and then disappears. Adams ( 1942 ) states that there is considerable variation in the character of the pulse. 20 : Dudgeon’s Sphygmograph. P wave is the percussion wave which rises fairly rapidly without any interuption on it and having rounded peak. pulse wave is recorded by indirect m ethod by applying a pressure sensitive capsule to the artery.

It is also clear from the diagram that sometimes aftfcr a slight . the tidal wave ( t ) near the peak between the percussion and dicrotic wave. But H urst and Logue .126 Nadt-Vtjnana only represents the rapid shock of left ventricular contraction but also it represents that the escape of the blood into the capi­ llaries is not as rapid as the ejection of blood into the blood vessels. The fall towards the end of systole is due to the redu- •C l Fig.depression from the peak there may be another systolic wave. W ood ( 1956 ) and Friedberg ( 1969 ) state that the tidal wave is caused due to the sum m ation o f the uncompleted percussion wave and waves reflected from the periphery. ced ejection phase of the ventricle delivering less blood than is passing out the arterioles. 2 1 : N ofm al Pulses.

it appears that the sys­ tolic upstroke time ( S U T ) is measured from the onset o f the upstroke. 2 1 ). Although in general the systolic upstroke time is shorter in peripheral tracings. the largest wave on the discending limb of the trace.14 second in norm al pulse. Bel et al ( 1968 ) state that this wave together with other smaller subsidiary waves often observed.Formation of Radial Pulse 127 ( 1966 ) are in the opinion th at it is caused by continued but slower ventricular ejection in addition to reflected waves from the periphery. is not smooth but contains several m inor oscillations. and it is known as dicrotic notch. there are some curious and erroneous statements in the clinical texts. or ascending limb to the summit of the pressure pulse and it is not more than 0. if we go through figure 21. Wood says that it is produced due to the shock of aortic valve closure. The most common relates to the lowest point on the wave the diastolic b’ood pressure. but one thing to be noted here that for ( S E T ) measurement is commonly corrected for heart rate by dividing the measured internal by square root of the cycle length in seconds. Friedberg realizes that it is formed due to shock of closure of the aortic valve with consequent rebound of blood 'plus’ peripheral factors. The ( S P ) which is peak of the percussion wave represents systolic pressure and the ( D P ) represents the diastolic pressure which is measured from the beginning of the ascent ( Fig. The most cons­ tant of these is the dicrotic wave ( d ). Difference of opinion also exists here regarding the mechanism taking p art in the form ation of this wave. the systolic ejection period is longer. Many consider peripheral resistance to be uniquely related to diastolic pressure rather than to mean . As it is also clear from the figures that the discending limb is interupted by incisura which is produced by closure of the aortic valve. Further. The discending limb of the pulse is usually less steep and it is due to a more gradual fall in pressure corresponding tb the elastic recoil 'of the arterial walls. It is about 0. It is also seen th at the discending curve. Regarding interpre­ tation of contour of the pulse and diastolic blood pressure.30 sec. whereas Hucst and Logue say that it is constructed m ainly due to reflected waves from the periphery. represents oscillations of the aorta and its own natural frequency. The normal pulse is called catacrotic pulse.. The systo­ lic ejection time ( S E T ) is measured from the onset of upst­ roke to the incisura or dicrotic notch.

most prominent in proximal vessels and is synchronous with aortic valve closure. goes so far as to state tha. because this termino­ logy is not consistent. “ tidal” . Whereas the second-the true dicrotic notch-is more gentle. Yet Wood. Further stressing upon the point of rationalization. “ tidal” . most prominent in peripheral vessels. “ diastolic” describes timing in relation to the cardiac cycle. Pickering and Dexter pointed.128 Nadi-V tjnana arterial pressure. In relation to time the “ percussion” . it is found that the diastolic wave is actually the third undulation on the pulse. “ tidal wave” . Their relationship‘varies with sites in the arterial tree and with mean arterial pressure. M aking an attack on terminology. and -the diastolic or dicrotic wave are confusing. “ late systolic” . In his opinion “ percussion” appears to refer to a mechanism. Thus it is obvious that they represent different events and that each has a diffe­ rent significance. including aortio incompetance and heart block ( and sometimes arteriosclerosis ) are associated with peripheral vasodilatation. Giving interpretation of “ dicrotic” wave. A bout the conventional belief that the incisura or dicrotic notch separates the systolic from the diastolic part o f the pre­ ssure wave and is caused by aortic valve closure. Giving his remark on “ diastolic” . The first or two incisura is short and sharp. Michael Rourke ( 1971 ) says that the terms “ percussion” wave. inter­ vals between the aortic arch and iliac artery ( Fig. 18 ). and “ dia­ . he says ihat there are two notches found in curves recorded at 5 cm. because the dia­ stolic wave moves out of diastole into the systolic portion o f the pulse when blood pressure rises*. and represents the foot of the diastolic wave. and “ dicrotic” waves may be termed as “ early systolic” . while “ tidal” has no clearly relavent mea­ ning. he feels that the terminology like “ percussion” .out that peri­ pheral resistance is related through cardiac output to mean arterial pressure and that systolic and diastolic pressures-repre­ sent simply the highest and lowest points o f oscillation around this mean. and should be replaced by a system which refers entirely to timing or entirely to mechanism.t conditions characterized by a low diastolic pressure. he says that this term is not always appropriate. he says that literally it means twice beating. but at the same time when observed in the central aortic pressure wave recorded in a nor­ mal dog. and “ dicrotic” waves should be discarded.

It does not involve the aorta. Diffuse hyperplastic 9 N. ( 2 ) Thrombo-angitis obliterans. The main diseases which lie under this group are : ( a ) athero-sclerosis. and it is particularly here that calcification often in the form of encircling plaques or rings can be demonstrated on X-ray films. ( 7 ) Functional disease of the arteries. and “ caudal reflected” . . ( c ) arteriolar sclerosis and hypertension. (. ( c ) DifFu&e A rte rio -s c le ro s is : ( Syn. The Diseases of Arteries The diseases of the arteries which admit o f clinical recogni­ tion are : ( 1 ) Arterio-sclerosis. ( ii ) increased pulse pressure. including the Monckeberg type. ( b ) medial sclerosis. It is characte­ rized by fibrosis. This happens as a result of ageing and it causes lengthening. a term used to describe a group of degenerative diseases. The nomenclature based on timing rather appears simpler and better. fatty degeneration and later on calcification of the muscle coats of the larger arteries of the limbs and their branches. tortuosity and hardening Of the arteries but it does not reduce their calibre. ( 3 ) Polyarte­ ritis nodosa. causing no ill effects over many years. ( b ) M onckeberg’s M edial S clerosis is a diffuse form of arterial disease which occurs after 50 years of age. generally associated with a rise in systolic pressure.5 ) Ane­ urysmal dilatation. It is often found in early adult life.The Diseases of Arteries 129 stolic” respectively. And in relation to mechanism these waves may be termed as “ impact” . ( 4 ) Chronic and acute endarteritis. In older people we observe gross signs of medial sclerosis with thickened tortuous brachial. Both atheroma and medial sclerosis are commonly associa­ ted. and ( iii ) alteration in the second aortic sound. intimal sclerosis ) starts as a patchy thickening of the intima of the larger arte­ ries. In the leg it occurs in more advanced form. ( 6 ) Compactions such as an embolism and thrombosis. but becomes more marked after middle age and then becomes more or less wide spread. “ cephalic reflected” . Physical signs particularly related to cardio-vascular systems are : ( i ) thickening of the palpable arteries. (a) A th ero-sclerosis : ( Sign Atheroma. 1. radial and tem poral arteries and a raised systolic pressure. V.

pancreas. diastolic or more. Functional Diseases of Arteries and Arterioles i Under this heading can be placed Raynand’s disease migraine. Factors Affecting the Poise Pressure The pressure pulse contour in addition to representing its qualitative form also signifies the values of systolic and dia­ stolic pressure (Fig. various other arythematous conditions. in arteriolar sclerosis the intimal thicke­ ning ( or hyperplasia ) is the distinctive pathological feature. systolic and 100 mm. It is commonly found in the brain. reacting 260 mm. Persistent hypertension or essential hypertension developed due to diffuse arteriolar sclerosis is further sub-divided into . The factors affecting pulse pressure are : . in which the lesion affects the media as well as the intim a. which is localized. and suprarenals.( i ) benign hypertension. 7. It does not occur as a complete lesion in' the heart o f skeletal muscle. cold hands and feet dead hands. and ( ii ) m alignant hypertension. 3. Syphilis affects arteries in two ways : ( 1 ) a proliferation o f intim a o f small vessels reduce their lumen. systolic and 120 mm. arterio-capillary fibrosis ). chil blains. Chronic and Acute Endarteritis is due to syphilis and other causes. In contrast to arteriosclerosis. It is responsible for persis­ tent hypertension. Further in arterio-sclerosis the main incidence of the lesion is in the conducting arteries. In contrast to atheroma. Polyarteritis N o d o sa : It is a collagen arterioles disease of smaller arteries and arterioles which is usually generalized and produce wide spread effects. and rarely in the liver or digestive tract.130 Nadi-Vijnana sclerosis. In benign hypertension kidneys are not involved the blood pressure is persistently 180 mm. 23). and generally in both. whereas in arteriolic sclerosis it is in the arterioles. The lesion is always found in the kidneys or spleen. alternate flushing and pallor. It may be much higher. the lesion in arteriola r sclerosis ( hyperplasia ) is diffuse. paroxysms of copious urination and itching. This condition may also be responsible for thrombosis in the affected vessels ( 2 ) weakening o f the muscular coat of the large vessels. The radial pulse is hard and resists compre­ ssion. The artery is generally thickened and it may be tortuous. diastolic or more. The organ distribution is characteristic. 4.

23 : Assessment o f Systolic and Diastolic Pressure Values from Pressure Pulse.Factors Affecting the Pulse Pressure 131 ( 1 ) stroke volume. 1. S tro k e V o lu m e : In general. Thus a greater pulse pressure will be the net result. therefore the greater is the pressure rise during systole and the pressure fall during diastole. and they are : ( a ) an increase in heart rate while the cardiac output remains constant causes the stroke volume o u tp u t to decrease . In effect then the pulse pressure is determined nearly by the ratio of stroke volume output to compliance o f arterial tree. mean arterial pressure. There are many different conditions which change th e stroke volume output but only a few need explanation here. the greater is the am ount o f blood th at m ust be accomodated in the arterial tree with each heart beat. A highly distensible vessel which has very slight volume may have for less compliance. the greater the compliance o f the arterial system the less will be rise in pressure. total distensibi­ lity o f the arterial tree. O n the other hand. And. and ( 2 ) pathological changes that affect the distensibility o f the arterial walls. ( 2 ) rhe compliance i. for a given stroke volume o f blood pumped into the arteries. the greater the compliance o f the arterial system the less will be rise in pressure for a given stroke volume of blood pumped into the arteries. N aturally any condition o f the circulation that will affect stroke volume or compliance o f the arterial tree will also affect the pulse pressure. the greater the stroke volume output. On the other hand. From clinical point o f view we can say that the factors affecting pulse pressure are : ( 1 ) change in Fig. e. In regard to compliance and distensibility one should be very clear th a t compliance and distensibility are quite different.

( d ) the character o f ejection from the heart affects the pulse pressure in two ways : ( i ) if the duration of ejection is long. and there are replaced by fibrous tissue and sometime even calcified plaques that can not stretch a significant amount. ( c ) an increase in mean circula­ tory pressure. the pulse pressure is considera­ bly increased. As arterial pressure rises from low to high values. Therefore. in old age the arterial walls lose much of their elas­ tic and muscular tissues. again the pulse pressure is accordingly increased. a large portion of the stroke volume output runs off through the systemic circulation while it is being ejected into the aorta. For this reason. if all other circulatory factors remain constant. . and the pulse pressure decreases accordingly. So far as pathological changes affecting distensibility are concerned. This increases the venous return to the heart and increases the stroke volume output. of Hg. pressure rise. ( ii ) sudden ejection of blood from the heart causes the pre­ ssure in the initial portion o f aorta to rise very high before the blood can run off to the more distal portions of the aorta.132 Nadi-Vijnana in inverse proportion to the increased heart rate. increases the rate of venous return to the heart and consequen­ tly increases the stroke volume output. ( b ) a decrease in total periphe­ ral resistance allows rapid flow of blood from the arteries to the veins. C om pliance : As it has already been stated that the compliance or total distensibility is the total quantity of blood that can be stored in a given portion of the circulation for each mm. Therefore. the magnitude of the stroke volume output effect on pulse pressure is increased. Thus we see that how the mean arterial pressure is changed which is of overwhelming importance in affecting the pulse pressure. in a person. sudden ejection causes a greater pulse pressure than does more prolonged ejection. the pulse press­ ure is also greatly increased. Here. 2. the compliance decreases slightly. Therefore. in the low pressure range considerably more blood can be accomoda­ ted for a given rise in pressure than in the high pressure range. Therefore. who has high arterial pressure but a normal stroke volume output. These changes greatly decrease the com­ pliance of the arterial system which in turn causes the arterial pressure to rise very high during systole and to fall greatly during diastole as blood runs of from the arteries to the veins.

if the volume of the arteries is greater than normal. Thus. and ( 3 ) impaired elasticity of the vessels. as in mitral or tricuspid stenosis or constrictive pericarditis. pressure is not increased as much as it might be. And a small percussion wave is due to : ( 1 ) small output. A low resting cardiac output with an inadequate response to exercise results either from inadequate ventricular filling. in old age. the arte­ rial wall thick or if aortic regurgitation is present. the two factors are likely to nullify each other. By definition cardiac output is the quantity of blood pum ped by the left ventricle into the aorta each minute.Factors Affecting the Pulse Pressure 133 Two factors determine the over all capacitance of the arte­ rial system : ( 1 ) the distensibility of each segment of the arte­ rial tree. ( 2 ) high peripheral resistance from increased arterial tone. or both filling and emptying are inadequate due to impaired myocardial con­ tractility associated with left ventricular failure. In this . It is quite obvious that decreased distensibility of any segment tends to decrease the distensibility of the entire arterial system. heart rate and resis­ tance states that a large percussion wave is due to ( 1 ) large cardiac output. and ( 3 ) low peripheral resistance. He further says that in a circulating model the descending limb of the curve falls more steepy if the diastolic pressure is low. but the pulse. Samson Wright ( 1968 ) describing the percussion wave of radial artery in terms of cardiac output. ( 2 ) slow heart rate. The commonest mechanism leading an increased cardiac ou tput is a decrease in peripheral vascular resistance. a rapid down stroke is observed. In aortic regurgitation in m an and on stimulation of the aortic nerve in animals to produce relaxation of the arterioles. because the arteries also become considerably dilated in old age. Seeing the importance of cardiac output in determining the configuration o f percussion wave it appears rather necessary to highlight the factors which are responsible for its decrease and increase. the distensibility o f each segment of the arteries is tremendously reduced. even though the distensibility of each segment of the arteries is less than normal. inadequate ventri­ cular emptying as in pulmonary or aortic stenosis. The diastolic pressure also rises slightly in arterio-sclerosis and in old age. The reason for this is not totally known but it usually rises coincident with the occlusion of vessels in old age. On the other hand. and ( 2 ) the volume of the arterial tree.

( iii ) ano­ xic cor-pulmonale. ( 2 ) warm. variations in body tem perature. Clinical Examination of the Pulse There is in clinical medicine no physical sign more basic or im portant than the arterial pulse. (v) hepatic disease. An increase in cardiac output may be accomplished either by increasing the heart rate or the stroke volume or both. palpation of the pulse is the first observation to make. ( vi ) an acute glomerulonephritis. In addition to tachycardia and raised jugular venous pressure. the cardiac output must rise in order that the tissue may receive sufficient oxygen. The pulse reflects disease of the heart and arteries from’which most patients succumb. The de­ crease peripheral vascular resistance results in vasodilatation with a warm flushed skin and distended forearm veins. Pathological conditions responsible for increased cardiac output are ( i ) anaem ia ( ii ) thyrotdxicosis. or has lately .134 Nadi-Vijnana condition cardiac output is increased in order to m aintain a normal blood pressure. alteration in blood viscosity. radial and femoral pulses. ( 4 ) the hyperkinetic heart syndrome. In hypoxic state there is an increased secre­ tion of adrenaline. W hatever examination is to be made. Examination of the pulse provides evidence of great value both as to the state of the circulatory system and the general condition of the subject. If the subject is nervous or emotionally disturbed. In hypoxic states such as anaem ia. Physio­ logical conditions responsible for increased cardiac output are : ( 1 ) exercise. and the effects of harmones and other chemical substances such as those produced by phaeochromocytoma or carcinoid tum ours. Other factors affecting the cardiac output include the effect of the sympathetic nervous system. the radial pulse is generally chosen. when the stroke volume is increased as a result of a decrease in peripheral resistance typical clinical signs are produced inclu­ ding a strongly beating heart with a forceful apical impulse and an increase in systemic pulse pressure giving rise to bounding or ‘water-hamm er’ carotid. ( 3 ) anxiety state. ( vii ) polycythemia vera and ( viii ) beri-beri. For clinical examination of the pulse. ( 6 ) pregnancy. hum id environment. and in chronic cor-pulmonale. since jt is easily accessible and lies against the bone ( radius ). Another im portant factor which influe­ nces the cardiac output is the need of the tissues for oxygen. (iv) carcinoid syndrome. ( 5 ) fever.

popliteal.the pulse has resumed its norm al rate.Clinical Examination of the Pulse 135 hurried. not when the fingers are first laid upon the pulse. temporal and facial pulses o f both sides. Counting o f beats is not made less than half minutes. Oram ( 1971 ) has advised only for the examination of ( 1 ) rate. To feel the pulse three fingers are placed over the course of the artery. and also abdominal aorta. I f is counted. and the difference between this rate and the pulse rate at the wrist should be recorded. During the counting of beats per m inute we should be cautious whether the pulse is . dorsalis pedis. brachial. Rate : The rate of the pulse is stated as so many beats a minute. it is usually sufficient to feel the radial pulse at the wrist. the rate o f heart beat should be counted by auscultation at the apex. (7) the state of the arterial wall. femoral. rate ). ( 3 ) form. but in cardiovascular disease the physician should also feel the other radial. In all such cases. F or accurate record the pulse is always taken under similar conditions as to posture. We should remem­ ber that in other cases as in atrial fibrillation. that is of the blood pressure within the vessel by palpation. are quite unreliable. carotid. ( 2 ) rhythm. ( 5 ) tension. the index finger nearest the heart. Giving rem ark on examina­ tion o f ‘tension’ Hutchison states th a t estimates of the ‘tension’ of the pulse. the observation is repeated later when the pulse has settled. ( 2 ) rhythm. time of day. According to Savill ( 1964 ) the clinical features to be studied in palpation of the pulse are its ( 1 ) fre­ quency ( speed. In cases of non-cardiovascular disease. ( 4 ) volume ( amplitude ). Hutchison (-1968) has excluded out the examination of ‘tension’ and has added upto examine the presence or absence or delay of the femoral pulses compared with the carotids. ( 3 ) force. During exami­ nation of thepulse the patient’s forearm is pronated and the wrist slightly flexed. ( 6 ) character ( quality. This difference is referred as pulse deficit. and ( 4 ) condition of the arterial wall. form ). but when any quickening due to nervousness of the patient has subsided and. the pulse rate counted at the wrist may not indicate the true rate of ventricular contractions. Wood ( 1968 ) excluding only ‘force’ has included the rest point in his book. He says th a t attem pt to esti­ mate the blood pressure by the degree of pressure required to obliterate the pulse at the wrist are a waste o f tim e. relation to meals ctc. posterior tibial.

sleep. ( 2 ) Early tuberculosis sho­ uld always be born in mind. 90. In normal hum an too the heart rate varies considerably and it is due to variations in the rate of impulse predution in the normal pace-maker ( the sinoauricular node ). the number of the beats falls ten to twenty per minute when the patient alters his position from standing to lying. A few people have pulse rates under 60 or 80 but such must not be accepted as within normal limits without careful consideration. Other cardiac conditions in which an increased rate forms the most striking feature are : auricular flutter. streptococcalrand penuniococcal infections. Any other bacterial infection is a common cause e. Pathological Causes of Sinus Tachycardia : The pathological causes of sinus tachycardia are numerous. meals. It is faster in the female than in the male. paroxysmal ventricular tachycardia. These features differentiate simple tachycardia from paroxysmal auricular tachycardia. It is also more rapid in the eve­ nings and after meals. and in old age 80 per m inute. In the foetus and new born infant its average rate is 140 per minute. emotion. 70.. After a severe illness and in asthenic states the pulse more easily becomes rapid. not the result of myocardial changes. in which the pulse rate is unaffected by posture. ( 1 ) Pyrexia is the most common. ( ii ) uraemia. from 14 to 21. whether generalized or local. The normal pulse rate is 70 per minute. exercise etc. from 21 to 65. under I year.136 NadirVijnana abnormally fast or abnormally slow. ( 3 ) Of endoge­ nous toxaemias : ( i ) Grave's disease is the most common. from 7 to 14. under 3 years. Such as when the tachycardia is due to simple cau­ ses. The pulse is normally more rapid during the m en­ strual period and menopause. auricular fibrillation. 80. close observations for larval forms o f this disease should be made in any obscure case of tachycardia. The American Heart Association accepts between 50 and 100 beats per minute as the normal range. especially in scarlet fever. is compatible with perfect health. ( iii ) malignant . 120. Other physiological causes res­ ponsible for tachycardia are : exercise. This is called sinus tachycardia. Frequency of pulse also varies according to the sex and ages. 100. Change in the post­ ure also plays im portant role in causing variation in the rate of the pulse. Rarely a pulse rate of 50 or just under or of 90 or just over. Pulse frequency is increased in the acute specific fevers. g.

