Unani Pulse Diagnosis

8/10/2019 Unani Pulse Diagnosis

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Unani Pulse Diagnosis

Flickering pulse

Your first finger feels the pulse as small, the middle finger feels it large andswollen, and the last finger feels it small again. This signifies weakness of thearterial wall and destruction of tissues around the artery. The cause is extremedisability, often due to unresolved inflammations of long duration.

According to the Hakims who practice the Unani system, all discomfort,disease, decay, and destruction is ultimately traceable to lack of life--thediminished metabolic force that is responsible for fully assimilating nutrientsin the body. The word lift that we use in everyday language is the result of twoactivities working harmoniously: one is the constant life of the spirit; the otheris the life that "matter" provides to give expression to the spirit.

In Unani, we use the word nafas to express this concept of the primary lifeforce. The word nafas also means soul, spirit, essence, and breath. The nafas isthe breath or thread of life that runs through all human beings, and is the oneelement without which life could not be sustained even for a short time.

While some physicians may try to determine how a person is "breathing,"Unani's concept of the life breath/force is broader. Breath is the mostimportant nourishment to human life, much more important than any othersubstance, for there is a connection between our own breath, the life force, andthe light of the cosmos. In many scriptures, the word light (Ar. nur) is used

frequently in connection with life. This is not merely a metaphor. Theconnection between light and our life, our breath, is demonstrated by thescientific knowledge of the West as well; for through the process ofphotosynthesis, light catalyzes in the transformation of the chlorophyll ofplants into oxygen, which is then taken into the lungs as the sustaining lifeforce. Indeed, our breath is simply another manifestation of the pure light ofthe sun and of the universe. Yet how unconsciously we engage in our breaths!


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Realizing that breath is the carrier of the life force, we must discover amethod for evaluating the efficiency of this process. The key to this is thepulse. It is worth noting that in the Unani terminology, the words for breath,pulse, and ego are all spelled the same. In other words, the ego represents allof the various excessive appetites of the body, and the breath is the means of

regulating those factors, while the pulse is the monitor over this process. Theintimacy of the interrelationship of these factors is conveyed by using thesame word for all three.

In determining the relative harmony of this life force within the body, theHakim performs an evaluation of the pulse. The system of pulse diagnosisevolved by the Chinese was studied by Avicenna, who incorporated its mostsalient features into the Unani system. While pulse evaluation can becomequite complex, and does require extensive personal instruction in order tomaster it fully, the essential features are presented here for those who want to

study and begin to apply pulse evaluation.

The pulse is a movement in the heart and arteries which expands andcontracts, whereby the "breath" of the innate life force becomes subjected tothe influence of the indrawn air. Every beat of the pulse consists of twomovements and two pauses. The movement is thus: expansion--pause--contraction-pause.

The pulse is felt at the wrist because it is readily accessible, there is littleflesh covering it, and the patient is not embarrassed by exposing this part of

the body. When feeling the pulse, the palm should be turned upward,especially in thin people. If the palm is turned downward, the readings will behigher and exaggerated in degrees of excess. If the patient is a male, read fromthe left hand; if a female, use the right hand. Both patient and examinershould be in a calm state, without having performed exercise or eaten withinone hour before the reading.

Developing sensitivity to the subtle actions and elements of the pulse takes much timeand practice. The capacity to sensitize the fingertips to the pulse variations can beenhanced by taking a single strand of one's own hair, and so that you do not see the

placement of it, have someone put it between two sheets of plain white paper on a hardtable top, so that you do not know the location of the hair. You must then "feel" the hairthrough the paper. Once the position of the hair can consistently be identified through asingle sheet, a second sheet is added. This process is repeated until the hair can be feltthrough seven thicknesses of paper.

Techniques of Pulse Evaluation


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In pulse evaluation, the examiner's middle finger must be placed exactly atthe junction of the carpus with the lower end of the radius. The other twofingers are allowed to rest on the artery, one on each side of the middle finger,but with the index finger nearest the heart.