( 4 ) bradycardia is not uncommon in convale­ scence from acute infection. such as may be due to diabetes. B radycardia : Besides increased heart rate ( tachycardia ). ( 2 ) bradycardia is one of the car­ dinal features of myxoedema. via the vagus nerve. neurasthenia. such as tobacco. A slow pulse should be verified by counting the frequency of heart beats on listening to apex. the other abnormal condition o f the heart rate is decreased heart rate. The pathological causes o f sinus bradycardia may be : ( 1 ) the result of reflex neuros effects. ( 3 ) Toxic conditions : ( a ) endogenous. ( 5 ) incre­ ased intracranial pressure of whatever etiology. ( 6 ) M ost forms of heart disease. As it may be the first con­ sideration of serious organic disease such’ as heart block or cerebral tumour. such as jaundice. tea. infla­ m matory or dege'nerative. e. belladona and atropine. bradycardia. g. diabetes and uraemia. and sometimes staphylococcal infections and influenza. often of trivial kind. A slow and . thyroid extract. e. toxic. coli. anxiety neurosis and neuro-circulatory asthenia for common cause in which the border-line between physiological and pathological disturbance is hard to define. cachexia and melancholia except in the term inal stages of these conditions. ( 4 ) Exo­ genous toxaemia includes a large variety of drugs and poisons.Ctinical Examination o f the Putse 137 disease. A slow pulse rate may be a personal idiosyncracy and is compatible with perfect health. and in exhaustion states. with an overactive carotid sinus. which has been dealt with so f a r . A slow heart rate is an advantage because it allows of an increased cardiac output without of increase of heart rate. and ( b ) exogenous. (iv) ali blood diseases with moderate and severe anaemia. ( 5 ) Nervous states^ include ordinary emotional disturbance. such as exposure to cold. and whether acute or chronic. A low pulse rate in proportion to the fever is found with infections by the typhoid and salmonella group. influenza. anorexia nervosa. coffee. In healthy subjects. bradycardia is due to a slow rate o f impu­ lse production in the sino-auricular node. E. starvation. i. At first tobacco may slow the heart. and other states of lowered meta­ bolism. alcohol. stropanthus and opium. A frequency of 60 per minute or under requires careful consideration. e. especially when under going degenerative changes. I t is associated with a low basal metabolic rate. g. It is known as sinus bradycardia. It is sometimes familial. In­ creased pulse rate is an im portant sign of heart-faifure.

The F o rce: It is estimated by the impact against the finger. and the irregularity is physiological.138 Nadi-Vijnana irregular pulse may also occur in meningitis. inflammation or degeneration. Here the beats not only follow one another at irregular intervals. hyperthyrodism. This irregularity is in most cases abolished when the rate is increased by exercise. If it is irre­ gular. or whether an otherwise regular rhythm is occasionally interupted by some slight irregularity. and ( 3 ) pulsus alternans ( where big beats and little beats alternate at regular intervals ). e. (2) pulsus bigeminus or pulsus trigeminus (where the pulse beats in twos of threes followed by a pause ). anaemia and in certain febrile conditions. It depends upon the rapidity of the filling and emptying of the artery. it is seen whether it is completely irregular or the irregu­ larity has a recurring pattern. In addition the pulse rate may differ from the apex rate. but are of unequal strength and volume. ( 2 ) the irregularity due to irregularly occurring pre­ m ature beats or extra systoles. If the’ vessel becomes rigid. resulting from fatigue. Bradycardia in heart disease is generally due to heart block. Rhythm : ' It tells whether the pulse is regular or irregular. the result of regularly occurring prem ature beats. The Volume : The volume. g. “provi­ ded that the arterial wall is normal this is measure of the pulse pressure” . Hutchison says. in aortic regurgitation. The most common regular irregularities are : ( 1 ) sinus arrhy­ thm ia ( where the pulse speeds up during inspiration. This indicates myocardial hyper irritability. however. indicative of left ventricular failure. and slow during expiration ). the slowing is vagal. The commonest irregular irregularities are : ( 1 ) The consi­ stently irregular pulse due to auricular fibrillation. The great clinical test of the presence of auricular fibrillation is that the irregularity is increased by exercise. commonly . estimated by the lift and duration of the wave provides a useful estimate of left ventricular output per beat i. >Vhen the vagus is pressed there occurs tem porary slowing of the pulse rate and characteristically in an ordinary fainting (Vaso-Vogal slowing). It is modified by local conditions such as a sclerotic or anatomically small artery. stroke volume. e. the force is considerable.

The Character : It is worthy to note here th at problems regarding classifica­ tion of abnorm al pulses have been recognized for m any years. Lewis and Osier did not m ention the terms anacrotic and dicrotic. This may be attributed to the faults lying in the process of recording. Regarding mechanism of form ation such as of dicrotic pulse Osier and mechanism of form ation such as of dicrotic pulse Osier and Machenzie are silent on the point that prominent dicrotic wave is a sign of vasodilatation. The diastolic pressure can also be estimated roughly by noting the degree o f hardness ( high tension ) or softness ( low tension) o f the pulse between beats. Following Mackenzie.Clinical Examination o f the Pulse 139 the pulse-pressure may widen whilst the pulse-volume on palpation may appear normal. W hen one goes through the various text books from the time of M ackenzie ( 1905 ) till now. When we have a glance over there curves. The pulse of high tension is perceptible between beats as a cord which can be rolled beneath the fingers. . dicrotic and bisferiens pulses from norm al individuals also. To estimate the tension the pre­ ssure is exercised by the forefinger in order to obliterate the pulse wave and prevent it reaching the middle finger. The pulse of low tension appears to collapse so th at nothing is felt. we find that there exists differe­ nces of opinion in the interpretation of the contours of various abnorm al pulses and mechanism involved in their formation. The volume o f the equivalent pulses on the two sides should then be compared. H urst and Logue and Bramwell regarding illustrations o f some o f the curves of abnorm al pulses. In case there is a return pulse wave through the palmer arches it may be necessary at the sametime to obliterate the pulse with the third finger. The Tension : The tension is estimated by the*obliterative forces and it indi­ cates systolic blood pressure. bisferiens pulse of H urst and Logue is appare­ ntly like Bramwell’s water-hammer pulse and so on. Likewise controversy also prevails among the m odern authorities like W ood. M ackenzie claims that he could be able to record anacrotic. W ood correlate it that it is due to vasodilatation. Similarly. we find th at W ood’s illustration of bisferiens pulse is very similar to the anacrotic pulse in the text-books of H urst and Logue.

140 Mzdt-Vijnana Above all these facts. Davidson. Ana means up. The resulting pulse- P T e Fig. e. with the h elp . e. g. Friedberg. This is a greek word which comprises of two syllable. ( 1 ) Anacrotic pulse. or slight variations from the normal. the diagnosis made by experts by direct examination o f the pulse i. to its rise. Oram ( 1971 ) et6. have confidently described in the latest editions of their books about the various character i. The character ( the term character refers to the nature of the pulse wave. e.o f the fingers is still undoubtful and unchallenged in the clinical branch of the medicine. and krotos means beat. But in certain diseases the character o f the pulse is detectably abnor­ mal. Such type of pulse occurs in aortic stenosis. Hutchison. qualitative form of abnorm al pulses. . which gives rise to a slow ejection of blood from the left ventricle. summit and fall ) of the pulse wave is most satisfactorily appreciated by palpating a large vessel. and that is why even today the clinicians of repute like Savill. 24': Pulses of the Diseased Condition. One very im portant thing to note is th at it is not usually possible to detect the waves of the normal pulse. the carotid artery. Wood. Below descriptions are made of abnorm al pulses most commonly found in the diseases of cardiovascular system.

It is also felt in heart block and hyperkinetic states. and in fact may reach zero. 24. being greater in aortic incompetence. so that often there is peripheral vasodilatation generally responsible for increased cardiac output.Normally during inspiration the fall of systolic pressure is mainly due pooling of blood into the . heart block and hyperkinetic state and low in mitral incompetence. If the amplitude of P is less than T. 24. a point of clinical importance is that if the amplitude of P is greater than T. As shown ( Fig. ( c ) arterio-venous fistula.. during inspiration. b ). has an ill-sustained crest and the collapse of the pulse is also rapid ( Fig. In the condition of peripheral vasodilatation the arteries are too full in systole and too empty in diastole. The amplitude if the pulse varies considerably. The colla­ pse occurs during systole prior to the second sound and not during diastole. Tfye meeting o f the returning tidal head resulting in a summation effect. and ( d ) m itral incompetence. ( b ) potent ductus arte­ riosus. aortic stenosis is dominant. 24. The systolic pressure is usually raised and the diastolic lowered. The pulse becomes smaller. when the patient breaths deeply. reflected back before. This sign is found in pericar­ dial effusion and in constrictive pericarditis. (4) Pulsus paradoxus. T is a tidal wave. Here. and according to Bramwell is due to the head of the percussion wave P. It occurs when there is an abnormal leak from the arterial system for example ( 1 ) ( a ) aortic regurgitation. or even disappears at the end of inspiration. It may also be possible to bring out the bisferiens characteristic by exercise. then incompe­ tence is the more severe lesion. c ) two components are P and T. (2) W ater-hammer pulse. ( 3 ) Pulsus bisferiens. It is best felt when the patients arm is elevated and the wrist is grasped with the palm of the observer’s hand against its palmer surface. Such a pulse implies a low filling resistance in the reservoir into which the left ventricle is pum­ ping.Clinical Examination of the Pulse 141 wave has a slow upstroke. The percussion is abrupt. It is a combi­ nation o f the anacrotic and collapsing pulses occurring in com­ bined aortic stenosis and incompetence. the valsalva manoeuver. Dicrotic notch may be recordable displaced towards the baseline. an anacrotic wave on the upstroke and the pulse is of small volume ( Fig. In addition to above conditions it may o ccu r in obstruction to the superior venacava. a ). The responsible factor in causing pulsus paradoxus is dropping of systolic pressure more than normal value of 10 mm. it tail has passed.

24.the radial tracings are seen alternate large and small beats at equi­ distant. the peripheral resistance is low and blood pressure is also giving a form o f double pulse felt a t the wrist ( Fig. ( d ) cardiac infarction. However. This condition is often discovered when the systolic blood pressure is taken. and any form of low output failure. in fever. ( b ) severe hypertension. ( 7 ) Pulsus parvus et Tardus. the weak may not be palpable a t the wrist and this termed “ total alternans” . ( c ) aortic stenosis. the heart rate is m oderate and no abnorm al rhythm is present. It may be detectable at the wrist but this uncommon.142 JVadi-Vijnana pulmonary vessels as a result of expansion of the lung and the more negative intrathoracic pressure. Pathological conditions causing pulsus parvus are : ( a ) throm ­ bosis or coarctation of the aorta where there is partial occlu­ sion. ( 8 ) Dicrotic pulse. e ) that in. ( e ) m itral stenosis.tic valve. It may be both produced and abolished by exercise. It is a characteristic of severe or moderate aojtic stenosis. It is a characteristic of a serious obstruction or leak in the circulation proximal to the aor. and ( j ) pericardial effusion. ( g ) severe pulmonary stenosis. ( h ) tricuspid steno­ sis. This is characteristic of failure of the left or r\ght ventricle. Bounding pulse is found . poor cardiac filling. Physiologically it can occur as a result o f cold and anxiety. This type o f pulse is found when the heart muscle i-s severely damaged. ( 5 ) Pulsus altem ans. It is a small pulse with delayed systolic peak. usually reaches a small level higher than normal. and the rate of sounds suddenly dou­ bles as the p ressure in the cuff falls. Norm ally in health the dicrotic wave is impalpable at the wrist. ( 9 ) Bounding pulse. ( f ) extreme pulm onary hyper­ tension. ( 6 ) Pulsus parvus. It is due to a shortened ventricular systole and concomitant diminution of peripheral resistance. Ofcourse. Rarely. ( i ) constrictive pericarditis. Pulsus parvus also indicates th at the pulse pressure is reduced. Transmission of the negative intrathoracic pressure to the aorta and great vessels may also be the contributing factors. and disappear quickly. A pulse o f small amplitude but norm al configuration indicates th at the blood flow is diminished in the vessel conce­ rned and is generally due to a low cardiac output due to vaso­ constriction. although it can be brought out by gently compressing the brachial artery above whilst the radial artery is felt below. It is evident from the diagram ( Fig : 24. classically typhoid. d). The wave swings sharply upward.

as the result of progressive obliterative endarteritis of the vessels to the head. but before doing so the radial artery should be cmphied by pressure on the brachial artery in the bevipital groove against the humerus. e. the arterial w all is just palpable but is neither thickened no r torturous. emotional disturbances.Clinical Examination o f the Pulse 143 in severe febrile states. (11) Pulseless disease. they are more easily palpable. In young persons. and no other conclusions concerning th at or other arteries may be made from this sign’" Delay of Femoral Compared with the Carotid Pulse : This is found in coarctation of the aorta. Oram rem arks “ even if the t h i ­ ckness can be estimated the implication is that the particular itich or so o f radial artery being palpated is thick. The rate is rapid. In arterio-sclerosis they may feel hard like whipcard 4nd m ay be tortuous. the wave appears qui­ ckly. thyrotoxicosis. This can also be done by obliterating the pulse by pressure with all three fingers. The beats are regular in rhythm and equal in volume. neck and arm. the wall o f the artery is felt by rolling the empty vessel under them. the arteries can not be felt or are soft. After the description of rate. and other disorders causing peripheral vasodilatation. Occurs more comm­ only in Japan than elsewhere. The aortic arch aneurysm is the usual cause where the pulse is absent a t both wrist and the neck. The typical pulse o f a healthy adult man is described in the following ways : The rate is 70 per minute. The Condition of the Vessel Wall : The condition of the vessel wall i. giving the impression of very little strength. the lower end o f which runs along the back o f the radius. ( 10 ) Thready pulse. In older persons. . This is found in some cases o f severe myocardial failure and in peripheral circulatory collapse. thickness is estimated by rolling the artery on the underlying bone o f the wrist. The pulse is o f normal volume and is not collapsing in character. producing absent brachial and radial pulse. Pressure of aortic aneurysm is also one of the cau­ ses. An extre­ me form of the pulse is corrigan pulse { water-ham m ar pulse ). or it may result from an aberrant origin or course of the left subcla­ vian artery. An absent or greatly diminished radial pulse now--a-days is usually found as the result o f left heart catheterization but may occur on one side as a result of a displaced radial artery.

perfpration of bowel. tem pera­ ture and respiration rates together in cases of pneumonia is indi­ cative of crisis. and their extreme importance in diagnosis the case. In abdominal conditions if the pulse is rapid it indicates perhaps that the patient is suffering from some inspec­ tion. A sudden drop of pulse. In toxic myocarditis a pulse frequency increased out of proportion to the rise of temperature. and a pulse rate over 130 per minute in pneumonia is evidence of severe toxyalmia. In an adult pulse frequency increases 8 to 10 beats per minute for each degree rise of tem­ perature.144 Nadi-Vijnana rhythm. has definite abdominal discomfort but no localized pain. In cases of appendicitis the pulse rate is of outstanding significance. The pulse is small and thready in states of stock. In doubtful cases. In relation to fever if the pulse frequency is slowing it may be indicative of heart block. An increase of pulse rate with fall in temperature in abdominal conditions occurs in intestinal haemorrhage. force etc. Indeed there is so much to be le'arnt from palpation of the pulse by the experienced fingers that it should always be the first step in the general examination of the patient. A rapidly rising pulse rate is a common turmirjal event in both febrile and afebrile diseases. A full bound­ ing pulse is characteristic of an acute febrile illness and arthenic state. The pulse is diagnostic measure of cardiac efficiency by its response to exer­ cise an d the time taken for its return to normal. so that it may be read in conjunction with the tem perature and respiration rate. both medical and surgical. a bit explanation is required here to assess the impor­ tance as a whole by describing its role in relation to prognosis and treatm ent of disease. But without a fall in pulse rate or even a slight increase in pulse rate with the fall of temperature is evidence of complication. profuse diarrhoea complicating typhoid fever. In Grave’s disease the pulse rate ( specially during sleep ) and the height of the pulse pressure with the patient at rest in bed pro­ vide a fair index of the basal metabolic rate and the toxae­ mia. In emotional reaction there is transient increase in the frequency of pulse rate. whereas in colieky pain the pulse rate is slow. when the patient looks ill. an increasing pulse rate may be the deciding factor for immediate operation. and a soft abdomen. . In case of children pulse frequency increases by 12 to 15 beats per minute with each degree rise of temperature. The pulse frequency in febrile diseases should be char­ ted four-hourly.

tense pulse which feels like a cord. examination and technique of taking the pulse in the above said cultures. fracture. em­ bolism.to raise itself to a point in order to strike the finger at a single point. Arabic and Unani systems of medicine. P. Among the arrhy­ thmia beats are : ( 1 ) Extra systoles ( 2 ) Auricular fibrillation ( 3 ) Paroxysmal tachycardia ( 4 ) H eart block ( 5 ) Premature contractions ( 6 ) Inequality o f the pulses ( 7 ) Sinus arrhy­ thmia. size and division of the vessels.. and the pulse have been described in the chapters seventh and the tenth respectively. It is usually found in instances where compensation fails. Among the other chapters which mention about the normal pulse. exophthalmic goiter. their book “ The Pulse in Occident and Orient” have given a good deal of information about the varieties of pulses which were used in the past by the modern medical men to diagnose diseases. or compression of a vessel by tum our within or without the thorax.Clinical Examination o f the Pulse 145 Amber and Brooke ( 1966 ) in. Chinese examination of the pulse.: Wiry pulse. in prostration it runs above. Abdominalis . A small. in which case the pulse will be slow. V. and the disease. The pulse of the adult rarely exceeds 150 beats per minute even in acute inflammatory infection.. the Western examination of the pulse. per­ nicious anaemia may be suspected. an atheromatous plate within a vessel. Allorhythmic : Irregular in rhythm. seen in acute peritonitis. Some of the different types o f pulses are enumerated below : P. 10 N. AcceleratedA common symptom in all fevers.. rapid. but usually regular p. aortic aneurism.. The soft compressible. locomotor ataxia. . Ayurvedic and Unani examination of the pulse. Asymetrical radial : May result from an anomaly of dis­ tribution. Chapter fifth describes about the definition. The first deals with the historical survey o f the subject. The book has been divided into eleven chapters. An accelerated pulse may be due to valvular defects of the heart except in aortic stenosis. Angry. P. Second. P.. P. occurring in certain abdominal diseases. Ayur­ vedic. In the absence of cardiac condition or fever.. P. Ardent : Artery seems. early phthisis. third and the fourth chapters are devoted for the description of pulse-lore in Chinese. cervical rib. Addison’s disease. luxation causing compression o f a vessel.

. Critical : The subsidence of irritation results . P. A ortic regurgitation chief sign.. P. P... thyrotoxicosis.. Cordis .. Contracted : Indicates a capillary obstruction and intense engorgement... then subsides abruptly and completely. pulsation being narrow.The apex beat of the heart. : Observable in the bulbar o f the jugular vein and ^synchronous with the systole. P. open. the pulse feels free.leap : Imperfect dilatation of the artery being suc­ ceeded by a fuller and stronger one. and somewhat hard. P. P.. the pulse returns to normal with the subsidence of the irritation and as it return to normal.. Convulsive : Unequal frequency or unequally hard. P.‘The strong beat and Jhe follow­ ing weak beat are coupled. P. Bigeminal : Two regular beats followed by a longer pause. After having been irregular or abnormal in respect to the diseased condition.n a more perfect equilibrium in the circulation and a general improve­ ment in the patient’s condition. Changeable : Denotes nervous derangement and sometimes organic heart disease.as in the case of the liver.Dcbilis : A weak pulse.. Bigeminus : Paired beats. Breath : A peculiar audible pulsation of the breath corres­ ponding to the heart beat. Seen in cases of dry cavities of the lung with thick walls not separated from the heart by perme­ able lung tissue. emotional disturbances and disorders causing peripheral vasodilatation. Found in febrile states. occurs in tricuspidal inadequacy. Pulse feebly strikes the finger. Artery seems to leap. particularly that associated with high blood pressure in aortic regurgitation. P. Celer : A pulse beat swift to rise and fall. P . Bamberger'i bulbar P. . A pulse may also at times occur in a vein in a vascular organ#. P. A bounding leaping pulse irregular both in force and rhythm. P . peculiar weak pulsation succee­ ded by a stronger one. Epidemic cholera. Goat. Cannot be felt without difficulty nor without strong pressure. deep. Nearly the opposite o f the full pulse..146 Nadi-Vijnana P. Caprisans : An irregular. P. Deep : Pertaining to the situation of the artery. P.. Bounding or Collapsing : Due to a shortened ventricular systole and a concomitant diminution of peripheral resistance. and soft. It has the same significance as an irregular pulse..

.. P. indicating arte­ rial hypertension.. P... P. as if the direction of th e wave of blood haji been reversed. A or­ tic stenosis.. deep. Aortic regurgitation. Parvus . Duplex : Dicrotic pulse.. Sometimes noted after violent exer­ cise. short duration* and rapid decline especially noted in degeneration o f the heart.. Monocrptus: Grave condition of the circulation and impending death. P. Entroptic : The subjective illumination of a dark visual field with each heart beat. Magnus : A large full pulse. Durus : A hard incompressible pulse.. P. debility. P . Pistol shot : Pulse produced by rapid distention and collapse of an artery as occurs in aortic regurgitation. Artery from a stat'e of emptiness is suddenly filled with blood. but which is maintained. Jerking : M arked by a quick and rather forcible beat followed by a sudden.. Depressed : Weak and contracted. Mollis . A pulse in which the artery is suddenly and markedly distended. abrupt cessation. P. P. Large : Open and full beat. P.. Languid: Slow and feeble. Low tension : One with rapid onset. A small pulse. P. A prolonged pulse usually with an anacrotic interruption. A soft easily compressible pulse. P. Mormeretis : A full slow and soft pulse-jaundice... Low : Pulsation scarcely perceptible... fevers. P.. . Laboring : Blood seems to t e partially emptied a t each pulsation.. due to the mechanical irritation of the rods by the pulsa­ ting retinal arteries. P. and low state of nervous system. indicates that structural disease of the valves of the heart may be present. Long : One in which the duration of the systolic-wave * is comparatively long. Deficient or Flickering : A feeble beat which seems every instant about to cease. co­ llapse. P. P. Plateau: One slowly rising.Clinical Examination of the Pulse 147 P.. P. Lack of a beat due to the failure of the heart to contract. P. P. Sphygmograph shows a simple ascending and descending uninterrupted line and no dicrotism..

. Hard. like the motion o f a musicql instru­ ment. firm. but yields more easily and completely to strong pressure. seen in haemorrhage. it is called wiry. Soft : N ot m arked by active inflammation o r much debi­ lity. Vibratory : Jarring. Week :■Denotes impoverished blood and an enfeebled condition of the system. The comm on diseases and their characteristics pulses descri­ bed in the work o f Amber and Brooke are given below : Aho- . P . one in which a series of oscillations is felt with each beat. Undulatory : Resembles that o f a wave. Resistant.. snuff. P. Excessive irritation with considerable debility. alcohol. When it resists compression. P . Tense. P. Thready ... Offers nearly as great a resistance a t fust as a strong pulse. a h srd full pulse. is small. P. wave appears quickly. Tense : W hen artery resembles a cord fixed at each extre­ mity . P. Small and rapid as seen in great prostration from wasting diseases or haemorrhage. P.. Tracuus . Tremulous : A feeble fluttery pulse.. observed in arteries near a joint in rheu­ matism. P. Small : Debility with m ore or less local irritation. Tea. Vagatonia : 66 beats per minute. P. or resistant. it is called weak.. tobacco arc among its common causes. and dis­ appears quickly. one which may be stopped by digital pressure. A very weak frequent pulse with low tension in the arteries. P. R u n n in g . Firm ..P. P. Unites the character of the weak or' feeble with the contracted pulse.. A scarcely appreciable one as observed in syncopc. Debility. Trigeminal: Three regular beats followed by a pause. one pulse wave running into the next with no apparent interval. Beats lightly against the finger ceasing entirely on very slight compression. Extreme nervous debility with violent irritation or excessive internal congestion. it is said to be hard. -When it feels still harder and smaller.148 t Kadi-Vijnana P. When pulse is said to be small as well as hard. Rate is rapid. P. M yocardial failure and peripheral circulatory failure. Steel Hammer : A brupt and energetic as the rebound of a blacksm ith’s hammer...A very weak pulse hardly distending to the arte­ rial wall.

Pulse fceble and of low tension.. usually low tension. infrequ­ ent. Catarrh Jaundice. Pulse 40 to 60. Pulse slow compared with other febrile diseases. rapid. Slow pulse. Slow pulse. intermittent pulse. High tension pulse. slow pulse during post-febrile stage. Atropinpoisoning. feeble pulse. Indigestion. Bacillary Dysentery. Miliary. H ard full pulse. Bronchial asthma. Tuberculosis. Uremia. Sunstroke. Perforated peptic ulcer. Strong pulse increasing steadily. Sepsis. Angina Pectoris. Anxiety.Clinical Examination o f the Pulse 149 holism. Goitre. Rapid pulse. Yellow Atrophy of Liver. Soft. Rapid pulse. intermittent pulse. Meningitis Tuberculosis. Intestinal obstruction. Rapid at first and later irregular and slow. volvus bands.. Full pulse. hard. In physiological disturbances. and rapid pulse. Fast pulse. Heart beats rapidly in proportion to the am ount of atropin injected. T. pulse may be slow. Typhoid Fever. a t first wiry. Smallpox. Renal Coma. hernia strangu­ lated. due to the peripheral vagus paralysis. Rapid pulse. Slow and small pulse. all of which have the same rapid feeble pulse : intussusception. H ard pulse. Rapid full pulse. Hypertension. Proportional to temperature. Hepatic diseases. Tachycardia pulse. Pregnancy. Malaria. Rapid. Small. Toxic. regular. Myxedema. Pneumonia. but regular. Peritonitis. . irregular. usually low tension. Rapid feeble pulse. Rheumatic fever. B. serious if increasing rapidly. Lobar form. Hypotension. Rapid pulse. Rapid and small pulse. rapid pulse 100-120. Ulcerated Colitis. Heart rate may be slow. Slow cardiac rate in relation to tem perature is basic characteristic of the disease. Appendicitis. During later part and puerperium. later thready. Small. Includes the following. Meningitis Pneumococci. Rapid pulse.

Each harmonic component has a definite modulus or amplitude and a definite phase or delay from a set point of reference ( Fig. We can calculate vascular resistance by measuring and relating mean values of the waves and thus we can interpret the resistive properties o f the vessels downstream. They explained pressure wave contour in different vessels in terms of wave reflection between the aortic valves and peripheral sites. changes in the pulse wave form can be visualized in terms o f its frequency content. Thus in addition to distortion o f the wave form resulting from reflected waves from a wide variety of peripheral points. The m ajor contribution in this field was the classic paper of H am ilton and Dow ( 1939 ). They recorded pressure waves at inter­ vals between the ascending aorta and femoral artery. Any pressure pulse can be considered as the sum o f a num ber of sinusoidal wave form. Fourier analysis' is a mathematical technique by which a complex periodic wavte can be broken down into a series o f sinusoidal waves having a fundam ental frequency equal to the frequency of the original wave and harmonics ha­ ving frequencies that are integral ‘ ultiples of the fundam ental m frequency. In the same way one can compare corresponding frequency components of pressure and flow—the first harmonic of pressure with the . Such type of analysis is done by the help of computer. Frequency analysis has long been a standard procedure in the physical sciences and is used widely in electrical and acoustic engineering and in other fields. Both performed their experiment on the dog. Later on M cDonald and Taylor made revolution in this field. Given amplitude or modelus and phase of the different harmonics o f the pulse one can resynthesize the original wave.Chapter VIII Frequency Analysis and Current Status of Sphygmology Frequency Analysis of the Pulse By definition. The most precise information about functions o f the arterial system has come from quantitative studies of the arterial pulse. Thus the advantage of harmonic analysis is that it enables one to describe the arterial pulse in quantitative terms. 19 ).

the second harm onic pressure with the second o f flow.Frequency Analysis o f . and the diastolic wave is absent. . Hypertension and Arterio-sclerosis : In hypertension and arterio-sclerosis amplitude of the aortic pressure pulse is increased. Here also pulse velocity is increased and the amplitude and contour is the same as mentioned above. The wave reflected from the lower part of the body returns to the proximal aorta not during dia­ stole but during the later p art of systole where it merges with the echo from the upper body reflecting sites to augment the tidal wave and increase systolic pressure. reflected waves are blended and not recognizable as discrete events. We now in the light of quantitative analysis of the pulse. U nder these conditions incident. Frequency analysis thus enables us to describe a wave in precise m athematical term s and to define the relationship between different waves. In these conditions pulse velocity is increased so th at the wave traverses the arterial system more quickly. In central vessels there is less delay between incidence and reflected waves so th at summation effect is nearly as great as a t the periphery. These changes in wave contour can be seen to develop and regress during and after intravenous infusion of a drug which increases mean arte­ rial pressure. Aortic Coarctation : In aortic coarctation the normally placed lower body refle­ cting site is replaced by another m uch closer to the h e a rt The .the Pulse 151 second of flow.and so on. On palpation of finger we find that in hypertension the amplitude o f the pulse fell smoothly during diastole from a prom inent systolic peak and which is associated with continued palpability of the artery throughout diastole. This finding can be explained on the fact th at the pressure wave is more widely spread over the arterial system at any one point in time when wave velocity is high than when i t is lower. In these conditions there is less evidence of reflected waves ' as discrete components of the arterial pulse than under normal conditions.. The above events are also found in central aortic and peri­ pheral pressure pulses hypertension and arterio-sclerosis. can explain the contour of the pulse under abnormal conditions. the tidal wave is prominent. All features of the pulse can be explained on the basis of increased wave velocity.

Aortic Valvular Disease : The characteristic pressure pulse of aortic stenosis can be attributed to two factors of which prolongation of ventricular ejection is probably less im portant and venture effects in the aorta. W hat we feel as a pulse in the radial artery is one of the peripheral pulses which are nothing but mere continuation w ith . In transmission of pressure wave through the arterial wall. elasticity of the wall plays the main role. the impu­ lse traverses the arterial system more slowly so that in the aor­ tic pulse the tidal and diastolic waves are further displaced from the percussion wave.from the heart. more important. This-can be attributed to the fact th at with slow wave velocity the disturbance generated by ven­ tricular ejection is at any time more discretely localized in space and so at any one site more discretely localized in time. and ( 3 ) the elasticity of the arterial walls. e. The pulse wave velocity is slower in larger vessels. Central aortic pressure waves in coarctation are sim ilar to those seen in arterio-sclerosis and severe hypertension. Current Status of Sphygmology The pulse is a pressure wave that travels along the vessel wall. And also the pressure wave tra­ vels through the arterial wall with much more velocity than the flow wave. stroke volume output. The factors responsible for the pulse are three in numbers. per second. This tendency for the diastolic wave to be exaggerated in hypoten­ sion is potentiated by shortening of the ejection period and by vasoconstriction. The pressure wave is different from flow wave which is produced merely from the flow of blood.152 Nadi-Vijnana pressure wave traverses the arterial system more quickly beca­ use of its smaller dimensions as well as i t s . namely ( 1 ) the intermittent flow of blood. Hypotension : Pulse wave velocity is decreased in hypotension. the diastolic wave is frequ­ ently more obvious than usual. ( 2 ) the resistance to outflow of blood from the arterioles into the capillaries. i. is falling steepy. increased distending pressure. On the other hand. The tidal wave is frequently less obvious than usual because it occurs so late in systole when pressure. The pressure wave travels 7 meters per second whereas the movement of the red cell or plasma is 10 to 20 cm.

Certain advancement has also been made in the field of clinical examination of the pulse. Hutchison. instead of an “ anacrotic” pulse. and “ dicrotic” waves are confusing. also states that the estimates of the “ tension” o f the pulse. and “ diastolic” for “ percussion” . “ late systolic” . In relation to for­ mer one may substitute “ early systolic” . and in relation to later “percussion” . a puls^w ith two systolic peaks. Because this ter­ minology is not consistent. Oram has advised that the pulse should be examined only for ( 1 ) rate. According to Rourke in normal arteriogram the terminology ‘percussion’. “ cephalic reflected” . “ dicrotic notch’1 and ’ “ dicrotic” wave.Current Status of Sphygmology 153 certain modifications of central pulses produced in the aorta and its greater branches. while “ tidal” has no clearly relevant meaning. should be described. This is done by frequency analysis of the . Latest commentary has come up regarding the terminology of pulse wave for normal and abnorm al arteriogram . and ( 4 ) condition of arterial wall. Therefore. In his opinion the ter­ minology should be best replaced either entirely in relation to timing or entirely in relation to mechanism. in aortic stenosis. “ Percussion” refers to a mechanism. is the quantitative analysis of the pulse. ( 2 ) rhythm. Between these two. and so on. The attem pt to esti­ mate the blood pressure by the degree of pressure required to obliterate the pulse at the wrist are a waste of time. “ bisferiens” . a pulse with slow rise and low am plitude in aortic stenosis. A normal arterial pulse con­ sists of “ percussion” wave. “ tidal” . Modifications in the contour of peri­ pheral pulses are mainly brought by reflected waves produced at the sites o f branches of arteries. Similarly more familiar terms of abnorm al such as “ anacrot'-3” . “ tidal” wave. “ diastolic” describes timing in relation to the cardiac cycle. e. these terms should be described in simple terms. the nomenclature based on timing appears simpler and better. Frequency Analysis : The most im portant advancement in the recent years in the field o f pulse examination has been made. and “ dicrotic” waves may be replaced by “ impact” . i. “ tidal” . and “ dicrotic” . “ dicrotic” . that is of the blood pressure within the vessel are quite unreliable. instead of a “ bisferiens” pulse. and “cau­ dal reflected” . and “ water-hammer” are neither descriptive nor informative. “ tidal” . ( 3 ) form.

or when one wants to investigate underlying mechanism. Actually the conve­ ntional approach to analysis of the pulse suffers from the dis­ advantage o f being only descriptive and qualitative. or which are mixed with or obscured by other features. To the modern physician the pulse is beginning to assume even greater importance.154 Nadi-Vijnana pulse. it is almost incredible that text books have shown virtually no change in their descri­ ptions and explanations o f arterial pressure pulse contour over the last seventy years. . While i t is perfectly acceptable to describe a phenomenon such as the pulse in terms of its easily identifiable features. but rather is a consequence of the complicated nature of the subject and the inability o f clini­ cians to absorb all th e advances that have been achieved by workers in the paramedical sciences. This failure of progress is not due to lack of headway in subsequent years. In this type of analysis. While importance of the pulse is undisputed and its increa­ sing significance can hardly be denied. this approach is quite restrictive when one wants to describe features th at are not easily identifiable. In attempting to follow changing cardiovas­ cular status under emergency conditions the modern physicians frequently records the pulse directly through an intra-arterial cathetor. the pulse is considered to be regularly repeated as a series of harmonics. and he wishes^to gain as much information as possible from inspection of pulse contour. The early physicians paid great attention to the character of the pulse in health and the changes which occurred in disease.

P a r t Four Clinical and Experimental Studies on Nadi Pariksha .

.

( 2 ) hypertension. They . recently O ’Rourke (1971) has published an article showing that haemodynamics certainly can bring about a revolutionary change in the way of thinking and quantitative interpretation of different curves of pressure waves. modern medical men limit its scope as a means of diagnosis only to the cardiac diseases. selection of 160 cases have been done. Selection of Normal Volunteers : These belonged only to male sex. Because in the field o f Ayurveda. though its wide scope has been described in books of sphygmology. ( 3 ) jaundice and ( 4 ) thyrotoxicosis. the importance o f this science cab only be judged that plenty of old literature in diffe­ rent languages of India is still available on the subject. Out of the total cases. and the pulse tracings done with the help of an instrument known as Dudgeon’s sphygmograph. mainly the clinical aspect has been touched in detail. The tradition is still being practiced by Vaidyas and Hakims of India. And some of Vaidyas claim even to-day to be the master of this science in diagnosing all kinds of diseases only with the help of pulse-examination. in the present time. Thirdly. Secondly.to certain groups of diseases namely. symptoms in relation to predo­ minance of Doshas.Clinical and Experimental Studies The aim behind to conduct study on pulse-examination is its traditional use as an im portant means of diagnosis. And also. ( 1 ) Cardiac valvular lesions. e. And they were students and teachers of Industrial Training Institute of Varanasi. due to lack of highly advanced tech­ nical help. And four­ thly. pulse-examination. the effort has chiefly been made in the direction of correlation of the triad. These were important points that stim ulated to conduct study on Nadi-Pariksha. this is the first work of its own kind. we limited our study only . Therefore. both in normal and diseased groups. Methods and Materials To conduct the study on Nadi-Pariksha in normal and diseased groups. i. 40 were normal volunteers and the rest were diseased persons. In the present study.

to 75 Kg. Arid their body weight varied frqm 48 Kg.158 Nadi-Vijnana were selected in different range of age groups. these cases were subjected to a careful case taking and thorough investigations. the volunteers were subjected to their laboratory and other shorts of investigations. albumin. Total number of cases taken under study were 160. volunteers were put under the physical examination. D uring case taking they were interrogated for their appetite. percussion and auscultation. In laboratory investigations. In systemic examination. Out of total cases. Before taking under study. Selection of Diseased Cases : This group of cases were selected from indoor. body tem perature and body weight were recorded. 50 were of cardiac . tongue. In this examination their pulse rate. The systems examined were cardio­ vascular. body built. blood pressure. red blood cells and casts. comprising of both sexes. F or radiological examination M M R was done. sugar. the laboratory and the rediological. urogenital and the ner­ vous to confirm whether the volunteers have any kind of even m inor abnorm ality or not. Investigations : This included two types of investigations. respiratory. Next. ears. bile pigment. gastro-intestinal. Blood was examined for total and differential count. nose and lips etc. every system of volunteers was examined thoroughly under the heads. head. Enquiry was made also about states of psychology. nutrition. Banaras H indu Uni­ versity. when it was confirmed that no one was suffering from any kind of disease. digestion and condition o f bowel. outdoor and special clinics of Sir Sunder Lai Hospital. After putting under these investigations. Next. volunteers were subjected to routine investigations of stool. and ery­ throcyte sedimentation rate. eyes. Physical and Systemic Examination : After completion of taking the history. these volunteers were selected for the purpose of further study. palpation. inspection. urine and blood. The stool was examined for any kind of ova and cysts. any drug taking or habit of taking alcohol or tranquillizer or sedative etc. respiration. varying from 17-40 years. their general examination was started to see the condition of teeth. And the urine was examined to check for the presence o f pho­ sphate.

any drug taking or habit o f taking alcohol or tranquillizer. gait. 20 cases of jaundice of average age of 42. lips. jaundice. . In personal history. all cases were subjected . In this group also. Physical Examination : This included full general examination o f the patient. Clinical History : This was completed under the heads ( a ) chief complaints and the process of development of disease ( b ) p ast history of any disease or diseases to show the relation with the present illness and ( c ) personal history. measels and veneieal diseases. teeth. And also included the examination of facial expression. body tem pera­ ture. neck veins. • In noting down the past history. cyanosis. physical and systemic exa­ m inations were performed..Clinical and Experimental Studies 159 valvular lesions including both mitral and aortic of average age of 27. or suddenly or in phases of exacerbation and remission. spoon­ shaped nails. blood pressure. After recording the clinical history. dyspnoea. quality of diet. The general examination was started with the physical verification of the stated age and sex of the patient. states of psychology o f the patient. attitude. And if treated what was the effect of treatm ent. tongue and faueies. . oedema. before taking under study. ears. supra­ clavicular fossae. sedatives and analgesics. anamolies of pigmentation. And this included the recor­ ding of pulse rate. anaem ia and pallor. gums. m arried status. nose. state of appe­ tite and digestion apd condition o f bowel were noted down. nutrition. and 20 cases o f thyrotoxicosis of average age of 27. 30 cases of hypertension of average age of 50. respiration. In chief complaints. head. neck glands. because the diseases o f valvular lesions usually happen to occur due to rheum atic fever and venereai diseases. This was done so. built. it was also noted down whether the disease developed incidiously . decubitus. clubbing. eyes. hairs. In the process of development. the' patients were interro­ gated for rheum atic fever. the history was noted down in chrono­ logical order to know the process of development of disease. typhoid fever.to a careful case taking and thorough investigations. followed by a survey of the general condition of the patient.

In inspection. Similar study was also done in case of diastolic m urm ur. jaundice and thyrotoxicosis. e. ( c ) percussion and ( d ) auscul­ tation. epigastric region and the neck. pulsations in praecordial region. the character of murmurs was correlated in relation to the cardiac cycle. case beside s examining the particular system related to'disease. If the thrill was present. It was observed whether the mur­ m ur o f systolic or diastolic.and physical examina­ tion was prepared and a provisional diagnosis was made. And in auscultation the character o f the first sound was confirmed to know whether it was accentuated or not. To exclude out the presence of congestive heart failure. Neck was also searched for venous engorgement. Other systems were also examined in brief. And if any of the two was present. it was seen whether the m urm ur is pre-systolic. it was correlated in terms of systole and diastole of cardiac cycle. auscultation of lungs was also done. the same p attern o f examination like previous cases was followed-up. Under percussion area o f the borders of the heart was decided. inspec­ tion of apex beat and in palpation. In hypertensive cases besides examining the other systems. Then the routine and special laboratory investigations and the other investigations were started. localization of apex beat was confirmed. the cases were sear­ ched for location of apex beat in norm al or abnorm al position. During palpation. ( b ) palpation. Investigation was also done for ejection click and gallop rhythm . The percussion was conducted to know the superficial and deep cardiac dulness of the heart and thus to localize the boundry of the heart. . D uring inspection. other system were also examined.160 Systemic Examination : Nadi-Vijnana This examination was conducted classically under the heads ( a ) inspection. cardiovascular system was full examined. mid systolic or late systolic. In auscultation. In rest two diseases. Before starting the laboratory investigations a synopsis of the clinical findings o f the case taking . i. the presence of thrill and heave were searched out. In each. in valvular lesions.

t>. Erythrocyte sedimentation rate was also done to know the severity of the disease. P. E. any abnormality o f the red cell as anisocytosis. F or example in cases of jaundice. S. Stool was also examined for stercobilinogen. C. the level of serum choleste­ rol. poikilocytosis. Routine Laboratory Investigations : This comprises of routine examination o f stool. and S. blood sugar. urine was examined for the presence of bilirubin. And the serum was examined for serum bilirubin. R. albumin and globulin ratio. blood urea and urine for albumin and casts were investigated. T. and V. its dilatation. T . It may be pointed out here that the investigations which were done in these cases as would be described hereunder have not been selected due to any other reason. urine and the blood. pulmonary conus and m itralization o f the heart. radioactive iodine uptake was done. Special Investigations . In cases o f thyrotoxicosis. And in cases of hypertension. L. And the blood was subjected to investigate the total and differential count. O. e. It may be specifically mentioned that the investigations done in the present study could give sufficient inform ation about the clinical condition and to some extent about the status o f the systems involved. urobilin and urobilinogen. the cases were sub­ jected to certain routine investigations and several special inve­ stigations specific to the diseases. 11 N. In cases o f valvular lesions. albumin and the sugar. M M R was done in every case. as mentioned earlier. i. V. thymol turbidity. G. In other investigations. red blood cells and casts. but because they were simpler.Clinical and Experimental Studies 161 Laboratory and Other Investigations : In addition to the careful history taking and a thorough physical examination. were relevant also and were conveniently possible in our set up. it proved to be of signifi­ cance to see the condition of the heart. G. Certain special investigations were also performed in certain diseases. . total serum protein. punctate basophilia and also to see the size of the cell as microcytosis and macrocytosis. The urine was examined to exclude out any presence of phosphate. Vandenbergh reaction. Parti­ cularly in cases o f valvular diseases. The stool was examined to exclude out the presence of oya and cysts. G. were done.

And further the tracings have been studied in their qualitative and. This instrument is equipped with a starter on its upper sur­ face. Now this smoked paper was fully prepa­ red for the further use. First of all a rectangular piece of thick smooth paper was taken. really this study has been specified particularly to the tracing of pulse waves propagated through the wall of radial artery in normal as well as diseased groups taken under the study. Before taking the actual tracings of pulse waves on smoked paper. After fixing the rectangular piece o f paper over the drum. And in the present context. Experimental study has been performed by tracing the pulse waves on smoked papers. the instrument is prepared for the work. When the complete paper turned black. the drum was allowed to stop and the smoked paper was detached from the drum with the help of knife. And a thin layer of gum was applied over the four cor­ ners of the paper to stick it over the drum. Pnlse Tracing : Dudgeon’s sphygmograph ( Fig. the drum was allo­ wed to rotate with a constant motion. I t is a small quadrangular instrument which is tied over the radial artery on the wrist like a wrist watch. The small rectangular piece was cut in such a way that its whole width could be fitted in between the two pulleys of sphygmograph. certain procedure was adopted to prepare the smoked papers. a freely hanging needle and a key which is set in the back of the body of instrument and that perform s the action like the key of a wrist watch. Before taking the graph of pulse over smoked paper. two pulleys at the two ends o f a small rotatory bar. By giving full rotations to the key in anticlock direction. both in normal and diseased groups. . Experimental Study In the present work our experimental study was limited. quantitative forms.162 Nadi-Vijnana. a small rectangular piece of it was taken out with the help of the scissors. Next a lamp was used to prepare smoked papers and was kept a little away from the drum in such a way that the whole smoke produced by the lamp could completely cover the rotating surface of the paper. 20 ) was used for tracing the pulse wave.