For some difficult or contradictory initial diagnoses, the Hakim will utilizewhat is known as "two-element" evaluation. This is obtained by taking the firstand second factors of the pulse. The length, width, and depth comprise thefirst element. The second element is obtained by comparing that pulse withone of a bird or some other animal, so that the patient's pulse can be judgedagainst a norm in nature. There is also a "three-element" evaluation, whichcombines the readings from the wrist, the forefinger, and the tips of the fourother fingers to arrive at a composite of the complete internal functioning ofthe body. However, I present here only the single-element evaluation.

These ten guides are used to measure and evaluate the condition of thepulse:

1. Quality of expansion (amount of diastole, measured in terms of length,width, depth)

2. Quality of impact of beating of the pulse against the finger of examiner(strong, weak, moderate)

3. Duration of cycle of pulse (fast, slow, moderate)

4. Duration of pause (successive, different, moderate)

5. Emptiness or fullness of vessel between beats (full, empty, moderate)

6. Compressibility of artery (hard, soft, moderate)

7. Moisture content of perspiration of pulse (full, empty, moderate)

8. Regularity (regular different, irregular different)

9. Order and disorder (ordered, irregularly ordered, irregularly disordered)

10. Rhythm (similar, different, out of rhythm)

Avicenna consulted the Chinese system of pulse diagnosis, and thesimilarities between the two systems are remarkable.


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Quality of Expansion

The quality of expansion and contraction is measured according to thelength, width, and depth of the artery carrying the blood. A long pulse is onethat is passing over the measuring point in a longer duration than a normal

pulse beat. The cause of a long pulse in this element is an excess of heat.

A short pulse passes over the measuring point more quickly than would anormal pulse. The cause of a short pulse is lack of internal heat, oftenaccompanied by body temperature lower than 98.0 Fahrenheit.

A moderate pulse is balanced between a fast and slow pulse; in other words,it is normal. We use the word moderate as opposed to normal when describingthe pulse measures because it implies that there is neither too little nor toomuch of a humoral substance. Hence, the word moderate indicates a condition

between extremes, or health.

The second factor within this classification is the width of a pulse. A widepulse can be felt to have expanded the arterial wall beyond the normal width.Its cause is an excess of moisture in the blood. A narrow pulse is felt as beingless in width than a normal pulse, and its cause is an insufficiency of moisturein the blood.

The third factor in this initial assessment of the pulse regards depth. Aneminent pulse is one that can be felt as the artery rises above and presses

against the surface of the skin on the wrist. The cause of an eminent pulse isexcess heat. A lowered pulse can be felt as having dropped down away fromthe surface of the skin of the wrist and below the point considered asmoderate. The cause of lowered pulse is lack of internal heat.

Thus, with this initial evaluation, we arrive at nine basic pulse types, orpossibilities, according to the factors of length, width, and depth:

Length of pulse--long, short, moderate Width of pulse--wide, narrow,moderate Depth of pulse--eminent, lowered, moderate

The complexity of pulse evaluation is evident from this classification,because simply within this first factor, there are twenty-seven possiblevariations of the pulse. For the sake of interest, the twenty-seven variationsare reproduced in Table 6.

Quality of Impact


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There are three qualities: strong (resists the finger during expansion), weak(the opposite character), and moderate (between the two). A strong pulse isdue to an excess of animal power (sexual energy, libido*). A weak pulse is dueto a weakness of the animal power.

Duration of Cycle

Duration of cycle is the measure of the speed with which the pulse beatpasses over the measuring point of the fingertips. It is a measure not ofduration (as with the first component), but merely of speed. Fast cyclecompletes the cycle in a brief period of time. Slow cycle completes in a longerperiod. The moderate pulse is between the two.

This movement of speed and undulation is sometimes compared to themovement of waves for the last twenty yards or so before they break upon the

shore. In fact, one can observe this "wave" of the motion of the arterial pulsealong the forearm in some individuals who have eminent arteries.