Qualitative Study of the Pulse : In studying the qualitative form o f the pulse. the strip o f the paper was dipped into the fixing solu­ tion in order to fix the tracing perm anently. tension and the condition of the arterial wall. rhythm. And when . as stated already. as a param e­ ter various movements of birds. For example. Next. the starter is set at work. Pitta and Kapha. But was only done in the morning hours at the time of pulse exa­ mination. Dudgeon’s sphygmo­ graph was put over the radial artery in such a way th at the brass leaf lying a t the base o f the instrum ent should cover the width of the radial artery. After fulfilling these basic necessities. e. pulleys start their wor­ king by rotating the small bar so that the smoked paper is moved forward and the pulse is recorded over it by means of the hanging needle. Then. reptiles and amphibians des­ cribed by Sharngadhara was chosen. Every time the pulse was examined by the classical method as described in Ayurvedic texts. the forearm was slightly flexed with the little flexion and a bit medial rotation of the wrist with the fingers dispersed and extended. the form of Vatika pulse has been standardized with the m ovement of the .Clinical and Experimental Studies 163 To record the putse wave a rectangular piece of smoked paper is fitted in between the two pulleys to record the pulse wave over it generated by the movement o f the radial artery. the stop watch was also brought into the action to note the time. before and after meals and in the evening.the pulse waves were recorded over the foil length of smoked paper. In diseased cases recording was not done in relation to various times. the various character of the pulse was determined yin the terms of Vata. the time was immediately noted down by the stop watch. force. the starter was set at work causing forward movement of smoked strips of the paper with simultaneous recording o f the pulse wave over it. volume. Ulti­ mately. As soon as. First. The pulse tracing in normal cases was performed in diffe­ rent conditions i. the individuals were asked to sit peace­ fully. Same process' of pulse recording was also adopted in diseased cases. The pulse was studied every time in relation to its rate. Then with the help o f expert Ayurvedic physici­ ans having good knowledge of pulse examination. in the morning at the basal condition of the body. As soon as the starter was set at work.

To exclude o u t the presence of enequality. The rate of the heart beat was also counted by auscultating the apex beat of the heart in order to see any pulse deficit. The artery was palpated between the successive pulse waves to know that it was full or emptied out. It was observed whether the ascent or increase of pressure was sudden. In the character of the pulse wave. It should also be noted here th at taking of graphs of movements of various birds. the' pulse at both the wrist was counted. If irregular. And the form of Kaphaja pulse has been standardized with the movement of goose ( Hans ). The radial artery was pressed against the under­ lying bone with the more proximal o f the two palpating fingers till the pulse was no longer felt with the distal finger. summit and descent were studied. The form of Paittika pulse has been standardized by correlating it with the move­ ment of frog ( M andooka ). By studying the tension the level of diastolic pressure was assessed. It was counted not when the lingers were first laid upon the pulse. By studying the force the level of systolic blood pressure was assessed. rhythm and character. moderately rapid or slow. the manner of its ascent. The rate of the pulse was counted as beats per minute. whatever subjective ideas we could derive from various movements of birds. rhythm. Therefore. volume and character etc. to standardize Vatika. W hether the pulse was well s-ustained. First of all the pulses were studied for their rate. whether it was completely irregu­ lar or irregularity had a recurring pattern or whether an other­ wise regular rhythm was occasionally interrupted by some slight irregularity. Attention was particularly paid to the character of the pulse.164 Naii-Vijnana leech ( Jalauka ) and snake ( Sarpa ). Whether having . the amplitude of the movement or lift of the vessel wall during the passage of pulse wave was observed. those have been tried to be explained as far as possible in terms of rate. Paittika and Kaphaja pulses could not have been possi­ ble. but when any quickening due to ner­ vousness of the patient had subsided and the pulse had resume its norm al rate. In studying volume. Rhythm was studied to observe whether the pulse was regu­ lar or irregular. amphibians and reptiles. Details of these have been given in discussion. reptiles and amphibians etc.

Thus the distance from lower end to the perpendicular on the base line was measured.percussion with time of each pulse wave arid divided by the distance . ( 2 ) length of percussion wave from the point of its start to the highest point of its top. Time of per­ cussion wave from the point of its start to the point of its top was calculated by multiplying the length of.points o f the waves. Quantitative Study : Vatika. pulse pressure and the other measurements of length etc.» . ( 3 ) distance between two nearest top . Time taken by each pulse wave was calculated by dividing the standard time 60 seconds by the pulse rate counted in 1 mi­ nute. Paittika and Kaphaja pulses in normal as well as diseased groups were studied quantitatively in terms of pulse rate. 0. ( 5 ) angle of deviation of percussion wave and ( 6 ) distance of dicrotic notch from the base line.Clinical and Experimental Studies 165 ■reached its height. gradual or slow. By means of natural cosine table we calculated the value of 0. To know the condition of the vessel wall sufficient pressure was exerted on the brachial artery to abolish pulsation in the radial artery and it was rolled beneath the fingers against the underlying bone. include the cal­ culation done to take out the mean values of the followings : ( 1 ) time taken by each pulse wave. e. Deviation of angle of percussion wave has been calculated by putting the satisquare such that its base line pessed through the lower end of the percussion wave and the perpendicular line passed through upper end of percussion wave.between the two nearest top points. Length of percussion wave was measured by metric scale upto 5 mm. Cos 0 = bf e------hypotenuse calculation was done upto 5 points of decimils. This distance is taken to be as the base and the length of percussion wave as hypotenuse of right angle triangle for the angle of deviation So. Distance between two top points were also measured with the help of metric scale. (4) time of percussion wave from the point of sta rt to the point of its top. Distance of dicrotic notch from the base line was also measured by means of satisquare. i. e. The later i. the study by measurements etc. it fell off abruptly or whether the descent or fall of pressure was rapid.5 of cm.

Ram aining 120 cases belong to diseased group. 25 : N um ber of Normal Volunteers. Regar­ ding sex and age of normal group. Paittika and Kaphaja characters has been performed in their qualitative and quantitative forms. they are all males varying from 17-40 years in their ages. And in this ' group criteria o f putting the pulses into Vatika. of Paittika character in 20 cases and of Kaphaja character in 11 cases ( Fig. the study of pulses in their Vatika. In this group pulses have been found of Vatika character in 9 cases. 40 are norm al volunteers and the rest belong to diseased group.166 Nadi-Vijnana Observations As it has been mentioned earlier the study on pluse exami­ nation has been donducted in normal volunteers as well as dis­ eased cases. NUMBER OF VOLUNTEERS OF PULSE EXAMINATION IN NORMAL GROUP Fig. 25 ). Total num ber of volunteers and diseased cases taken under study are 160. Paittika and K aphaja characters are based upon the predominance of Do- . Cha­ racter of pulse in the morning and in the evening has also been studied in 20 cases of normal group aijd in 20 cases the chara­ cter of pulse has been studied before and after meal. Out of total number.

28 ). 25 ). 27 ). Average age o f the patients in this group was 50 years. 50 belong to different valvular lesions including mitral and aortic stenosis. aortic incompetence and congestive heart failure. All the 20 cases suffe­ ring from thyrotoxicosis of average o f 27 belonged to Paittika group only ( Fig. 22 of Paittika and the rest 14 possessed the pulse of K aphaja character ( Fig. and the character o f the pulse in 9 cases was of K aphaja nature ( Fig. The average age in this group was 42 years. 29*). O ut of total number of 120 cases. 6 were having Vatika pulses. Average age in this group was 20 years. In total 30 cases of hypertension. NUMBER OF CASES OF PULSE EXAMINATION IN CARDIAC VALVULAR LESIONS Fig. .Clinical and Experimental Studies 167 shas found in symptoms and pulse examination during the time of history taking. O ut of 20 cases of jaundice. Paittika character of the pulse was found in 11 cases. In the valvu­ lar lesions group. 14 cases possessed the pulse of Vatika chara­ cter. 12 Paittika type and the rest 12 were having K aphaja character of the pulse ( Fig. 26 : Num ber o f Cases of Cardiac Valvular Lesions.

TOTAL P .KAPHAJA T Fig. 28 : Number o f Cases o f Jaundice. 27 : Num ber of Cases o f Hypertension.16$ Nadi’Vijnana. NUMBER OF CASES OF PULSE EXAMINATION IN JAUNDICE T . .PAVTTiKA K . NUMBER OF CASES OF PULSE EXAMINATION IN h y p e r t e n sio n T V P K - TOTAL VATIKA PAITTIKA KAPHAJA Fig.

And the summit underneath the fingers was found to be of slightly sustaining nature. Because the time interval between appearance and disappearance of pulse wave underneath the fingers was small. Out of this.PAITTIKA Fig. e. Normal Group : Total cases studied in this group were 40. Volume was small. the pulses were beating every time after definite intervals. 29 : Number of Cases of Thyrotoxicosis.TOTAL P . Force and tension were also found to be on lower side in relation to Paittika and Kaphaja pulses. Paittika pulses were found to be increased in their rates in medium range i. As regards character. but was increased than K aphaja pulse. And the rate was more increased in relation to K aphaja pulses. Rhythm was regular. Vatika pulses were found to -be increased relatively in their rate^thari Paittika pulses. 9 were of Vatika. Qualitative Study : On examination. the percussion wave was found to be of short duration underneath the fingers. the rate of Paittika pulse was slower than Vatika pulse. 20 were.Clinical and Experimental Studies 169 NUMBER OF CASES OF PULSE EXAMINATION IN THYROTOXICOSIS T . Volume in this group of pulses was found to be . The rhythm was found to be regular i. of Paittika and remaining 11 were having K aphaja nature of pulses. e.

The whole im­ pact felt beneath the fingers was of jumping nature. In few tracings where the fall of dicrotic wave is quite rapid. In some . the rates were found to be slowest of all. are of more rounded character.took maximum time than the rest two varieties of pulses. But both were more than Vatika group of pulses. Force was a bit more.170 Nadi-Vijnana more than Vatika and K aphaja varieties. In some tracings slightly visible dicrotic notch is present and in some of the tracings. Regarding tension and force. As regards character of the pulse. 31 ) it is found to have an appreciably large percussion wave. the notch is found to be situated relatively a bit higher. but the time interval between two su­ ccessive waves was found to be maximum in this group of pul­ ses. there was found no appreci­ able difference than Paittika group of pulses. As regards Paittika type of pulses (F ig. In Kaphaja pulses. The rhythm was regular. The summit in this group of pulses was of sustaining nature. As regards character of the pulse. The summit is a bit conical. The Kaphaja pulses ( Fig. the time taken between 9 nset and disappearance of percussion wave in this case was a relatively more than Vatika pulses. 30 ) it is found to have appreciably small percussion wave. As regards configuration of Vatika pulse ( Fig. the tracings o f the pulse appear to have curvilinear motion and the look of the tracings as a whole gives the wavy appearance resembling to the movement of the snake. The fall upto dicrotic notches is quite rapid a n d . The summit is quite conical. it is completely absent. But in cases where the fall is not so rapid. The distance in between the onset of two points of percussion wave is relatively greater than Vatika type of pulse. the rise of percussion wave felt beneath the fingers was moderately rapid and summit was found to be of a bit sustaining nature. At a glance the general appearance looks to be of jum ping character resembling the movement of frog. Due to more small distance between two points of onset of percussion wave. the rise of percussion wave was of longer duration and . The summits in few tracings appear to be of sustaining nature and therefore. most of the part of dicrotic wave assumes more or less horizontal position immediately. Therefore. the dicrotic notch has been found at the lower level. 32 ) of this group are found to have quite distinct percussion waves with the height occupying an intermediate position in between Vatika and K aphaja gro­ ups.

Clinical and Experimental Studies 171 Fig. 31 : N orm al Paittika Pulse. 30 : Normal Vatika Pulse. Fig. Fig. . 32 : Norm al Kaphaja Pulse.

172 jJa d i-V ijn a n a tracings the summit is not so rounded. Paittika and K aphaja pulses to show the relative values among them and has not been done in morning and evening pulses and pulses before and after taking meal. Quantitative S tu d y : This has been accomplished under two heads. And the configuration of the pulse after taking meal appears to be of relatively Paittika nature than the pulse traced before meal ( Fig.216*** P /0 .5 t = A 7^1*** t = 4. b ) resemble to those of Vatika pulse. The character and general appearance of morning pulse (Fig. D.6 74±5.5 respecti­ vely ( Table 1 ). In relation to Vatika and Paittika pulses. 33 & 34 a. namely ( 1 ) statistical and ( 2 ) other mathematical studies.6 and that of Paittika pulse to be 74±5. TABLE 1 Statistical Analysis of Rate of Normal Vatika. G roup Vatika pulse rate Paittika pulse rate Comparison between above two Vatika pulse rate K aphaja pulse rate Com parison between above two M ean±S. The later study has been limited to normal Vatika. And the fall of dicrotic wave is' more Steady and gradual than the other two varieties of pulses.6 65+3.0 0 1 .001 ). 36 ).761. a ) resemble to those of Kaphaja pulse. Paittika and K aphaja Pulses.0 0 1 84±3. Statistical comparison between the above two groups shows that M PR of Vatika pulse is significantly more than Paittika pulses ( t=4.761* P /0 . The slow and steady character of the pulse coincide more to the movement of the goose. the dicrotic notch is found to be situated at higher level. ( 1 ) Statistical Comparison of Normal Group : Mean pulse rate ( M PR ) of normal Vatika pulse was found to be 84±3.9 t = 11. And the character and appearance of evening pulse ( Fig. 35. P /. 0. The distance between tjvo points of onset appears to be more than the rest varieties of pulses. 84±3. 33.

805*** _____________ PZ 0-001 ***Significant at 0. 1% level of probability. Fig. • . Fig. 36 : (a) Pulse Before Meal (b) Pulse After Meal.Clinical and Experimental Studies 173 paittika pulse rate K aphaja pulse rate Comparison between above two 74+5.9 t = 4. 33 : (a) M orning Pulse (b) Evening Pulse.5 65+3.

805. P Z 0.05 .001 ).2.I 74 Nadi-Vijnana Mean pulse rate ( M PR ) of normal Vatika pulse is found to be 84+3. D.5 and that of normal K aphaja pulse to be 65+3. * M ean pulse pressure-in normal Vatika pulse is found to be 35+4.0 respectively. 6 and that of Kaphaja pulse to be 65±3.475*** P z o .412. Statistical comparison between the above two groups shows that Vatika M PR is significantly more than K aphaja pulses ( T = 11. Paittika and K aphaja Pulse Pressures. Group Vatika pulse pressure Paittika pulse pressure Comparison between two Vatika pulse pressure Kaphaja pulse pressure Comparison between two M ean+S.001 ).9 and that of K aphaja pulse to be 42+6. P Z 0.5 respectively.9 49+6 9 t = 5.0 respectively. M ean pulse pressure (MPP) in normal Vatika pulse is found to be 35+4.05 ).216. Mean pulse rate ( M PR ) of normal Paittika pulse is found to be 74+5. Statistical comparison between the two shows that Paittika pulse pressure is significantly higher than Vatika pulse pressure ( t * 5. P Z 0.825.0 0 1 35+4.05 ). M ean pulse pressure in norm al Paittika pulse is found to be 4 9+6. Statistical comparison between the above two gro­ ups shows that Paittika M PR is found to be more significant than K aphaja pulse rate ( t = 4.9 and that of normal Paittika pulse to be 49+6.0.412* P Z 0.9 respectively.0 t = 2. TABLE 2 Statistical Analysis o f Normal Vatika.475. Statistical comparison between the two ' shows that Paittika pulse pressure is significantly more than K aphaja pulse pressure ( t . 35+4.9 respecti­ vely. PZ.9 and that of K aphaja pulse to be 42+6.001 ). Statistical comparison between the two shows that Kaphaja pulse pressure is significantly more than Vatika pulse pressure ( t = 2.9 42+6. P Z 0.

0.52 t .825* P /0 0 5 * Significant at 5% level of probability.0 t = 2. (T a b le 4 ) .73 and after meal is found to be 73.459.60+5.01 72. P / 0.0+7.289.1+5. The mean pulse rate of same persons in the evening is found to be 72.459 P /0 .1% level o f probability.0 5 ) . . M ean pulse rate with standard deviation before meal is found to be 66. On comparison.Clinical and Experimental Studies 175 Paittika pulse pressure K aphaja pulse pressure Comparison between two 49+6.01 ). Mean pulse pressure and its standard deviation is found to be the same in the morning and evening as 45. TABLE 3 Statistical Analysis o f Pulse in the M orning and Evening in Norm al Group.52 45.55+4.05 * Significant at 5% level of probability.45 with its standard deviation as +8.0 2.01. pulse rate after-meal is found to be significan­ tly increased ( t « 3. Statistical comparison between morning and evening pulse rate shows a significant-rise in evening pulse rate ( t = 2.0.45+8.55+4. G roup Pulse rate in the morning Pulse rate in the evening Comparison between above tw a Pulse pressure in the morning Pulse pressure in the evening Comparison between above two J M ean+ S.0 P > 0.0 5 * 45.42. 67. Mean and standard deviation of pulse pressure has been found to be same before and after meal as 48. The mean pulse rate of normal persons in the morning is found to be 67. *** Significant at 0. D.15+3. P / 0 .9 42+6.52 ( Table 3 ).55+4.15 with its standard deviation as +3.46.

The time of each pulse o f Vatika.76 0.62 2.27 65 0. The result shows that time taken by K aphaja pulse is maximum and the minimum value stands for Vatika pulse. The Paittika pulse occupies the intermediate position. TABLE 5 M athem atical Calculations of Vatika. 66.81 0.V to 0.2 P >o o *ri h..30' .2 60 < 3 < - O © s s ° t«. -D.81 sec. 0.2 0 ) £ Normal Vatika Paittika K aphaja *c c « < .73 0. .S D <p L> <G L > *£ ^ cu -w < o > -3 1. ^ O S.46 48.1+5.94 sec. length of percussion wave.40 0.10 0. G roup Pulse rate before meal Pulse rate after meal Comparison between two Pulse pressure before meal Pulse pressure after meal j M ean+S. Paittika and K aphaja pulses of nor­ mal persons heve been studied in relation to their time o f each pulse.60+5.42 t= 3.0+7.21 a o . time of percussion wave.40 1. Paittika and K aphaja Pulses. respectively.8 77 c30' 0.40 1. and 0.289 P /0.15 81.73 sec.60+5.73 73. angle of deviation and distance of dicrotic notch from the base line ( Table 5 ).48' 0.46 ** Significant at 1% level of probability.50 o 5o 2 UV 3 oG ° £ s * p 0. o O a a> > E<st s *i c a 3 s UG £ °j £ _ c d -C > WJg C u . length between two top poi­ nts.176 N aA i-V ijnana TA B LE 4 Statistical Analysis of Pulse Before and After Meal. Paittika and Kaphaja varieties of pulses is found to be 0.94 0.a ° »H ^ 83 ao «a 3 s . ( 2 ) Other Mathematical Studies : In this group Vatika.01** 48.

40 cm. The Kaphaja pulse occupies the intermediate position.15 cm.40 cm. The K aphaja variety here also occupics the middle position between the two extremes. The result of complete ( 64. Here the maximum value stands for Paittika pulse and the minimum for Vatika pulse. partial and no correlation at all am ong these three.26% ). Here it is observed that maximum height is achieved by Paittika pulse and the minimum height is of Vatika pulse. the result in percentage has been assessed. The angle of deviation of percussion wave in case of Vatika. All 22 cases ( 100% ) were found to have complete correlation between pulse examination and pulse tracings. and 0. And thus.. As regards time of percussion wave the respective valuse for Vatika. 0.74% ) correlation was found Jo be partial. And total 14 cases ( 100% ) in this group were having complete coincidence of pulse examina­ tion to the pulse tracings. Out of total 50 cases of cardiac valvular lesions ( Table 6 ) in 14 cases having Vatika character of pulse.8 cm. and 0 62 cm. 1. symptoms and pulse examination were found to be completely correlated to ^ach other ( 64.Clinical and Experimental Studies 177 In relation to length of percussion wave the respective va­ lues for Vatika.26% j and partial ( 35. Paittika and K aphaja pulses has been found 65. and 0. The result shows that the bent of percussion wave in case of Vatika pulse is more towards the horizontal base line. As the result shows that the maximum time is taken by Paittika pulse and the minimum time by Vatika pulse. Paittika and K aphaja pulses are 0. Paittika and K aphaja group has been further conducted to show the com­ plete.76 sec. Diseased Group In every disease of this group the study related to symptoms. In 22 cases of Paittika group o f valvular lesion. 12 N. .74% ) correlation was found to be the same in case of symptoms and pulse tracings. The K aphaja pulse occupies the intermediate position.30 cm.. The respective values for distance of dicrotic notch in Vatika. Paittika and K aphaja pulses are 0-21 sec. Pulse examination and pulse tracings in Vatika. 0.. V. And in 5 cases ( 35. no correla­ tion was found between symptoms and pulse examination and the symptoms and pulse tracings.27 seconds. 8 l 648' and 77e30'. Paittika and K aphaja pulses are 0.

Regarding correlation of symptoms and tracing 3 cases ( 50% ) in complete group and 3 cases ( 50% ) in partial group were kept respectively.0 0 0. cases ( 50% ) were found to be completely coincided. . 0. 0 0 0.14% ) and negative group ( 42. 1 Negative % N o.0 Symptoms and pulse tracing.0 and tracing.0 Symptoms and pulsf tracing.14 examination. 2 cases ( 33.7% ) belonged to nega­ tive group.3% ) partially^coincided and 1 ( 16.0 6 42.0 0 Paittika ( 22 cases ) : Symptoms and pulse examination.0 9 64-26 5 Pulse examination and pulse tracing. Pulse exami­ nation and pulse tracings were found to be completely correla­ ted in all 14 cases (1 0 0 % ).26.0 and pulse tracing. 5 0.74 0 9 64. Complete No'.14 Pulse examination 0 14 100.0 14 100.86% ) were having no correlation at all. O ut of total 30 cases of hypertension ( Table 7 ). 0 0.0 tracing.0 0 0. 35. 0.0 0. Regarding symptoms and pulse tracings. 1 % l Partial No. 0 0.0 0 0.86 8 Symptoms and pulse 0 0. 1 % Vatika ( 14 cases ) : Symptoms and pulse examination.0 In 14 cases of K aphaja group of this disease. But 8 cases ( 57.178 Nadi-Vijnana TABLE 6 Comparative Studies of Pulse Examination in Valvular Lesions.86 •S'.0 Kaphaja ( 14 cases ) : Symptoms and pulse 0 57. same percentage was found in partial ( 57. regarding symptoms and pulse examination 3. 0.14% ) were found tphave partial and 6 cases ( 42. Regarding pulse examination and pulse tracing all 6 cases belonged to complete group. in 6 cases of Vatika group.0 0 0. there was found to be no correlation between symptoms and pulse exami­ nation. 6 42.74 0 0.0 0 0 0.57.86% ). 35.0 0.0 Pulse examination 22 100.

6% ) remained to be partially correlated and again 5 cases ( 41.5 — — 7 7 58. 5 cases ( 41.0 _ 1 _____ 16.5% ) were kept in negative group. | o | No. whereas 7 cases ( 58.6% ) happened to belong to partial group and ag&in 5 cases ( 41.5 — 5 — 100.5% ) were found in negative group.3 50.5 100.5% ) were found to be partially correlated regarding symptoms and pulse examination.5% ) were having no cerrelation a t all.7 - 3 * _____ _____ 41. All 12 cases ( 100% ) were having complete coincidence with pulse examination and pulse tracings. Pulse examination and pulse tracing.0 50.5 41. 5 Symptoms and pulse tracings. 3 Pulse examination and pulse tracing. Regarding symptoms and pulse tracing.0 2 2 16. TABLE 7 Com parative Studies o f Pulse Examination in Hypertension. and‘7 (58. | % /o V atika ( 6 cases ) : Symptoms and pulse examination. Symptoms and pulse tracings.0 100.5 - __ 5 _____ 41. 3 Symptoms and pulse tracing. | o/o | No.5% ). 6 Paittika ( 12 cases ) Symptoms and pulse examination.Clinical and Experimental Studies 179 In 12 cases o f Paittika group of this disease symptoms and pulse examination were found to be completely correlated in 5 cases ( 41. Observations Complete | Partial | Negative No.0 2 33.0 In this disease 12 cases were having K aphaja pulses. 5 Pulse examination 12 and pulse tracing.5 41.6 16:6 _____ 5 5 _____ 41. 2 cases ( 16. Regarding corre­ . Kaphaja ( 12 cases ) Symptoms and pulse examination. 12 _____ 50.5 41.5% ) were kept in partial group. 2 cases ( 16. O ut of 12 cases. Similarly regarding symptoms and pulse tracing there was found complete correlation in 5 cases ( 41.5% ) belonged to the negative group.5 58.5% ). 5 cases ( 41.

In 30 cases o f jaundice ( Table 8 ). Regarding correlation between symptoms and traci­ ngs. And 3 cases (33. 11 cases were found to have Paittika pulses. Regarding symptoms and pulse tracing. As regards correlation between symptoms and pulse examination in this group.3%) belonged to partial group.i .0 64. But all 9 cases ( 100% ) were found to have complete correlation between pulse examination and pulse tracing. N o result was found in partial and negative groups.3 22.6% ) were found to have complete correlation regarding symptoms and puls* examination. only 3 cases ( 27. 3 3 11 27.0 9.6 100. Pulse examination and pulse tracing. 1 case ( 9. Complete | Partial | Negative Observations No. Pulse examination and pulse tracing.0 1000 1 1 9.6 66. No. tive group. 3 cases { 27% ) belonged to complete group.0 —: ■ .0% ) beonged to complete group. — 6 6 66. TABLE 8 Comparative Studies o f Pulse Examination in Jaundice. j % Paittika ( 11 cases ) : Symptoms and pulse examination. 9 were having Kaphaja pulses. the result belon­ ging to complete group was hundred percent.0 27.—i li. In this group o f disease.0 3 2 33.0 — 7 7 — 64. Symptoms and pulse tracings.1% ) was related to negative group. |\ % |. 2 cases ( 22 . 1 ( 9% ) be­ longed to partial group and 7 cases ( 64% ) belonged to nega-.I % I No._ 9 .2 % ) were related to partial group and remaining 1 case ( 11. Kaphaja ( 9 cases ) : Symptoms and pulse examination.0% ) belonged to partial group and the 7 cases ( 64% ) were found to be related to nega­ tive group. Symptoms and pulse tracing. 6 cases ( 66.2 — 1 . Out of 9.6% ) were found related to complete group. 6 cases ( 66 .180 Nadi-Vijnana lation o f pulse examination and pulse tracing. All 11 cases ( 100% ) were found to have complete correlation regarding pulse examination and pulse tracing.

37 ) than those of Paittika and Kaphaja pulses and have more lateral bending towards the base line. j % | ' k o . dicrotic notch has been found com­ pletely absent.0 100. And in most of dicrotic waves. Complete | Partial ( Negative No. TABLE 9 Comparative Studies of Pulse Examination.' Cardiac Valvular Lesions : In Vatika pulses o f this group. Paittika and K aphaja pulses have but with the difference of dominance or diminution of one or the other fac­ tors as shown in their respective figures. . The fall of dicrotic wave has been found quite rapid. percussion waves have been found significantly small ( Fig. | % 20 20 20 100. 37 : Vatika Pulse o f Valvular Lesion. Symptoms and pulse tracings. | % | No. Fig.Clinical and Experimental Studies 181 In thyrotoxicosis ( Table 9 : all 20 cases 100% ) were found to have complete correlation regarding symptoms and pulse examination. The distance between two points of onset of percussion waves has been found quite short. Pulse examination and pulse tracing. The summit is a bit angular and does not have rounded tip. symptoms and pulse tracings and pulse examina­ tion and pulse tracings. ( 20 cases ) Observations Symptoms and pulse examination.0 — — — — — — — — — — — — Qualitative Study : Regarding qualitative interpretation of contour of different pulses in diseased group it should be noted down here that cases of this group also have the same configuration in general as normal Vatika.0 100. in Thyrotoxicosis.

41) percussion waves have been found rising steeply with marked angular summits and marked dicro­ tic notch. The distance between two onset points of percussion waves in also greater. and in some cases quite rudim entary. The fall of dicrotic wave in such types of pulses has been found quite gradual. the length of percussion waves has been found relatively a bit taller than Vatika type of pulses.182 N adi-V ijnan a The Paittika pulses ( Fig. . 38 ) of valvular lesions are found to have tallest and straight percussion wave of sharp rise. 38: Paittika Pulse of Valvular Lesion. The summits of percussion waves have been found quite angular with rapid wavy fall of dicrotic waves. On dicrotic waves dicro­ tic notches have been found significantly marked. 39 ) of valvular lesion. In K aphaja pulses ( Fig. The distance between two points of onset of percussion waves has been found greatest of all. the percussion waves have been found completely in rudimentary form having insignificant summits. Hypertension : In Vatika pulses ( Fig. The percussion wave has been found much more taller than Vatika pulses. Fig. 40 ) of this group. In Paittika pulse (Fig. The distance between two onset points of percussion waves is found to be greater than that of Vatika pulses. The dicrotic notches have been found a bit significant. And in the cases where K apha has been found quite dom inating the bent of percussion wave from per­ pendicular has been found much more with the significant rounded summits of percussion waves. The dicrotic notch has been found absent in most cases and in few cases it has been found slightly visible.

Paittika Pulse of Hypertension. . 4 1 .Clinical and Experimental Studies Fig. Fig. 42 : Kaphaja Pulse o f Hypertension.

43 : Paittika Pulse o f Jaundice. The dicrotic notch has been found a little significant. 44) have been found to possess smaller percussion wave with rounded summit and gradual fall o f dicro­ tic wave with a bit significant or without dicrotic notch. Jaundice : Paittika pulses ( Fig.184 Nadi-Vijnana In K aphaja pulses ( Fig. The summit has been found rounded and the fall of dicrotic wave is quite gradual. Fig. Fig. Dicrotic wave possesses over it the dicrotic notch which is quite visible. In some tracings the notch is found to be below than its usual site. . 44 : Kaphaja Pulse o f Jaundice. And the distance between two onset points of percussion waves is significantly more. The distance between two onset points o f percussion wave has been found appreciably greater. The rise is qdite stra­ ight. 42 ) the percussion wav e has been found more deviated away from perpendicular. K aphaja pulses (Fig. 43 ) in this group also have the taller percussion wave than the K aphaja pulses. And the length of it occupies a middle position in between the Vatika and Paittika groups. And the summit is appreciably angular with the rapid fall o f dicrotic wave.

Fig. Therefore.o o i .9 t=5.6 108+5.63*** P /0 . Pulse rate Mean+S.06*** p z o . The summit is not rounded and the fall is rapid with marked undulations over the dicrotic wave. TABLE 10 Statistical Comparison Between N orm al and Diseased Groups.9 30+5. of cases Comparison with normal.0 t=2. The percussion wave is quite straight like a perpendicular with appreciable angulation a t the summit. the dicrotic notch is quite prominent.D.'— Vatika : Norm al Valvular lesions Hypertension 9 14 6 Group 84+3.2 56+12.0 0 1 108+13. 45 ).02*** P z o .304* PZ0. D. Quantitative Study : Like normal group.o o i 35+4.Clinical and Experimental Studies 185 Thyrotoxicosis : All the cases of thyrotoxicosis have been found to possess Paittika pulses ( Fig. this study has also been conducted under two heads namely ( 1 ) statistical comparison with normal group and ( 2 ) other mathematical studies ( Table 10 ).05 t=6. Pulse pressure Mean+S. 45 : Paittika Pulse of Thyrotoxicosis.2 — t=12. Comparison w normals ith No.

87* P Z 0. ( 1 ) Statistical Comparison with Normal Group : Valvular Lesions : In Vatika group mean pulse rate ( M PR ) in normal and valvular lesions groups are 84.05 11 P> 0.05 ).23. ** Significant a t 1% level of probability. e.3 52+11.64 P > 0.64** PZ0. Mean pulse pressure ( M PP ) in normal and diseased groups are 35.001 tz i P > 0 . It is observed th a t mean pulse pressure is significantly reduced in valvular lesions group (t=» 2.59*** PZ0. PZ 0.1 86 JVadi-Vijnana 20 22 12 20 11 Paittika : Normal Valvular lesions Hyperten­ sion Thyrotoxi­ cosis Jaundice Kaphaja : Norm al Valvular lesions Hyper. In Kaphaja group mean pulse rate in normal and diseased groups are 65 and 69 respectively.2 68+6.5 73+3.2 62+17.0 35+4.6 87+7.645. P Z 0.001 t=6.001 t=l 1.0 — t=3.46** PZO^Ol t=3.0 and 78.9 70+21.001 ) i. It is observed that mean pulse rate is highly increased in valvular lesions group ( t = 12.05 ).0 5 ).5 78+11.1% levei of probability. pulse pressure is significantly more in diseased group.2 76+16.0 — t=1.4 t-1. There is no significant difference in these two groups ( t=1.8 — t=l .0 and 30.0 respectively. P Z 0.0 and 108.0 These two values are differing significantly ( t = 4.405. Mean pulse pressure in the above two groups are 42 and 35 .05 t=1.304. P / 0.0 respectively. Mean pulse pressure in these respective groups are 49. *** Significant at 0.01 .23*** PZ 0. mean pulse rate in normal and diseased groups are 74.0 5 tzi P > 0.4 103+10.0 and 70.37*** P Z 0.9 69+7.2 51+7.t=2.02 14 12 65+3.7*** PZ0.001 ).001 tzi 49+6.tension Jaundice 74+5.05 * Significant a t 5% level of probability. In Paittika group.4 33+8.40 P > 0 .0 5 t=5.0 5 9 62+3.0 respe­ ctively.405 P > 0 . P > 0 .79 P > 0.63.05 42+6. There is no significant diffe­ rence in these groups ( t = 1.7 — t=4.

Hypertension : In Vatika group mean pulse rate in normal and hypertensive groups are 84 and 108 respectively.001 ).06. Mean pulse rate is found highly increased in hypertensive group ( t . PZ0. Mean pulse pressure b found highly increased in hypertension group ( t = 6. P > 0.5. In Kaphaja group mean pulse rate of normal and diseased groups are 65.0 respectively. M ean pulse pressure in norm al and diseased groups are 35.0 respectively.0 respectively.0 and 76.41). pulse pressure is significantly reduced in diseased group ( t=2.64.0 and 33. Mean pulse pressure in normal K aphaja and diseased groups are 42.001).59.0 and 87.001 ). P /0 . There is no significant difference between two groups ( t = 1.0 respectively.0 respectively. i. Pulse pressure is found to be highly increased in diseased group ( t = 3.001 ). normal and diseased groups are 49.01 ).05 j. P > 0.0 and 62. In Paitltika group mean pulse rate of normal and hyperten­ sion groups are 74. PZ 0.0 respectively. PZ0. It is observed that mean pulse pressure is signifi­ cantly low in diseased group ( t = 3.0 and 51. P Z 0.0 and 52.7. Thyrotoxicosis : Mean pulse rate in normal as well as diseased Paittika groups are 74. P > 0.05 ).0 respectively. Mean pulse pressure of. both groups are nearly the same. PZ0. Mean pulse pressure of normal and diseased groups are 42.0 respectively.02. Jaundice : In Paittika group. P > 0.0 1 ).0 and 103. e. T here is no significant difference in pulse pressure of two groups ( tZ 1. It is observed that mean pulse pressure is significantly increased in hypertension group ( t = 6.79. M ean pulse pressure in normal and diseased Paittika groups are 49. In K aphaja group. P Z 0.0 and 73. There is no significant difference between two groups for pulse pressure ( tZ 1.0 and 68.0 and 62.37. There is no Mgnificant difference in pulse rate of two groups ( tZ 1. P > 0.0 and 56.001 ).87. P Z 0.05 ).Clinical and Experimental Studies 187 respectively.0 respectively.460.0 respectively. mean pulse rate in normal and diseased groups are 74. .02 ). It is observed that pulse rate is highly increased in diseased group ( t=l 1.05 ). No significant difference is found in two groups for pulse rate ( t=1. Mean pulse rate is found highly increased in diseased group ( t = 5. mean pulse rate in normal and diseased groups are 65. Mean pulse pressure in normal and hypertension groups are 49.05 ).0 respectively.

The time of percussion wave is 0. Paittika and K aphaja groups respectively.50 0. 0.54 0.20 2.54 sec.s & o >-1 P k £ ! 1 3 -TD £ a< H O l CL. and 0.00 0. and 0. 2. The data indicate the highest value in Paittika type of pulse. in Vatika.20 1.80 2. 84°24' and 75t> 30' res­ pectively.74 1.12 Kaphaja 0.40 .00 0. TABLE 11 M athem atical calculations of Vatika. Paittika and K aphaja types of pulses.32 sec.32 70‘30' 84°24' 75°30' 0. and most acuteness of the angle in Vatika pulse.74 sec. The K aphaja pulses occupy the intermediate position.00 0. length of percu­ ssion wave. in diseased group also. Paittika and K aphaja pulses res­ pectively. time of percussion wave.. Paittika and K aphaja pulses o f different diseases have been studied in relation to their time of each pulse. Paittika and Kaphaja gro­ ups of pulses has been found to 70°30'.75 sec.10 cm. and 1.80 cm. The angle of deviation in Vatika.10 1.. in Vatika.30 2.75 0. r ! Valvular le s io n s Vatika Paittika 0. Paittika and K aphaja Pulses in Diseased Group. in Vatika. C .30 cm. i o i Ut > o o O s Vh CS 2 <u C3 o o .o o Q C3 a) Pk wO O 1£ a C2 <u n < D a £ o o e 8 ’5b a UiJ ■ 5 +•» C/5 W c <u o _ <D a e E > i C c <u > < (U * 0 B <3J <u a . Valvular Lesion : In this group time taken by each pulse was found to be 0. angle of deviation and distance of dicrotic notch from the base line ( Table 11). This indicates the highest value of time taken by percussion wave of Paittika pulse in describing the course from its point of start to its top. 0. length between two top points.12 sec. The length of percussion wave is found to be 0. Vatika. These values indicate the highest length of percussion wave in Paittika group and the smallest length in Vatika group.m Nadi-Vijnctna ( 2 ) Other Mathematical Studies : Similar to norm al group. This indicates that the pulse of Vatika group occupies the lowest position and the K aphaja pulses occupy the highest position.00 sec..

Paittika and Kaphaja pulses are 0.00 cm.40 0.. and 0. Paittika and Kaphaja pulses are found to be 0.15 sec.63 0. 0.20 cm.25 cm. Regarding time of percussion wave. and 0. Kaphaja group occupies the intermediate position. Thus the percussion of Paittika group has been found to be largest and of Vatika group small­ est of all. 0.10 0.40 0.30 0.50 0.75 Kaphaja 1.40 cm. As it is evident from the data that the distance occupied by Paittika group is more and the Vatika.38 The distance of dicrotic notch from the base is found to be 0.89 sec.03 sec.63 Paittika 0.20 1.63 sec. sec. group is less.90 1. respectively..19 cm. respective values in Vatika.12 sec.25 0.10 1. and 0.45 0.. Paittika and Kaphaja.50 0. and 0.Clinical and Experimental Studies Hypertension: Vatika 0.35 0. 1.75 sec. for Vatika. The values calculated for the distance of dicrotic notch from the base has been found to be 0. pulses the respective values of time for each pulse is found to be 0. The respective values for Vatika.20 cm..10 45°12' 88e25' 60° 89°17' 48‘ 12' 83°36' 3.70 0.28 0. 0.49 0.. Paittika and K aphaja pulses respectively. 88e25'> and 60° respectively. respectively. The result indicates the least angulation in Paittika group and the most angulation in Vatika group.15 0.12 189 0. Hypertension : In Vatika.40 cm. and 1. The result shows the greatest distance in Paittika group and the least distance in Vatika group.30 2. Paittika and Kaphaja pulses respectively.70 K aphaja 0. Similarly in relation to length o f percussion wave the values for Vatika. 0. respectively.70 cm. Here also Kaphaja pulses are found to take more time and the Vatika pulses the least time.19 0. .80 0. Jaundice : The time of each pulse wave for Paittika and Kaphaja groups has been calculated to be 0.03 Thyrotoxicosis : Paittika 0. and 0.89 Jaundice : Paittika 0. respectively.70. The time taken by Kaphaja pulse is more..40 2. Vatika.40 cm. Paittika and Kaphaja pul­ ses as regards angle of deviation are found to be 45° 12'. The result indicates the greatest time taken in Paittika group and the least time taken in Vatika group.35 sec.10 0.

more acute value has been found in case of K aphaja group.63 second. The time for each pulse is 0. Therefore. only Paittika pulses have been found.10 sec. Paittika and K a­ phaja pulses in diseased group and the results obtained show th at like normal group here also the relative values bear the same order. the time taken by percussion waves from the point of onset to the top in these both types of pulses has been found to be greatest and the smallest respectively. . the time of percu­ ssion wave is found to be 0.28 cm. time of percussion wave.30 cm. Therefore.90 cm. and 0. angle of deviation and the distance of dicrotic notch. As regards length of percussion wave.45 cm.49 sec. Here also the value for Paittika pulse is more.50 cm. Regarding distance of dicrotic notch the calculated values are found to be 0. And we find that time taken from onset of one pulse to the next is greatest in Kaphaja variety in all diseases taken under study.190 Nadi-Vijnana The length of percussion wave in Paittika and K aphaja groups has been calculated to be 0. these values have been found occupying intermediate position in K aphaja group of pulses. the length of percussion wave is found to be 0. and 0. The comparative studies in terms of time of each pulse and the length of percussion wave etc. Thyrotoxicosis : In this group. of Vatika. The angle of deviation has been found most acute in Vatika group. Between the two. and 0.. Similarly regarding time taken by each percussion wave in Paittika and K aphaja groups has bepn found to be 0.80 cm. The values calculated for angle of deviation are 89*17' and 48°12' respectively for Paittika and K aphaja pulses. The distance has been found to be more in case of K aphaja pulse. respectively.38 second... And the distance of dicrotic notch has been found to be greatest in Pai­ ttika group while it has been found smallest in Vatika group. the length of percussion wave of Paittika pulse is taller than the K aphaja pulse. The length of percussion wave has been found to be largest in Paittika group and the smallest in Vatika group. respec­ tively. the angle o f deviation is 83e36' and the distance of dicrotic notch is 0. respectively for Paittika and K aphaja pulses.

P a r t Fi ve Discussion .

.

V. As regards the time of pulse examination and the methodo­ logy of examination. rhythm. Only Bha­ vaprakasha has not followed this pattern. in hungry or thirsty states or during sleep and just after awakening and after anointing with the oil. constant practicing of examination of normal pulse must be continued. and certai­ nly it was a revolutionary contribution of its own kind to the traditional means of diagnosis in the field of Ayurveda. . These problems have been solved in two ways : ( I ) by describing various movements of pulses correlating thes* with those o f birds. Pitta and K apha from above downwards respectively and ( 3 ) anatom ical position of the hand of the patient at the time of pulse examination. force. In addition these works have also mentioned about the followings : '( 1 ) to examine the pulse of left hand in case o f females and that of right hand in case of males ( 2 ) the use of three fingers—the index. Also.Discussion Conceptual Sharngadhara has been the first Ayurvedic physician who included the knowledge of pulse examination but in the primi­ tive form as a means of diagnosis and prognosis. And it should not be examined just after the bath. tension and the condition of arterial wall. volume. and he has simplified and has given the more practical form of pulse movement to make it conceivable and to be stick to the memory. Including Sharngadhara and onward all have described the forms of pulses by giving simile of movements of various birds and amphibians etc. The radial pulse has been described as the usual site of pulse exami­ nation. The Ayurvedic pulse lore has not been described distinctly in terms of its rate. character. middle and the ring to detect Vata. the. Later works on the subject have indicated to se^ the pulsation of other sites and the foot to assess the expectancy of life of the patient. it has been despribed th at the pulse should be examined in the morning hours of the day by giving and releasing the pressure over it. there is men­ tioning that to acquire perfection in the skill of pulse examina­ tion to diagnose diseases. amphibians and 13 N. These all have been mentioned in the later works.

and. It would not be out of place to mention here. It usually indicates the rate of Paittika pulse. And for irregular pulse ‘T rutita’. the volume should be sm allest' and the character should be curvilinear. it indicates that the character of volume of the pulse would be insignificant. indicates that the pulse rate would be slowest and amplitude of pulse would occu­ py the intermediate position between Vatika and Paittika types of pulses. rhythm etc. Likewise. For example. Similarly for bradycardia the words used are ( a ) Marida ( b ) M anthara. the words used are ( a ) D ruta ( b ) Twarita ( c ) Tivra ( d ) Shighra ( e ) Vyakul and ( f ) Vikal. if Paittika pulse jumps like the frog.( 2 ) there is an abundance of terminological words jn the literature of pulse lore. ( 1 ) Correlation of Movements of Animals and Pulses : If one hand the simile of movements signifies character of pulse. . If K aphaja pulse moves like goose. it also indicates the rate and volume of pulses. ‘Vakra’ and ‘K autilya’ can safely be used. Rhythm : To explain regular rhythm the words like ‘Sarala* ( not crooked ) and ‘Samya’ ( regular ) have been used. the movement o f Vatika pulse resem­ bling to that of leech and the s h a k e signifies that the rate of the pulse should be fast. These words can be coined to explain satisfactorily the rate. The word “ M adhyagati” has also been used. volume and character etc. of modern ter­ minology is concerned. that Ravana and Y ogaratnakara have also mentioned about the rate of pulse in num ber by using the word “ Trinshadvaram ” while they have described the condition to assess the prognosis of the patient. it. on the other hand.194 N adi-V ijnana reptiles etc. rhythm. sufficient synonyms and explanation can be given from available literature of Ayurveda. while the rate would be too rapid. it indicates that the character of the pulse is of bounding nature and relatively the rate would be slower than Vatika pulse and the volume of the pulse would be. Rate : For tachycardia. Sannjpatika pulse. quite high.to sig­ nify that the pulse rate occupies the intermediate position bet­ ween “ M andagati” and “D rutagati” . ( 2 ) Explanation of Modern Terminology in Ayurvedic Terms : As regards explanation of rate. if moves like the act of woodpecker ( K ashthakutta ). Similarly.