Duration of Pause

There are three modes: successive, different, moderate. Successive pausemeans that the pulse not only moves across the measuring point in less timethan a normal pulse, but also successively slows (and this slowing may run incycles). This is not simply an opposite measurement of the quality ascertainedin the duration of cycle, because of this successive nature of the variation. The

cause of successive inaction is weakness of the animal power.

Different pause means that the interval between the pulse beats varies;usually it is shorter than that of a normal pulse. The cause of different pause isthe presence of the highest possible degree of animating life force, which is animbalance, not health.

The moderate state of this pulse finds the intervals between pulse beatsvirtually equal. It is the desired condition.

Emptiness or Fullness

The pulse is full (or "high"), when it seems to be overfull of humor andneeds to be allowed out; an empty (or "low") pulse is flattened and opposite incharacter. The Chinese describe this empty pulse as "the hole in the flute,"while Avicenna said it feels as if the artery were filled with bubbles of air, sothat the fingers seem to fall on empty space. The cause of the full pulse isthickening of the blood. The empty pulse gives a "clammy" feeling at the point


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of feeling the pulse. A moderate state is the condition of balance between thetwo.

"Animal power" does not precisely mean "sexual power" as it is used in currentpsychological and media jargon. Perhaps the Greek word animus would more closely

convey the connotation desired, including not only sexual energy, but also willpower,concentration, emotional stability, and similar factors.

Variations Of Quality Of Expansion

Length factor: long, short, or moderate

Width factor: wide, narrow, or moderate

Depth factor: eminent, lowered, or moderate

The possible variations are:

Long--Wide--Eminent Long--Wide--LoweredLong--Narrow Eminent Long--Narrow--LoweredLong--Moderate--Eminent Long--Moderate--LoweredShort--Wide--Eminent Short--Wide--LoweredShort--Narrow-Eminent Short--Narrow--LoweredShort--Moderate--Eminent Short--Moderate--LoweredModerate--Wide--Eminent Moderate--Wide--LoweredModerate--Narrow--Eminent

Moderate--Narrow--LoweredModerate-- Moderate-- Eminent Moderate--Moderate- LoweredLong--Wide--Moderate Long-- Narrow-ModerateLong-- Moderate-- Moderate Short--Wide--ModerateShort--Narrow--Moderate Short--Moderate-ModerateModerate--Wide--Moderate Moderate -- Narrow--Moderate Moderate--Moderate-Moderate

Compressibility of Artery

There are three forms: the soft pulse is easily compressible; the hard is dif-ficult to compress; and the moderate condition falls between the two.

Moisture (Temperature) of Pulse

This guide is simply measured by the sense of touch at the point of takingthe pulse and by reflecting upon the temperature of the surface "moisture" of


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the matter being eliminated by the pores of the skin. Both hot and cold pulseare easily determined. The former is caused by excess internal heat, and itsopposite by the lack of internal heat. The moderate temperature falls betweenthese two.

Regularity

This guide synthesizes all of the preceding evaluations into one measure. Bytaking all of these factors into account, one can note the general pulsecondition.

The modes of equality are regular or irregular. Regular means that it ismoderate in all of the above factors. Likewise, it would be called irregular ifexcessive in all of the factors. However, if it is regular in six aspects andirregular in one only, this fact is noted, along with the specific irregular pulse.

Normal Pulse

With the foregoing analysis of pulse providing the overall condition of thepatient, the last two factors allow the examiner to adopt more criticalmeasurements, which reflect the conditions of specific imbalances withinparticular organs.

Order and Disorder

The pulse may be irregularly ordered or irregularly disordered. These twoforms are sometimes referred to as regular different and irregular different.

A regular different pulse keeps one, two, or more circulations, or cycles,without changing the pattern of the beating of the pulse. One circulationsimply means the number of beats that occur within one second, and theinterval between beats. For example, one circulation might be consideredthus: two beats per second, with an interval of onequarter second betweenbeats.

The irregular different pulse has similar variations in the interval, but doesnot come around in a full circle to the original pulse beat pattern.