‘Vegadhara’. Similarly in ‘Gurvi’ ( heavy ). ‘Atisukshma’. the pulse wave refers to the manner of its ascent. ‘Atikshipa’. Character : In the charactar. ‘G am bhira’ ( heavy ) and ‘D irgha’ ( long ) pulses the rise of percussion waves would be slowest with an appreci­ able sustaining summit and the more gradual fall. It indicates the tem perature of skin over the pulse. ‘D aruna’ (violent). The . Condition of Arterial W a ll: Ayurvedic pulse lore is also furnished with good number of words to indicate the condition of arterial wall. As for example ‘K arkasha’. Various types of pulses can satisfactorily be explained in relation to these events. Such types of pulses resemble the bounding pulse where there is marked undulations over the dicrotic wave. But the word ‘Pushtihina’ can be coined as a single word for low tension. a n d ‘Atyuchchaka’ (jum ping). ‘Balawati’. ‘Prabal’ and ‘Uttanabhedin’ can be used. Such type of pulses denote excess vitiation of Vata and may also be taken as Sannipatika pulse. the ascent is very rapid without any appreciation of sustaining nature of the summit with rapid fall. Temperature of Skin Over the Pulse : Old treatises available on sphygmology also describe pulse in relation to its tempera­ ture. The words used to explain low volume also justify to denote the low tension of the pulse. W hen the pulse is ‘Balawati’ (vehement). For example. Atisukshma ( very thin ). ‘Vegawati’ ( vehement ). summit and descent. And these words also tell about high tension of the pulse. Therefore. Force : For forceful pulse the words ‘Vegavati’. feeble ) if explain that the pulse is of low volume.Discussion 195 Volume : The word ‘Atyuchchaka’ can be used for high vo­ lume pulse. ‘Sukshma’. For example. the words Sukshma ( fine. they also signify that the pulse is of low tension. The pulse ‘Sthira’ ( steady ) indicates that percussion wave would be rising fairly constant having sustained summit and gradual fall. ‘Gariyasi’ ( extre­ mely heavy ). Shithil ( weak. and ‘Tantusam a’ types of pulses indicate that. the rise would be more steep with transient sustaining of the summit and moderately rapid fall. ‘K hara’ and ‘Kathin a ’ ( hard ) denote the hardening of arterial wall. And this condition happens to occur when there is predominance of Pitta. thin ). These pulses indicate vitiatibn of Kapha. these types of pulses can be counted as to be Paittika pulses.

196

jYaeti-V ijnana

words ‘Koshna-’ and ‘Soshma* have been used for hot skin over the pulse and ‘Shita’ indicates the coldness of skin over the pulse. Haemodynamic Interpretation : Because stroke volume and heart rate play a major role in determining the contour o f the pulse, therefore, probable hae­ modynamic interpretations may be given for Vatika, Paittika and K aphaja pulses. V atika pulses can be explained haemodynamically on the ground that the stroke volume is reduced and sometime to that extent th at even minute output falls for below the normal. This condition occurs only where there is excessively increase in the rate of heart beating. In this condition the heart beats rapidly and the force of contraction is also reduced.'As a result of redu­ ction in force of contraction and stroke volume, the percussion wave becomes smallest of all and its ascent is most rapid. The summit of the percussion-w ave is not prominent. And the fall is also rapid. As a result the pulse becomes smallest of all, and dicrotic notch becomes sometimes rudimentary and sometimes disappears. Because the column of blood which regurgitates back in the aorta against the closing semilunar valve during diastole period of ventricle is small. And the impact given to this column of blood at the time of closure of semilunar valve is small producing rudimentary dicrotic notch or its complete absence in some cases. The Paittika pulses which become ‘Soshma’ and ‘Vegawati’ to touch can be best correlated with the hyperkinetic or high cardiac output states. As the name itself suggests, the resting cardiac output is incteased beyond the normal range. The main state of the body which can give rise to hyperkinetic state is the hypoxia in which there is increased secretion of adrenaline. There is peripheral vasodilatation in this condition which incre­ ase: the venous return and thereby there is increase in cardiac output. In the condition of peripheral vasodilatation the arteries too full in systole and too empty in diastole. Variations in body tem perature, effect o f hormones and other chemical substances play an im portant role in causing the increase of cardiac output. The decrease peripheral vascular resistance is associated with a warm flushed skin

Discussion

197

Above facts are quite sufficient in proving that the high car­ diac output states coincide completely w ith ‘Paittika’ stage of the body. Sometimes, high cardiac output state is also found in the condition of infective hepatitis which is well known Paittika disease. The apical impulse becomes forceful and the heart beats strongly. And the pulse becomes ‘bounding’ or ‘water-hammer’ type. This type of pulse can be truly correlated witk the move­ ment of frog which signifies the Paittika nature of the pulse f rom Ayurvedic point of view. In such type of pulse the ascent becomes fairly rapid and steep, giving rise to a quite long percu­ ssion wave with a bit appreciable sustaintion of the top o f the wave, and moderately rapid fall with marked dicrotism or undulations. As regards Kaphaja pulse, a moderately large percussion wave with a sustained summit and gradual fall determine the character of it. Such type of contour can be achieved only in regular and slow pulse, when the cardiac output is constant. In this condi­ tion with a constant force the contraction of the heart remains fairly constant. Thus a slow resting cardiac output determines the contour o f Kaphaja pulse. This condition can be found in ‘Sthira’ type o f pulse. In ‘G am bhira’ and ‘Gariyasi’ types of pulses when the Kapha is more predominent, the contour of the pulse will be slightly altered. Because in these conditions there is damping of the pulse wave and there is marked delay in its rise time, because a longer time is required to force blood. The ejection period is prolonged i. e. ‘D irgha’. The sum m it \vill be well marked and the fall will be gradual. From the above discussion of haemodynamic interpretstfions of Vatika, Paittika and Kaphaja pulses, we can safely conclude th at the pulse pressure would be highest in ‘Paittika’ type of pylses. Because, the percussion wave after achieving the maxi­ mum peak point after systolic ejection, comes down rapidly to the diastolic level creating a wider range between systolic and diastolic pressure. In Vatika type of pulses, because systolic ejection is smallest, in the same ratio the dicrotic wave is also small. Therefore, the range between two pressure is also reduced proportionately. Pulse pressure in K aphaja type of pulses occu­ pies the intermediate position between Paittika and Vatika vari­ eties of pulses.

Clinical Study
The total number of cases studied were 160. Out of these

198

Jiadi-Vijnana

total number 40 were normal volunteers, and among which on the basis of their pulse examination, 9 were o f Vatika group, 20 were of Paittika group and remaining 11 were of Kaphaja group. In remaining 120 diseased cases, 50 were of cardiac valvular lesions and out of which 14 were of Vatika group, 22 were of Paittika group and the remaining 14 were of K aphaja group. In total 30 cases of hypertension, 6 were of V atika group, 12 were o f Paittika group and the remaining 12 were of K aphaja group. Out of 20 cases of jaundice, 11 were of Paittika group- and 9 were o f Kaphaja group. All 20 cases o f thyrotoxicosis belon­ ged to Paittika group.

Normal Group :
Total cases studied in this group were 40. Out of this total number, 9 were of Vatika group, 20 were of Paittika group and 11 were of Kaphaja group. In Vatika pulses due to increased heart rate the pulse was found to be rapid. To explain increased heart rate in such type of pulse, it may be , said that in addition to chief role of para­ sympathetic activity there is also slight overtone of sympathetic nerves. The rhythm was regular. The impact of pulse felt under the finger was short and was of smaller duration. That is why the rise of percussion wave was of shorter duration, giving rise its length of small nature. The Pulse felt under the finger was of short duration. In Paittika type of pulses the rate was found to be slower than Vatika pulses. The rhythm was regular..And the amplitude was maximum appreciable under the finger. This indicates moderately rapid and steep rise of percussion wave. The pulse was relatively of a bit more sustaining nature than the Vatika variety. This indicates the moderately rapid fall of the pulse. In K aphaja type of pulses, the rate was found slowest. Here it may be said that parasympathetic overtone dominates in such varieties of pulses. The rhythm was regular due to regular beat of tbe heart. The percussion wave felt under the finger was of longer duration and of sustaining nature because of a relative increase in maximum ejection period. In the just beginning the fall of the wave was also appreciated under the fingers for a short while. That is why the pulse as a whole felt under the fingers was of longer duration.

Discussion

199

Diseased Group :
Total cases studied in this group were 120 and the diseases taken under study, were cardiac valvular lesions, hypertension, jaundice and thyrotoxicosis. Cardiac Valvular Lesions : Total cases studied in this group ware 50 out of which 14 were having Vatika nature of pulses, 22 were having o f Paittika nature of pulses and the rest 14 were having of K aphaja nature of pulses. Vatika pulses were found 14 cases. These cases were having m itral stenosis with congestive heart failure. In this condition due to compensatory mechanism caused by increased reflex activity the pulse was quite rapid. Here increased reflex activity may be correlated to predominance of Vata. In this group the pulse was found to be small and of shortest duration. The per­ cussion wave was found to be maximally of small size without any appreciable note of sustaintion of the summit. The fall was quite rapid without any undulation or insignificant undulation over it. And such type of pulse resembles the movement of leech or snake. These all happened due to increased pulse rate; because due to rapidity of the pulse, the force of contraction was reduced. As a result the less blood was ejected into the aorta with redu­ ced force of impact over the wall of it. Therefore, during exa­ mination also, the force and volume of the pulse were also proportionately reduced. Also due to increased heart rate, time taken for each pulse was reduced. Similarly length of percussion wave, lengthy bet­ ween two top points, time of percussion wave and distance of dicrotic notch were also reduced to an appreciable extent. P aittika pulses were found in 22 cases suffering from aortic incompetence. In this condition due to aortic regurgitation, the length of the muscle fibres of left ventricle is increased, and hence the force of contraction is also increased. Due to greater load of the work, the metabolic activity of cardiac muscle fibres also increases proportionately. On examination the pulse was found to be o f high amplitude, because of the greater force of contraction and thereby greater im pact over the walls o f the aorta. The pulse disappeared suddenly beneath fingers. Such type of pulse can be said of ‘U tplutya-gati’ which is criteria of the movement of the frog.

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Nadi-Vijnana

From Ayurvedic point of view such type o f pulse can be said to be of Paittika nature and from modem point of view, it is termed as ‘water-hammer’ type of pulse. In this pulse, the percussion wave was found to be rising steeply. The rise of percussion wave was moderately rapid and the fall was also quite rapid with marked undulations ov$r it. The pulse pressure was found to be high because there was wide gap between the systolic and diastolic pressure. Kaphaja pulses were found in 14 cases. The cases were suffe­ ring from aortic stenosis. In this disease due to prolonged eje­ ction period, the impact felt under the fingers was neither great nor too small. But occupied the middle position. Therefore, the percussion wave was found to be rising slowly, and of sustaining nature. The fall was also gradual. Such type of pulse can be correlated with the movement of ‘Hans’ indicating Kaphaja type of pulse. In this group, the length of the percussion wave occupies the middle position in between the Vatika and the Paittika pulse... Because the impact on the wall of aorta in this case is neither too great nor too low as in the case of Paittika and Vatika pulses respectively. Due to slow heart rate the distance between the onset points of two percussion wave was also more. Hypertension : •Total cases taken under this group were 30 out of which 6 belonged to Vatika group, 12 Paittika group and the rest 12 belonged to the K aphaja group. Vatika pulse : In Vatika type of hypertension,, the pulse rate was found to be quite significantly increased. And this played its dominating role in determining the contour of the pulse. Because, due to significantly increased heart rate the stroke-volume was reduced. As a result the impact of blood on the wall of the aorta was also reduced. Therefore, whatever the pressure pulses were generated, they were rapidly formed with the produ­ ction of smallest percussion wave. Since the column of blood falling back over the semilunar valves during the end of their closure was small. Therefore, the dicrotic notch found over the dicrotic wave, was also quite small. The arterial wall was found to be hard. Paittika Pulse : On examination, it was found that in Pai­ ttika type of hypertension, the wall of the artery was not so

As a rule. Kaphaja Pulse : The Kaphaja type of pulse in jaundice was found only because due to not increase in the heart rate. Out of which 11 cases belonged to Paittika group and the rest 9 cases belonged to Kaphaja group. Therefore. and remained about normal. The wall was also found to be less tortuous.Discussion 201 hard. the cardiac output was also increased. less development of arteriosclerosis and thereby relatively more preservation o f elasticity of the walls of the artery. The impact felt under the finger was lesser than Paittika pulses. the stroke volume output natura­ lly remained a bit smaller. Jaundice: This group consisted of total number of 30 cases. due to additive effect of above two factors. the heart and thereby the pulse was found to be relatively in­ creased than Kaphaja type of pulse in jaundice. cardiac output was not affected. Kaphaja Pulse : As it is proved fact that impaired elasticity of vessels causes a small percussion wave so it was the case in K aphaja pulse too. Due to these findings i. And this resulted into giving rise the long percussion wave with m arked dicrotism. Paittika Pulse : Paittika pulses in jaundice denote the hyper­ kinetic circulatory condition of the heart. giving the greater impact on the lateral wall of the aorta. the percussion wave was found to be relatively larger and steeply rising than the K aphaja type of pulse. And third. as in case of Kaphaja type of hypertension. e. But the tension was found a bit more in K aphaja variety of pulse. within the limited range of increment in heart rate. the pulse pressure was also higher. Hence. Due to the condition. Second due to bradycardia. and therefore. the cardiac output is also increased giving greater . causing relatively a bit higher cardiac outpuf. a bit increase in cardiac output and the great pulse pressure. The wall of the artery was found to be more tortuous and harder. what­ ever amount of blood was pumped into the aorta that gave the greater impact on the wall of aorta. The second point is that the pulse rate was also found increased. The pulse was found to be of jum ping nature. Because of moderate increase in heart rate. the percussion wave was found to be of smaller size with relatively longer pause. relatively than Paittika type of hypertension. These findings indicate th at arte­ riosclerosis was not so much as it was in K aphaja type o f pul­ ses..

the resting cardiac output is increased beyond the normal range. The pulses were of Paittika nature because of hyperki­ netic or high cardiac output states. 50 were of cardiac valvular lesions out of which 14 were of Vatika' group. In remaining 120 diseased cases. and among these on the basis of their pulse examination. The fall was rapid with marked undulations or dicrotism. harmones and other chemical substances also play an im portant role in cau­ sing the increase of cardiac output. 20 were of Paittika group and the rest 11 were of K aphaja group. The amplitude of the pulse was high and under the fingers the pulse was striking forcefully.2 02 Nadi-Vijnana impact on the lateral wall of the aorta. percussion wave was found to be of smaller size with steady fall of dicfotic wave and increased dis­ tance between the two onset points of percussion wave. Variation in body temperature. harmones and other chemical substa­ nces may be included in Paittika gorup. From modern point of view. e. Experimental Study The same number of cases of clinical group i.40 were norm al volunteers. . 1. giving rise to a quite long percussion wave without an appreciable sustaintion of the top of the wave. In this condition. 9 were of Vatika group. In this condition due to increase venous return there is increase in car­ diac output.60 have been studied in this group also. these findings were not present in K aphaja type of pulse in jaundice. 22 were of Pai­ ttika group and the rest were of Kaphaja group. The rate of the pulse was increased due to high cardiac o u tp u t. From practical point of view. causing larger percu­ ssion wave and moderately rapid fall of dicrotic wave with marked dicrotism. therefore. Out of the total number . Such type of character of the pulse coincides completely with the movement of the frog indicating the Pai­ ttika nature of the pulse. such type of pulse is called ‘bounding’ or ‘water-hammer’ type. Thyrotoxicosis : In all 20 cases of thyrotoxicosis the pulses were of Paittika nature. it was found that the per­ cussion wave was rising fairly steeply. Because. body temperature. Regarding character of the pulse. The skin in thyrotoxi­ cosis becomes warm and flushed due to decrease peripheral vascular resistance. due to 'lack of increased cardiac output.

the parameters taken were various movements of birds. It means that Vatika type of pulses should only possess the rate and as regards amplitude. it can be said that the movement of the frog mainly contains the amplitude of high range. And due to rapid rate after very short interval the next percussion wave is generated. the dicrotic wave forms an appreciable acute angle with percussion wave giving a quite conical'shape to the summit of the pulse. they move very fast and assume the curvilinear motion. For qualitative study. 6 were of Vatika group. And also due to rapid fall. reptiles and amphibi­ ans. Due to small amplitude. Vatika pulse moves like leech and snake. Since Pitta has the jumping character. Paittika pulses correspond to the movement of frog.Discussion In total 30 cases of hypertension. Out of 20 cases of jaundice. But as rega­ rds rate it is certainly appreciably less than those o f leech and the snake. and K apha­ ja pulses resemble the movement of goose. therefore. That is why in tracings we find that the percussion wave is quite small. That is why Paittika varieties of pulses acquire the highest range of amplitude than the Vatika varieties. Qualitative Interpretation : It has been observed. All 20 cases suffering from thyrotoxi­ cosis were of only Paittika nature. it would be quite small. This achi­ evement is also found in pulse tracings. when both leech and snakes move. the fall is quite rapid and smalls with a little significant or without dicrotic notch over the dicrotic wave. 12 were of Paittika group and the rest 12 were of K aphaja group. 11 were of Paittika group and 9 were of K aphaja group. Regarding Paittika pulses and their resemblance to the movement of frogs. Some time exacerba­ tion of Pitta is also responsible fo r causing dicrotic notch to be situated relatively at lower level in some tracings. we find marked undulations with marked dicrotic notch and sometimes tidal wave too. For example. As the experimental study has been conducted under quali­ tative and quantitative heads. But actually their movements do not poss­ ess the amplitude. therefore. interpretation is being given in the same light. it can be said that the goose neither . As regards Kaphaja varieties of pulses and their coincidence to the movement of goose. And we find that the percussion wave rises quite steeply with the moderate fall. dicrotic wave after short fall also assu­ mes the horizontal character.

we find that the percussion wave occupies the length in between the Vatika and the Paittika varieties with well marked rounded summit and the gardual and steady fall of dicrotic wave. After measurement the length of percussion wave. it is imperative here to discuss about pulses in the light of these studies conducted separately. Therefore. Pai­ ttika and K aphaja pulses respectively. time of each percussion wave. Paittika and Kaphaja pulses respectively. Secondly both groups of pulses have been studied in relation to their pulse rate and pulse pressure with their statistical studies. the rate of contraction is more. In vitiation of Pitta. Firstly. length of percussion wave. Instead the goose has steady and slow movement with the amplitude nei­ ther so much high. and in predom inance of Pitta it is relatively less. it can be said that K aphaja pulses occupy the interm ediate position in between Vatika and Kapfiaja varieties as regards rate and amplitude. Quantitative Interpretation : Quantitatively pulses of both norm al and diseased groups have been studied in two ways as have been mentioned already. relatively more blood is forced against . And due to slow movement the distance between two percussion waves are also found greatest of all.he base. whilst in case of K apha it is still less even than Pitta. The dicrotic notch is also not so much m arked as found in Paittika pulses. Therefore. In pre­ dominance of Vata. it has been found that time taken is minimum. medium and maximum in Vatika. Therefore. the increased car­ diac output as a result of peripheral vasodilatation and release of chemical substance. medium and maximum by Vatika. These findings depend on the rate of contraction of the heart. length between two top points.tracings. as that of frog nor too much low as that of leech. they have been studied in relation to the measurements of time of each pulse wave..204 Nadi'Vijnana possesses the rapid movement like leech and snake nor it posse­ sses so much range of amplitude like that of frog. A fter calculating the time taken by each pulse wave. T hat is why in pulse . it h&s been found minimum. nor so much small as found in Vatika varieties. the force of contraction of left ventricle is increased. These findings depend on force of contraction of left ventricle and to some extent ela­ sticity of arterial wall. angle o f deviation of percussion wave and the distance of dicrotic notch from t.

The minimum value has been found in Vatika pulses. Since jn vitiatton of Vata the force of contraction reduces maximum. it has been found maxi­ mum in case of Vata. medium and maximum ratios. Similarly in Vatika and K aphaja pulses the time would be minimum and medium respectively. Similarly if the rate of heart is slow the distance between two points would be maximum as in case of K aphaja pulse. Therefore. These findings are also in accordance with the force of contraction and thereby the length of percussion waves of Vatika. The K aphaja pulses occupy the inter­ mediate position. Therefore. there is no such condi­ tion as peripheral vasodilatation and thereby increase in car­ diac output. As regards angle of deviation from the point of start of percussion wave towards the base line. whereas maximum value has been found in Paittika pulses. of Vatika pulses. the percussion wave would be more nearer to the perpendicular drawn upwards from the point of start o f percussion wave. In case of predominance of K apha.and acquires the medium position. the force of contraction remains to be of medium nature or may be less than it. Because due to jum ping tendency of Paittika pulses its rise would be more straight. the length of percussion wave assumes its minimum height. the length of percussion wave assumes the height in the same ratio. That is why devia­ tion of percussion wave in case o f Paittika pulses towards the base would be much more lesser in relation to Vatika and K aphaja varieties. Therefore. it has also been found in minimum. maximum deviation . That is why the force of contraction is not so vigorous as in case of Pitta. G reater is the length. The distance between two top points of successive percu­ ssion wave depends on the rate. Regarding time of percussion wave taken from its point of start to the point of its top. As the rate is maximum the distance would be minimum as in Vatika pulses. Therefore. Paittika and K aphaja pulses.Discussion 205 the wall of aorta giving rise the maximum length of pcrcussion wave in this case. medium in case of K apha and medium in case of Pitta. Therefore. In case. the amount of blood propelled into the aorta and the impact given to its wall is maximally reduced. Here the Paittijka pulses occupy the intermediate position. maximum would be time taken as in Paittika pulses.