Rhythm

The final guide to the pulse derives from the concept that each man, woman,and child, while in good health, should possess a certain pulse rhythm that isappropriate for the age and emotional development of that person. If the pulse


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is beating in accordance with the norms, it is said to be benign. If it is out ofrhythm, it is said to be malignant (though not meant in the sense of malignanttumors or cancers). Malignant pulses are of three types. A similar rhythm isthat which resembles an age rhythm that follows immediately in developmentsequence, such as a child having the pulse rhythm of a young man.

Different rhythm is a pulse that does not immediately follow in thedevelopmental sequence, such as a child having the pulse rhythm of an oldman. The third form--out of rhythm--does not resemble any normal pattern ofany developmental age. This is the ultimate kind of irregular pulse, for itsignals an imminent and severe change in temperament.

The varieties of irregular pulse are classified according to distinctive names. These aresummarized below.

Varieties Of Irregular Pulse

1. Gazelle pulse: Expansion is interrupted and lasts for a longer durationthan normal, remains at a fixed height, then quickly increases to full height.The second beat begins before the first one is completed. The cause is the heatof fever. It is commonly observed in pericarditis.

Gazelle Pulse

2. Waving pulse: Beats follow in a rolling manner, one upon the other, likewaves. The beat is irregular in regard to largeness, degree of rise, and breadth.It seems to come too soon or late, and the force is soft. The cause is usually aweakness of the vital power. The significance of this pulse is that a form of thehealing crisis (see Chapter 9) by perspiration or diarrhea is imminent.

Waving Pulse

3. Sawlike pulse: This is rapid, successive, and alternating in hardness andsoftness of moisture content. The irregularity is with respect to the size ofexpansion, and of hardness and softness. It is caused by moisture mixed withblood humor, or excess of yellow bile or phlegm humor; or it may be caused byswelling of the nerves, which causes perspiration matter to become hard.

Sawlike Pulse

4. Antlike pulse (formicant pulse): This is similar to the wavy pulse, butmore intense in the successive and soft aspects. It is the smallest, weakest, andmost hurried of all pulses. It is caused by weakness of peristaltic action.


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Antlike Pulse

5. Rat-tail pulse: This pulse alternates between excessive and insufficientdimensions. It often begins in an excessive mode, reverts to insufficient, thenbreaks midway and returns to excessive. It is a sign of malignancy and is

caused by a very weak life force.

Rat-tail Pulse

6. Flickering pulse:Your first finger feels the pulse as small, the middlefinger feeds it large and swollen, and the last finger feels it small again. Thissignifies weakness of the arterial wall and destruction of tissues around theartery. The cause is extreme disability, often due to unresolved inflammationsof long duration.

Flickering Pulse

7. Cordlike pulse (twisted pulse): This feels like a band of thread or cordthat has become twisted. There is an evident tension. The "twisted" sensationmay only be for one part of the pulse and not the second beat. The cause is dueto dry intemperament.

Cordlike Pulse

These are the main kinds of simple pulses, although there are many more

forms of compound pulses, none of which have been given specific names.Pulse diagnosis is remarkably accurate in allowing the physician to recognizethe site, severity, and intensity of interior disease conditions. However, thebasic texts on the pulse run into many volumes (the Chinese classic text on thepulse is in twenty-five volumes), and I stress again that some formal personalinstruction by an experienced Hakim would be necessary to verify one'simpressions of the pulse.

There are several factors that provide the inherent pulse. These factors arethe vital power of the heart itself, the elasticity of the artery, and the

resistance, or urge, of the force of the pulse. These factors will not providevariation in the pulse, but together they are responsible for the normal pulsein any person.

There are a host of nonessential factors that may produce changes in thepulse. These include such things as age, season, changing temperament,bathing, exercise, gymnastics, sexual intercourse, pregnancy, foods,


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intoxicants, medicines, emotional states, pain, secretiveness, habits, andputrefactions.

You should also read the discussion on the subjects offever and pain, because theyare also quite significant in various imbalances.

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Unani Pulse Diagnosis