Therefore. That is why in case of Vatika pulses the pulse. There­ fore. pressure is much more reduced. medium and maximum distance. it is minimum because of least distance of dicrotic wave from the base. the pulse rate has been found maximum and the pulse pressure has been found mini­ mum in Vatika pulses in comparison to Paittika and K aphaja pulses. In Kaphaja varieties of pulse. In case of Paittika pulses.206 Nadi-Vijnana towards the base is due to short contraction of the heart cau­ sing quite rapid fall of dicrotic wave towards the base. Regarding second type of quantitative study done in rela­ tion to pulse rate and pulse pressure. That is mtfre than K aphaja pulses and lesser than the Vatika pulses. pulse rate has been found to occupy intermediate position in between Vatika and K aphaja varieties. really the rise of percussion wave takes a little more time than Vatika pulses and relatively it is straighter. As regards the distance of dicrotic notch from the base. neither there is so small filling and emptying of arteries nor so much filling and emptying of . the angle of deviation of percussion wave would naturally occupies the intermediate position. And the distance is medium and maximum respectively in Kaphaja and Paittika pulses because of their relative distances of dicro­ tic waves from the base. The maximum filling and emptying is due to hyperkinetic circulatory condition of the heart and peripheral vasodilatation. In this. In case of Kaphaja pulses due to heavy nature of Kapha. Such findings of pulse pressure in Vatika variety of pulse can be explained on the ground that during systole and diastole neither there is maximum filling nor there is maximum emptying of arteries respectively. the pulse pressure is found to be maximum in Paittika varieties of pulses. But certai­ nly the bent would be more in relation to Paittika pulses. But pulse pressure has been found acquiring maximum position than the rest two varieties. the pulse pressure has been found maximum because during systole and during diastole the filling and emptying of arteries is much more in relation to condition of vitiation of Vata and Kapha.so much as in the case of Vatika pulses. here there is found also three categories of minimum. the bent towards the base is not. There­ fore. In case of Vatika pulses.

And on looking the whole pulse tracings at glance it gives the appea­ rance of curvilinear motion resembling to the movements of leech and snake. they should have straight and longest percussion wave. Therefore. When summarising the whole discussion related to qualita­ tive and quantitative experimental studies. Vatika pulses should take minimum time in passfhg from one wave to the next and sho­ uld have smallest length of percussion wave. maximum period o f time of percussion wave from the point of its start to its top. minimum distance of dicrotic notch from the base. And on looking the pulse traci­ ngs as a whole. it gives the jum ping appearance as if these were produced by movements of some frog. maximum deviation of angle !n bending towards the base. As regards quantitative study. slightly conical summit. As regards Paittika pulses. The pulse rate is lowest of all varieties. Paittika and K aphaja pulses. insignificant or absence of dicrotic no|tch ancf small dicrotic wave assuming horizontal position quite immediately just after the dicrotic notch. the pulse pressure occupies the intermediate position. medium pulse rate and maximum pulse pressure. least period of time of percussion wave from the point o f start to its top. Vatika pulses should possess smallest percu­ ssion wave. The pulse rate in K aphaja pulses is slow probably because the parasym pathe­ tic overtone is more rather than the sympathetic. . As regards K aphaja pulses they should possess medium height of percussion wave. following results can be drawn for Vatika. exaggerated dicrotic notch and rapid fall having proportionately the same height as the percussion wave. high pulse rate and minimum pulse pressure in relation to Paittika and K aphaja pulses. Qualitatively. maximum distance of dicrotic notch from the base. least deviation of angle from normal line in bending towards the base. small dicrotic notch and steady aad gradual fall of dicrotic wave.Discussion 207 them. Paittika pulses should take medium period of time in pass­ ing from one wave to the next and should have highest length of percussion wave. maximum conical summit. flattened summit of sustaining nature.

medium devia­ tion of angle in bending towards the base from normal line. But so far as maintenance of relative values in each group is concerned. slow pulse rate and medium pulse pressure.208 Nadi-Vijnana Kaphaja pulses should lake maximum period of time in passing from one wave to the next and should have medium height. medium period of time of percu­ ssion wave from the point of start to its top. . Here it should be taken into account th at these values are both for normal as well as diseased cases with the difference that some of these values are exaggerated and some are reduced in cases o f diseased group. they follow the same order. of percussion wave. medium distance o f dicrotic notch from the base line.

Part Six Conclusions .

.

the pulse rate bet­ ween the two extremes of tachycardia and bradycardia has also been used which may be taken to interpret the rate o f Paittika pulse which occupies the intermediate position in between Vatika and K aphaja pulses. F or regular rhythm the word Samya ( regular ) and Sarala ( not crooked ) can safely be used. e. Latest research shows th at this terminology should be replaced either entirely in relation to timing or entirely in relation to mecha­ nism. Tivra and Shighra words signify the rapid movement of pulse i. e. Really speaking plenty of words are there in existing literature of Ayurvedic pulse lore. and “ dicrotic” . whilst for irregular pulse the words T rutit ( irregular ) can be used. volume and character etc. rhythm . And this condition is always found when there is vitiation of Vata. “ tidal” " and “ dicrotic” waves may be replaced by “ impact” . and in relation to later “ percussion” . ( 1 ) the intermittent flow of blood from the heart i. tachycardia. Paittika and K aphaja pulses have not been described distinctly in terms of rate. volume and character etc. In Ayurveda Vatika. rhythm. The word M adhyagati i. which may be coined to explain satisfa­ ctorily the rate. Similarly M anda M anthara indicate the slow movement of the pulse i. "late systolic” . e. And this condition is always found in predomi­ nance of Kapha. “ cephalic refle­ cted” and “ caudal reflected” . F o r example. reptiles and amphibians. tidal and dicrotic waves and a dicrotic notch found just before the beginning of dicrotic wave. The factors responsible for generation of pulse are three in numbers namely.Conclusions The pulse is a pressure wave that travels along the vessels wall. Instead they have been described vividly in terms of movements of various birds. The later also ad n .may substitute “ early systolic” . ( 2 ) the resistance to outflow of blood from the arteries into the capillaries and ( 3 ) the elasticity of arterial walls. and “ diastolic” for “ percussion” . “ tidal” . D ruta. e. The contour of a radial pulse possesses percussion. Tw arita. And the word Sukshma indicates the low YQlujne. stroke volume output. The word Atyuchchaka indicates high volume pulse. bradycardia. In relation to form er one.

This condition happens to occur in Paittika type of pulses.212 Nadi-Vtjnana indicates the low tension of the pulse. These words indicate the hardening of arterial wall. e. The whole study has been completed in clinical as well as experimental forms. Gariyasi and G urvi indicate that the rise of percussion wave would be slow for a bit longer period. F o r forceful pulse the words Vegawati. K hara and K athina words are used. Paittika and K aphaja groups. D ruta and Sukshma type o f pulses indicate th at the rise of percussion wave would be quite rapid. pulse examination and pulse tracings. As regards condition of arterial wall. As regards character. To conduct above*studies. 20 and 11 in numbers respectively. the rise o f percussion wave would be appreciated for a bit longer period with sustained summit i. Therefore. This condition "happens to occur in Vatika pulses. Volunteers belonging to Vatika. Balawati and Prabala can be used. K arkasha. These words also indicate the high tension o f the pulse. The word Pushtihina ( light and thin ) can be coined as a single word for low tension of the pulse. appreciated for a short while under the fingers. Radial pulse in this group were also studied in the morning and the evening in 20 cases and in rest 20 cases study was performed before and after meal. When the pulse is Balawati and Atyuchchaka ( jum ping ). 160 cases were chosen including both norm al and diseased groups. Paittika and K aphaja pulses have been studied for their qualitative and quantitative standardization. The K aphaja pulses like Sthira. 40 were normal volunteers and the remaining 120 cases belonged to diseased group. As mentioned in previous chapters th at Vatika. Vegadhara. Out o f total cases. N orm al volunteers were again classified on the basis of their pulse exam ination in Vatika. it indicates th at naturally the rise o f percussion wave would be moderately rapid giving greater impact beneath the fingers. the pulse fet under the fingers remains appreciable for a longer period than V atika and Paittika pulses. And the study has also been con­ ducted in the direction to see any correlation among symptoms. Paittika and K aphaja groups were 9. And therefore. the pulse would b e . Their range of age was varying from 1740 years. .

Clinical Study Before putting under this study normal volunteers as well as diseased cases were thoroughly interrogated to detect any abnor­ mality in volunteers and to decide the severity and characters o f diseases in diseased group. As regards volume the impact felt under the finger was appreciated nicely indicating relatively longer duration taken by percussion wave than in the case of Vatika pulses. Regarding laboratory investigations. the serum cholesterol level and blood sugar level was estimated. E. these were conducted under two heads namely ( 1 ) routine laboratory investigations and ( 2 ) specific investigations as for example estimation of S. After interrogation in both groups normal as well as diseased. Vandenbergh reaction and the other liver function tests etc. S. And the total cases belonging to this group were 120. In cases of hypertension. e. 20 cases were in jaundice group of average age of 42. Force was also relatively on lower side than Paittika and K aphaja pulses. O. . at every time beats were equidistant. In cases of cardiac valvular lesions. The rhythm was found to be regular i. The summit was also a bit relatively of more sustaining nature than Vatika pulse. in cases of jau n ­ dice. T . was also performed. O ut of the total number. laboratory and radiological investi­ gations were performed. G. The force was found to be more in cases o f Pai­ ttika pulse. G. In 9 normal Vatika cases during pulse examination the rate was found to be highest in this group. The rhythm was regular. and 20 cases were belonging to thyrotoxicosis of average* age of 27 years.. In 20 normal Paittika cases the pulse occupied the Madhyagati i. 50 cases were in valvular lesions group of average age o f 27. G.. The sustaintion of the pulse under the fingers was also o f short duration. hypertension. jaundice and thyrotoxicosis. The impact o f pulse felt under the fingers was o f shorter duration indicating shorter duration of time taken by percussion wave. e. P. and radioactive iodine study in cases of thyrotoxicosis.Conclusions 213 Diseases selected for the study were o f cardiac valvular lesions. the rate was slower than Vatika pulses and increased than K aphaja pulses. 30 cases were in hypertension group of average age of 50. T. C.

The rhythm was regular. In total 20 cases of jaundice. Out of 30 cases of hypertension. as the norm al Vatika. out of 50 cases of cardiac valvular lesions. And the time taken by each pulse felt under the finger was also quite small. 11 cases were possessing Paittika type of pulses and the rest 9 cases were having K apha­ ja variety of pulses. character and force etc. Paittika and K aphaja pulses bore the same relations among rate.214 Nadi-Vijnana In 11 normal K aphaja cases the pulse rate was slow. Cardiac Valvular Lesions : In cardiac valvular lesions. in the evening and before and after taking meal. In this group the heart rate was found to be much more increased than Vatika pulses of normal group. Relatively the tension and force were also found to be on lower side than normal Vatika pulses. In this group. Only the difference was found with the exaggeration or reduction of some values or the others. 14 cases were having Vatika type o f pulses and remaining 22 cases and 14 cases were having Paittika and K aphaja types of pulses respectively. 14 were belonging to Vatika group and these were the cases of decompensated heart of con­ gestive heart failure. The rate in this type of pulse was found to be relati­ vely slower than Vatika pulse. and the summit was of sustai­ ning nature. But the amplitude was found to . All 20 cases of thyrotoxicosis were having only Paittika nature of pulses. And the pulse felt under the fingers were appreciated for a longer period. volume. The above findings were also obtained in Vatika. Vatika. Succe­ ssive beats were coming after good period of intervals. The force was appreciable but was a bit on lower side than Paittika pulses. This indicates the greater time taken by the rise of percussion wave. 22 cases were having Paittika type of pulses. In cases rhythm was found to be irregular at certain moment. Paittika and K aphaja types of pulses examined in the morning. Paittika and K aphaja pulses could have. In this group of disease. Clinical examination was also 1conducted in diseased group. In diseased group too. rhythm. Volume was also found to be on lower side in relation to nor­ mal Vatika pulses. 6 were having Vatika type of pulse and remaining 12 cases and the other 12 cases were having Paittika and K aphaja varieties of pulses respectively.

this study was condu­ cted under two heads namely ( 1 ) Sphygmographic tracings of . In the rest 12 cases having K aphaja character o f pulse. The impact given by rise of percu­ ssion wave was maximum in this group. The tension was also found to be a bit on lower Side than K aphaja variety. the im pact felt under the fingers was quite appreciable and the sum m it was o f short duration. the force was found to be maximum and the arterial wall was not so hard as was in K aphaja variety. Experimental Study In normal as well as diseased group. Thyrotoxicosis : All 20 cases of thyrotoxicosis the character of the pulse resembled to that of Paittika pulses i . . e. And the tension was found to be relatively a bit more. There was relative reduction also in volume. because these cases were found to have water-hammer type of pulse. The impact felt under the finger was quite appreciable. Hypertension : In hypertension group. And the impact felt under the finger was of longer duration. These cases belonged to aortic stenosis. In remaining 9 cases. In all 12 Paittika cases of this group. In this case. th e period o f rise of pulse wave felt under the fingers was maximum.Conclusions 215 be highest in this group. force and tension in the poises of this group. In K aphaja pulses of this group. the force of im pact was maximum in this group. In relation to Paittika and K aphaja pulses. rate was found to be maximum in this case. the rise of wave was found to be appre­ ciably slow and the summit was found to be o f sustaining nature. The pulses felt were a little forceful. The amplitude and force were not st> much as in the case of Paittika variety of pulse. Jaundice: In jaundice group. 6 cases were having Vatika chara­ cter of pulse. the pulse was beating slowly. 11 cases were having Paittika nature of o f pulses. Therefore. the pulse was found to be of K aphaja character. The arterial wall was found to be more harder than Paittika pulses.

(b) statistical analysis of pulse rate and pulse pressure in Vatika. Quantitative study in this variety of pulse shows that Paittika pulses must take medium period of time in passing from one wave to the next and should have highest length of percussion wave. maximum devia­ tion of angle in bending towards the base line. Quantitative studies show that Vatika pulse takes minimum time in passing from one wave to the next and has smallest length of percussion wave. medium pulse . Paittika and K aphaja pulses. following conclu­ sions may be drawn. maximum distance of dicrotic notch from the base line. As regards qualitative and quantitative studies of Vatika. The look o f tracings as a whole gives the appearance of jumping character as if it were the movement of frog. least period of time taken by percu­ ssion wave from the point of start to its top. slight conical summit. least deviation of angle in bending towards the base line. Paittika and K aphaja pulses are concerned. angle of deviation of percussion wave and the distance o f dicrotic notch from the base.216 Nadi-Vijnana pulse wave and ( 2 ) Quantitative studies of pulse tracings. time o f each percussion wave. Paittika Pulse : Qualitative study shows that Paittika pulse possesses longest percussion wave. high pulse rate and minimum pulse pressare when compared to the values of Paittika and K aphaja pulses. The later study was further. maximum period of time of percussion wave in passing from the point o f start to the point of its top. exaggerated dicro­ tic notch and rapid fall.conducted under two heads ( a ) nume­ rical estimation of time taken by each pulse wave. On looking as a whole the appearance of tracings seems to be resembling to the movements of leech and snake. length between two top points. Vatika Pulse : Qualitatively it possesses smallest percussion wave. insignificant or absence of dicrotic notch and small dicrotic wave assuming horizontal position quite immedi­ ately just after the generation of dicrotic notch. maximum conical summit. length of percussion wave. minimum dis­ tance of dicrotic notch from the base line.

. In relation to above study respective percentage was 35. and symptoms and pulse tracings.74% and 35174% in partial group. In this disease out o f 22 Paittika pulses no correlation was found at all as far as correlation between sym ptom s and pulse examination. Numerical Correlation : Ultimately as regards the study of pulse in relation to its examination and its correlation with symptoms and pulse tra­ cings. In 50 cases of cardiac valvular lesions out of 14.26% ) in complete group as far as correlation between symptoms and pulse exami­ nation. mathematical data have been provided in the section of observations. and symptoms and pulse tracing was concerned.. it was found to be hundred percent ( 100% ): It means that correlation between pulse examination and pulse tracing was hundred percent in all groups of cases and in this. medium deviation of angle in bending towards the base line. and symptoms and pulse tracings was concerned. Quantitative study shows that a K aphaja pulse should take maximum period of time in passing from one wave to the next and should have medium length of percussion wave.Conclusions 217 rate and maximum pulse pressure as compared to Vatika and K aphaja pulses. It also indicates on the other hand that complete and partial correlation had their limited scope only with the symptoms and pulse examination. slow pulse rate and medium pulse pressure as compared to Vatika and Paittika pulses. flattened summit looking to be of sustaining nature. hypertension. Vatika pulses maximum correlation was found ( 64. Kaphaja Pulse : Qualitative study shows that the pulse of this nature should have medium height of percussion wave. no one was. it should be noted here that in all diseased cases of valvular lesions. small dicrotic notch steady and gradual fall of dicrotic wave. Study o f correlation of above three has been fur­ ther conducted under the heads complete. partial and negative. In this connection. jaundice and thyrotoxi­ cosis as far as correlation between pulse examination and pulse tracing in different groups of Vatika Paittika and Kaphaja cases is concerned.found to be related to partial or negative groups. medium period o f time of percussion wave from the point of start to its top.

86% cases were fouqd to be non­ correlated respectively.5% and 58. and symp­ toms and pulse tracing. and symptoms and pulse tracings was 41. 42. In 30 cases of hypertension. and symptoms and prise tracing the percen­ tage in complete group was 66 . and symptoms and pulse tracing the percentage of correlation in complete group was 27% and 27% respectively.14% and 57fl4% respectively.5% and 41.3% and 50% respectively. 41.6% respectively. One case ( 16.5% respectively.6% and 66 . The percentage in complete group regarding symptoms and pulse examination. In 9 K aphaja pulses of this disease regarding symptoms and pulse examination.1. the percen­ tage of correlation between symptoms and pulse examination.5% cases were found in partial correlation group respetively. Regarding partial group the percentage was 33.5% and 41. 64% and 64% cases were found to be non-correlated.6% and 16. Regarding symptoms and pulse examination. 6 were having Vatika pulses. And in partial correla­ tion group percentage was 9 % and 9 % respectively.6% respectively. One case ( 11. In all 20 cases of thyrotoxicosis the pulse was found to be of Paittika nature. was found having no correlation between symptoms and pulse examination. And the percentage in complete group regarding symptoms and pulse examination and symptoms and pulse tracings \vas 50% and 50% respectively. 12 cases were having Paittika pulses.5% cases.218 Nadi-Vijnana In this disease out of 14 K aphaja pulses there was no corre­ lation found in complete group. In 30 cases of hypertension. percentage was 33. In partial group. and symptoms and pulse tracing the . 12 cases were having K aphaja pulses. 11 were having Paittika pulses. no correlation was found in complete group. In this disease out of 30 cases.5% cases were found to have no correlation. and symptoms and pulse tracing was 57.3% and 22. and regarding correlation between symptoms and pulse examination. Iff partial group percentage was 16.5% and 4. And 58. O ut of 20 cases of jaundice.86% and 42.1% ) was having no correlation between symp­ toms and pulse tracing. In both studies no correlation was found in 41. Regarding symptoms and pulse examination.2% . In partial correlation group the.7% ).

and symptoms and pulse tracing. (2) The new advent of pulse tracing to diagnose diseases in their Vatika. And thus the con­ tours help in bringing into the light of more subtle process of Doshas going on in the body. For example. maxi­ mum result was obtained in complete correlation group of Vatika group of cardiac valvular lesions and hypertension. if on one hand different contours obtained after tracing standardize the chara­ cter o f Vatika. The above study in all groups of diseases irrespective of their Vatika. volume.n complete correlation group was hundred percent in both types of observations. rhythm. But in rest other types of studies belonging to correlation between symptoms and pulse examination. Because. on the other hand they also predict about im portant roles of different Doshas affecting the haemodynamics of the body. Now from the above studies it can be concluded that ( 1 ) Vatika. Paittika and Kaphaja pulses. the shortness of percu­ ssion and dicrotic wave occupying immediately horizontal posi­ tion just after the form ation of very small dicrotic notch or without its presence not only indicate the vitiation of Vata but also suggest that if there would have been a little increase in am ount of Pitta. A nd in negative group. Paittika and K aphaja chara­ cter is more scientific and reliable. maximum percentage was obtaind in K aphaja group of hypertension and Paittika group of jaundice. and symptoms and pulse tracing was found in partial correlation group. Vatika pulse not only denotes the predominance of Vata but side by side it also tells about the condition of Pitta and K apha too in the same patient at the same time. maximum correlation between symptoms and pulse exami­ nation.Conclusions 219 percentage . Paittika and K aphaja groups shows the hundred percent result as far as complete correlation between' pulse examination and pulse tracing is concerned. the summit of the wave would have become . In K aphaja group of valvular lesi­ ons. force. K apha would have been there. And if in relation to Pitta. but one can very easily assess the relative values of Doshas from the contour of any specific pulse. Paittika and K aphaja pulses can be well explained in their rate. tension and condi­ tion of the arterial wall. the percussion wave would have occupied a bit more straight position with relatively marked undulation over dicrotic wave. ( 3 ) N ot only this much. F or example. and K aphaja group of jaundice. character.

it is quite’evident that the present work conducted in the direction o f evaluation of Vatika. Thus.220 M aii-Vijnana rounded with a bit gradual fall o f dicrotic wave. . Paittika and Kaphaja pulses has certainly lead the way in the great service of Ayur­ vedic pulse lore and has laid down the foundation stone for further study. Pitta and K apha in each tracing with the help of freque­ ncy analysis as described in the term inal portion of m odem review. If there would have been a good pro­ portion of K apha in this case. the uplift of percussion wave would have not been possible to that extent and the fall of dicrotic wave would have become a bit more gradual and steady without so much marked dicrotic notch. ( 4 ) F urther the knowledge of pulse tracing can be utilized in detecting even the finest shades of Vata. In case of Paittika pulse. the ‘Ushm a’ character of Pitta becomes responsible for greater uplift and moderately rapid and straight rise of percussion wave. Similar expla­ nations Can also be given to Paittika and K aphaja pulses. The gradual and steady fall with rounded summit of K aphaja pulse indicates' th at the Pitta is less dominating.

P a r t Seven Summary .

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in both papyruses there is no inform ation available about the procedure of examining the pulse and the pulse signs with reference to diagnosis and prognosis. Controversies exist among the scholars of Ayurveda as to how and from where Ayurvedic pulse lore took. the back of the head. breadth and depth and has described over 27 vari­ eties of them. either in the form of simple means ju st to know only the condition of the heart or to diagnose different diseases and to assess the expectancy of life o f the patient. Greek Pulse Lore : In this system of medicine Gaien is seen to have written several treatises on the pulse according to their length. arms and feet to see the pulsation. the surgical papyrus o f Edwin Smith and Eber’s papyrus refer to pulse examination. its origin. Both lim it their knowledge to the pulse only to know th 6 condition o f the heart. The usual site for pulse examination he has described to be the radial artery. ‘dicrotic’ and vibratory pulses. The papyrus of Ebers also mention about the various sites as for example head. Egyptian Folse Lore : Two authoritative Egyptian papyruses. 1. The know­ ledge of pulse examination handed dow n. Pulse has been described only in its qualitative form and there is no where reference to its counting. ‘wave like’. whereas the practical know­ ledge of Indian pulse lore ows its indebtedness to the GreekoArabic system of medicine who practised in India. hands. In this regard giving the concluding rem ark a synthe­ tic view has been hypothesized th at the theoretical knowledge o f Indian pulse lore has been derived from pre-existing pulse lore o f Tantrik literature of India. Beyond the imperfect reference to the pulse vis a vis the heart. 2. 3. Chinese Pulse Lore : I-Tsing’s claim th at “ his country was never superseded by any other country in the skill o f the . stom ach. And also on account o f his experience he has mentioned to ‘slow' and ‘fast'.Summary Historical Review : From time immemorial different civilizations of the world have been aware o f the importance o f pulse. ‘ant-like’. ‘caprezens’. from civilization to civilization is explained here in following passages. ‘regular* and ‘irregular’. ‘strong’ and ‘feeble’.

According to most historians of Chinese medicine. Thus twelve pulses have been described. age.pulse signs and symptoms nor is the interpretation of the pulse signs and symptoms made in terms of im pairm ent of the one or the other or all of the four humors. pulse has also been used to assess the expectancy of life of the patient. the pulse should be examined at Sunrise. among others are seen to form the basis of the study o f pulse examination in ease and diseases. concept and principles of Greek medicine particularly Galen’s medicine inheriting the humoral doctorine o f the Greek medicine. Pulses have also been described as a superficial and deep and Yang and Yin belongs to female principle. and the normal ratio to pulse beat is four beats to one respiration. Describing qua­ ntitative form of the pulse it has been mentioned that one inspiration and one expiration constitute one cycle of respira­ tion. And he has advised to examine the pulse in its ( i ) size .224 Xadi-Vijnana feeling o f the pulse” is probably not an exaggeration. e.. location. Chinese have wealth o f treatises on the pulse and they are considered to be utterly disproportionate to other branches of medicine. temperament and the sex of the subject. 4. Besides diagnosing diseases. Bar and Cubit correlating again these three to external and internal organs. K hoon. The pulse has been advised to examine on both wrist putting the fingers a t three places Inch. The description of pulse lore in Arabic medicine is qualita­ tive and the pulse has been described in the form of its ( i ) length ( ii ) breadth ( iii ) height ( iv ) needs of the body ( v ) hard ( vi ) soft ( vii ) irregular and ( viii ) strength. Chinese physician has also observed the pulse variations under the influence of seasons. course and treatm ent of diseases depend upon this alone. Arabic Pulse Lore : The A rabic medicine is founded mo­ stly on the physiology.o f outstanding impor­ tance. Sofra and Sauda have neither been to the. Balagam. Instead. the temperament or Mizaz and the vital force or Roop. The description of main features of the pulse which Avice­ nna in the later period has described are. Chinese physicians assert that entire superstructure of medi­ cal practice'js buik upon the theory of the pulse. constitution. The nature. so far as prognosis and diagnosis are concerned. But the four humors o f Arabic medicine i.

( iil ) Yogaratnakara : The knowledge after Bhavaprakasha 15 N. A nd thus he has made the subject more practicable. Vaidyam ) including pulse lore. Ayurvedic Pulse Lore : In the classics and after works of A rurveda till the period of Sharngadhara the word ‘Nadi’ has been used in various denotations but the pulse. The number of Siddhacharyas grew to eighty-four between the eight and tenth centu­ ries. Thus the pulse lore i§ seen to be an outcome of Yoga which deals among other things with the pulse (Nadi) and the control of breath. Though the theoretical knowledge has been derived/rom Tantrik literature and the practical one from Greeko-Arabic system of medicine. reptiles and amphibian has been given to correlate the character of the pulse.Summary 225 ( ii ) strength ( iii ) velocity ( iv ) quality ( v ) temperature ( vi ) rate ( vii ) consistancy ( viii ) regularity and ( ix ) rhythm. And there we see the dawn of life of pulse examination as a means o f diagnosis. Tantrik Pulse Lore : There have been many Siddhacharya belonging to the school of Shaiva-Agama Tantrism who along with the development of alchemy ( Rasavada ). 6. iatrochemistry (Rasatantra/R asashastra) also developed medicine ( Ayurveda. 5. yet Sharngadhara has been the first authoritative Ayurvedic physician who has implanted the knowledge of pulse examina­ tion in third chapter of his work—Sharngadhara-Sam hita. The im portant thing is that simile o f various birds. . From that onward the knowledge has constantly been gaining momentum till the period of Y ogaratnakara. In the opinion of Ghosh. ( i ) Sharngadhara-Samhita : Sharngadhara’s description to pulse examination is completed only in eight verses. “ It is specially to be noted that although the general ‘N adi-Chakra’ system has no real bearing on the pulse examination. Pitta and K apha respectively (b) inspite of giving the simile of move­ ments of birds etc. he has directly described the character of Vatika. The know­ ledge of pulse examination in the work is quite elementary. ( ii ) Bhavaprakash : Bhavamishra in his work Bhavaprakash has added the knowledge after Sharngadhara in describing ( a ) the use of three fingers index. Paittika and and K aphaja pulses. yet the consideration of the same in works on sphygmology has been considered imperative*by most o f the authors” . middle and ring for Vata. V.

this is the first work of its own kind. Three factors i. wrist during pulse examination ( b ) there is indication of fixed time to examine the pulse ( c ) there is description of quantitative form of the pulse as thirty time. The work mentions about ( a ) the great number of diseases to be diagnosed by means of pulse examination (b) in the same there is also enumeration of good number of pulses indicating bad prognosis ( c ) there is also enumeration of pulses indicating good prognosis and ( d ) above all character of pulse has been described after taking various foods. Taking the help o f frequency analy­ sis. Modern Concept : The pulse is a pressure wave that tra­ vels along the vessel wall. Ravana has followed K anada in describing diseases to be dia­ gnosed and the prognosis to be assessed by means of pulse exa­ mination. it can be analysed further that the radial pulse is made up of many such small waves having different troughs and crests at different phases and amplitudes. ( iv ) Kanada’s Nadivijnana : This is independent book of sphygmology written by Tantrik Kanada. Here the pulse has been des­ cribed to indicate good prognosis of the patient ( d ) there is enumeration of greater number of pulses indicating bad pro­ gnosis and death. In this work T antrik idea has been furnished about the' source of origin of Nadi. With the help of reflected waves genera­ ted at the origin of branches. Clinical and Experimental Studies : The aim behind to conduct study on pulse examination is its traditional use as an im portant means o f diagnosis. ( v ) Ravana’s Nadipariksha : This is also an independent work of sphygmology finding its source of origin from Tantrism. . And it is nothing but a more continuation of central and inter­ mediate pulses generated in the aorta and its other intermediate branches respectively.226 Nadi-Vijnana has been furthered in this work. are responsi­ ble for its generation. 7. e. ( 1 ) stroke volume output ( 2 ) resistance to outflow of blood from the arteries-into the capillaries and ( 3 ) elasticity o f arterial walls. the central and intermediate pulses constitute the radial pulse. Because in the field of Ayurveda. The work mentions a b o u t( a ) detailed anatomical position of the forearm including. W hat we feel as a radial pulse is one of peripheral pulses.

1. ( 1 ) quali­ tative study in graphic form s i. pulse examination and grouping it into Vatika. e. And also the. e. were perform ed. Paittika and K aphaja pulses. we limited our study only to normal volunteers and selected groups of diseases namely.effort has been made in diseased group in the direction of correlation of the triad. Paittika and K aphaja character. it has been completed in two -groups namely. length between two top points. ( 1 ) cardiac valvular lesions ( 2 ) hypertension ( 3 ) jaundice and ( 4 ) thyrotoxicosis. routine and specific laboratory investigations and M M R etc. Vatika pulses were found to have the following characte­ ristics ( i ) smallest percussion wave ( ii ) slight conical summ it ( iii ) insignificant or absent dicrotic notch { iv ) small dicrotic wave ( v ) minimum tim e in passing from one wave to the next . On experimental study. Normal Group : O ut of total 40 cases of this group. case taking. pulse examination and the pulse tracings performed with the help of Dudgeon’s sphygmograph. time of each percussion wave.Summary 227 therefore. symptoms depending on predominance o f Doshas. As regards experimental study in norm al as well as diseased groups. (a) Vatika Pulse : Clinically. all 6 Vatika pulses were found to have ( i ) high pulse rate ( ii ) regular rhythm ( iii ) small pulse i. e. length of percussion wave. The studies have been conducted in the direction to standar­ dize Vatika. Paittika and K aphaja pulses qualitatively and quantitatively in 40 norm al volunteers as well as in 120 cases of selected diseases as mentioned above. angle o f deviation of percussion wave and the distance of dicrotic notch from the base and ( b ) statistical analysis of pulse rate and pulse pressure in Vatika. thorough gene­ ral and systemic examinations. Before conducting the clinical study in norm al as well as diseased groups. the sustaintion o f pulse under the fingers was also of short duration ( v ) force was relatively on lower side than Paittika and K aphaja pulses. i. the rise of pulse felt under the fingers was of short duration ( iv ) after rising. sphygmographic tracing of pulse waves and ( 2 ) quantitative study o f pulse tracings which has been completed further in two subheads (a) numerical esti­ m ation of time taken by each pulse wave. 9 were having Vatika pulses and the remaining 20 and 11 cases were having Paittika and K aphaja type of pulses.

( b ) P aittika Folse : On clinical examination. which were distinguished by their following qualities : ( i ) medium pulse rate occupying intermediate position in between the rate o f Vatika and K aphaja pulse ( ii ) regular rhythm (iii) relatively high volume than Vatika and Kaphaja' pulses. . The pulse felt under the fiDgers were apprecia­ ted for a longer period. The look o f the tracing as a whole gives th e appearance of jum ping character ( iv ) medium period of time taken in passing from one wave to the next (v) maximum period of time of percussion wave in passing from the point of start to its top ( vi ) least deviation of angle in bending towards the base line ( vii ) maximum distance of dicrotic notch from the base line ( viii ) high pulse pressure.Nadi-Vijnana ( vi ) minimum period of time taken by percussion wave from the point o f start to its top ( vii ) maximum deviation of angle in bending towards the base line ( v iii) minimum distance of dicrotic notch from the base line (ix) high pulse rate and mini­ mum pulse pressure when compared to the values of Paittika and K aphaja pulses. i ) medium height o f percussion wave occupying intermediate position in between V atika and Paittika pulses (ii) small dicrotic notch ( iii ) rounded summit indicating its sustaining nature ( iv ) steady and gradual fall o f dicrotic wave ( v ) maximum period of time in passing from one wave to the next (vi) medium period of time of percussion wave from the point o f start to its top ( vii ) medium deviation of angle in bending towards the base line ( viii ) medium pulse pressure. 20 volunteers of normal group were found to have Paittika character of pulses. ( c ) Kaphaja Folse : On clinical examination 11 normal K aphaja pulses were found to have ( i ) slowest pulse rate ( ii ) regular rhythm. and the summits were also of maximum sustaining nature ( iii ) the force was appreciable but was a bit on lower side than Paittika pulses. On experimental study Paittika pulses were found to have ( i ) longest percussion wave ( i i ) maximum conical summit (iii) exaggerated dicrotic notch and moderately rapid fall of dicrotic wave. The rise of wave felt under the fingers was of relatively more dura­ tion than Vatika pulses ( iv ) the summit was also a bit relati­ vely of more sustaining n ature than Vatika pulses (v) the force was also found to be more in case of Vatika pulse. On experimental study K aphaja pulses were found to have (.

14 were having Vatika pulses. it should be noted down here that cases of this group also have the same configuration in general as normal Vatika. 2. 20 cases to the jaundice and the remaining 20 cases were studied in thyro­ toxicosis group. 22 were having Pai­ ttika pulses and remaining 14 were having K aphaja pulses. ( a ) Cardiac Valvular Lesions : Out of 50 cases studied in this group. .Summary ' 229 The same findings were also obtained in Vatika. 50 were belonging to car­ diac valvular lesions.vi ) low tension and force ( v ii) smallest percussion wave ( viii ) slight conical summit ( ix ) insignificant or absent dicrotic notch and small dicrotic wave assuming hori­ zontal position quite immediately just after the generation of rudim entary dicrotic notch ( x ) taking minimum time than Paittika and Kaphaja pulses in passing from one wave to the next ( xi ) least period o f time taken by percussion wave from the point of start to its top ( xii ) maximum deviation of angle ( xiii ) minimum distance o f dicrotic notch (xiv) minimum pulse pressure.Diseased Group : In this group study was carried out in 120 cases. O ut o f the total number. ( i ) Vatika Pulse : It was found to have ( i ) high pulse rate ( ii ) rhythm was irregular at certain moment ( iii ) volume was quite low ( iv ) small pulse wave felt under the fingers (v) least sustaining summit (. Regarding qualitative interpretation of contour of different pulses in diseased group. Paittika and Kaphaja pulses have b ut with the difference of dominance or diminution o f one or the other factors. Paittika and Kaphaja pulses examined in the morning. ( ii ) Paittika Pulse : It was found to have ( i ) slower rate than Vatika pulse ( ii ) regular rhythm ( iii ) highest amplitude of maximum appreciation when felt under the fingers (iv) good force with low tension ( v ) longest percussion wave ( v i ) maxi­ mum conical summit ( vii ) highly exaggerated dicrotic notch with moderately rapid fall o f dicrotic wave (viii) taking medium period of time in passing from one wave to the next (ix) highest length o f percussion wave ( x ) maximum period of time of per­ cussion wave from the point o f start to its top ( xi ) least devi­ ation of angle ( xii ) maximum distance of dicrotic notch and ( xiii ) maximum pulse pressure. in the evening and before and after meal. 30 cases to the hypertension.

but appreciated for maximum period under the finger during rise of wave ( iv ) m oderate force and tension (v) medium per­ cussion wave ( vi ) rounded summit ( vii ) small dicrotic notch ( viii ) steady and gradual fall of dicrotic wave ( ix ) maximum period of time in passing from one wave to the next (x) m edium deviation o f angle ( xi ) medium period o f time of percussion wave ( xii ) medium pulse pressure as compared to Vatika and Paittika pulses. 6 were having Vatika type of pulse and remaining 12 cases and the other 12 cases ware having Paittika arid K aphaja varieties of pulses respectively. ( iii ) Kaphaja Pnlse : It was found to have ( i ) slow pulse rate ( ii ) regular rhythm ( iii ) medium amplitude in between Vatika and Paittika pulses ( iv ) slow rising of waye felt under the finger for good period o f time in relation to V atika and Pai­ ttika pulses ( v ) more tension than Paittika pulse ( vi ) medium . ( i ) Vatika Pulse . ( ii ) P aittika Pulse : It was found to have (i) medium pulse rate in between Vatika and K aphaja pulses ( ii ) regular rhythm ( iii ) m ore am plitude than Vatika pulse ( iv ) more tension and force than V atika pulse (v) less hard arterial wall than K aphaja pulse of hypertension ( vi ) longest percussion wave ( vii ) coni­ cal summ it (viii) exaggerated dicrotic notch (ix) medium period of time in passing from one wave to the next ( x ) maximum period o f time o f percussion wave in passing from the ‘point of start to its top ( xi ) least deviation of angle o f percussion wave and ( xii ) m aximum pulse pressure. It was found to have ( i ) high pulse rate ( ii ) regular rhythm ( iii ) low volume ( iv ) force and tension was appreciable but was'on lower side relatively than Paittika and K aphaja pulses (v) the artery was found to be slightly hard ( vi ) quite small percussion wave ( vii ) slightly angular summit suddenly converting into dicrotic wave which occupies immedi­ ately the horizontal position (viii) insignificant or absent dicrotic notch ( ix ) minimum time taken by precussion wave from the point of start to its top ( x ) maximum deviation of angle to ­ wards the base line and ( xi ) minimum pulse pressure.230 Nadt-Vijnana ( iii ) Kaphaja Pulse : It was found to have (i) slowest pulse rate ( ii ) regular rhythm ( iii ) medium amplitude occupying intermediate position in between Vatika and Paittika pulses. ( b ) Hypertension : O ut of 30 cases of hypertension.

11 were having Paittika pulses and 9 were of K aphaja group. Tr. 0% . C. 64.74%. C. N. ). 3. C. C. ( c ) Jaundice : Out of 20 cases of jaundice. In 22 Paittika Pulses ( i ) Sy. ) and ( c ) no correlation ( N. C. C. ex.. P. ) ( 2 ) symptoms and pulse tracings ( Sy. C. 0 % ( ii ) Sy. ) i. 100%.26%. ex. ( a ) Cardiac Valvular Lesions : O ut of total 50 cases in 14 Vatika pulses ( i ) Sy. ) and ( 3 ) pulse examination and pulse tracings ( Pe. C. e. C. Each correlation group has been further studied in three sub­ groups namely. ) ( b ) partial correlation ( P. ( d ) Thyrotoxicosis : All 20 cases o f thyrotoxicosis were found to have the complete findings of Paittika pulses found in other groups. Tr.. ( i ) Paittika Pulse : It was found to have ( i ) moderate pulse rate ( ii ) regular rhythm (iii) good amplitude (iv) slightly forceful ( v ) longer percussion wave than K aphaja pulses ( vi ) maximum conical summit ( vii ) exaggerated dicrotic notch and moderately rapid fall of dicrotic wave ( viii ) medium period of time in between two percussion waves ( ix ) maximum period of time of percussion wave in passing from the point of start to its top ( x ) least deviation o f angle o f percussion wave (xi) maxi­ mum distance of dicrotic notch ( xii ) more pulse pressure than K aphaja group. nega­ tive group. 64. 35.26%. C. Tr. 0% (iii) Pe. . Tr. 35. N.. ( a ) complete correlation ( C. N. P. C. C.Summafy 23 1 height of percussion wave in between Vatika and Paittika pulses ( v i i ) maximum period of time in between the two pulse waves (viii) medium period o f time of percussion wave from the point of start to its top ( ix ) medium pulse pressure. C. ( i l ) Kaphaja Pulse : It was found to have ( i ) slow pulse rate than Paittika pulse (ii) regular rhythm (iii) medium ampli­ tude. Numerical Correlation : This study has been conducted to show the correlation in the followings ( 1 ) symptoms and pulse examination ( Sy. The pulse felt under the finger was of relatively longer duration than Paittika pulse ( iv ) smaller percussion wave than Paittika pulse ( v ) rounded summit ( vi ) gradual and steady fall of dicrotic wave ( vii ) small dicrotic notch ( v iii) more period of time in between two percussion waves ( ix ) medium deviation of angle of percussion wave ( x ) lesser pulse pressure than Paittika group. C.74%.

C. ex. P. C. Tr.6% .. N . 0 % ( ii ) Sy. 100%. 42. C. C. C. C.. P. P.. P. C. C. 0 % (ii) Sy.Tr.. C. C. P. 0% .. C. Tr. P.5% (Hi) Pe. 41. C..86% ( ii ) Sy. C. N. P. C. 100%. C. 0% . 0 % . P. ex. C. 66 . In 9 Kaphaja pulses (i) Sy. N. 50% .. 50% . 41. C. C. P. C. C. C. C. 0% . 57. 27% . ( d ) Thyrotoxicosis : In all 20 Paittika pulses ( i ) Sy. C.. C. 16. C. In 12 Paittika pulses (i) Sy. N . 22. C. 0 % ( iii ) Pe.. 100%. N. 33. C.232 Nadi-Vijnana ex. C. 64% (ii) Sy. N . C. C. C. C. Particularly the sphygmographic tracings have given a new practical form of standard Vatika.7% (ii) Sy. Tr. C. N. N. C.. C. N. C.14%. N. C. 16. 0% .. ( b ) Hypertension : O ut of total 30 cases in 6 Vatika pulses ( i ) Sy. C. P. P. C. C. C. 0% . C. ex. C. C. . C. C.14%. C. C. 0% . 27% . 11. Tr. 100%.. N . 0% . 41. 41. ( iii ) Pe..3% . C. N. P. 0% . N.. C. C. 100%. ex. 0% . Tr. 100%. P. P. 58. P. C.. ex.1% ( iii ) Pe. C.. C. P. 0 % (iii) Pe.5% (ii) Sy. C. 0% .5% . C. P. C. 0% .5% .. 58. N. Tr. Tr. C. 0% .. 50% . C. C. 0 % ( iii ) Pe. 100%. C. C. N. C. In 12 Kaphaja pulses (i) Sy. N. 42. Tr. C. 41. C.. *C. 0% . 0 % . C. 16. P. C.5%. 9% . C. P. C. C. Tr. P. C. 100%.86% . C. Tr. 0% . N.. (iii) Pe. 0 % . 0% . 100%. 0% . ( ii ) Sy. In 14 Kaphaja pulses ( i ) Sy. N. N. N. C. C. ex. C.. C.5% . C. ( iii ) Pe. 41. 64% . 66 . C.6% . P. C.. Tr. 0% . 0% . C.5% .6%. Tr. C . C. C. Paittika and Kaphaja pulses and has made. C.2% . Tr. 57.5% ( ii ) Sy. 6% . 0% . 0 % . C. C. P. C. C. N.the pulse examination more easy and pra­ cticable for an accurate diagnosis. 0% . 0% . 33. 100%. ex. (c) Jaundice : Out of 20 total cases of jaundice in 11 Paittika pulses (i) Sy. N. Tr. The present scientific sudies on Nadi-Pariksha has certainly given a new light of hope in the direction of abvancement of Ayurvedic pulse lore and has proved to be a good asset to this science. C. C. C. 9% . Tr. N. C.. C. 0% . 0% .3% . C.. P. C. P. N.

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