Selection of Panchakarma Through Pulse Diagnosis A Unique System

Disha - 2016
Direction to Future - Concepts to reach Application

On 18th -19th March 2016
Keynote Address
Selection of Panchakarma through Pulse Diagnosis A Unique System
Introduction:
Pulse diagnosis is a non-scientific diagnostic technique used in
Ayurveda, traditional Chinese medicine, traditional Mongolian medicine,
Siddha medicine, traditional Tibetan medicine, and Unani. [1].
Nadi Parreksha (Pulse diagnosis) is a fantasy of the Ayurvedic
Physician who is practicing. The physician wish to bring the knowledge back
and use in his practice that lost its precision of information and technology in
the time. Still with the information available through the doctrines and
manuscripts, the Ayurveda physicians are able to relocate our ancient Nadi
Vijnana.
In Ayurveda, practitioners claim that by taking a pulse examination,
Tridosha imbalances (Vata, Pitta, and Kapha) can be diagnosed. The ayurvedic
pulse also claims to determine the balance of prana, tejas, and ojas [2].
Nadi Pareesksha is one among the eight methods of examining a
patient in Ayurveda. The Nadi (pulse), Mootra (urine), Mala (feces), Jihwa
Prof. KSR Prasad (tongue), shabda (sounds), sparsha (touch), drig (vision) and akruti (gesture)
Vice-Dean (PG Academics) are the eight parameters that are tested in routine examination of patient. We
examine a patient for the understanding of
Professor, Panchakarma,
– Rogi Prakriti (Patient Body Constitution)
MGACH&RC, Wardha ,
– Vyadhi Prakriti (Disease Constitution)
Email:
– Dosha Prakriti (Humoral Constitution)
technoayurveda@gmail.com Rogi Prakriti (Patient Body Constitution)
The constitution is given enormous value in Ayurveda. In fact the
prakruti is of different kind viz. Jata (by birth), rituja (seasonal), viharaja
(occupational), Aharaja (dietetic), etc. out of these we may not be required
many but do need all. It always depends upon the symptoms presented by the
individual. Most of complaints are associated with either pain or discomfort.
Thus when we are to decide a specific Panchakarma program for a patient
approached, we do need the Dosha predominance raised by the causative
factors that influence the integrity of body.
Vyadhi Prakriti (Disease Constitution)
The disease diagnosis is major task for the physician well before
offering a treatment. For this threefold examination method of Darshana-
inspection, Sparshana Palpation and Prashna- interrogation; are indicated in
Ayurveda. Apart from this the fivefold understanding of the pathogenesis
(Nidana, Poorvaroopa, etc) model is also introduced. When the information's
brought out by these methods are insufficient the diagnostic evidences based
Astasthana pareeksha is introduced. Still to be on safe side to understand the
constitution and fitness of the patient for proposed management the
Dashavidha pareeksha (Dosham, dooshyam, prakriti, desha, kala, agni, etc)
are brought out as a comprehensive methods of examination. The Nadi
pareeksha (Pulse examination) do revel many aspects that cover in the process
of disease pacification. Text states that the recent food consumed or the
activity along with the dosha movement and disease state can be identified by
36 National Seminar on “Physiological Concepts Applications in Panchakarma”

& Pre Seminar Panchakarma Workshop
Organized by Departments of Kriya Sharir & Panchakarma
Mahatma Gandhi Ayurveda College, Hospital & Research Centre, Salod (H), Wardha, Maharashtra, India
A Constituent College of Datta Meghe Institute of Medical Sciences (DU), NAAC Accredited Grade ‘A’
Disha - 2016
Nadi. For such more practice in this concern is needed to identify the state of
pulse through its rhythm and rate by given examples.
Dosha Prakriti (Humoral Constitution)
The constitution of the Dosha again is a question in the practice. A
birth time constitution is not necessary to know by a treating physician through
Nadi. What he require is the state of Dosha with reference to its movement i.e.
krityakaala (Sanchaya, Prakopa, etc). The kriyakaala has good value in the
ayurveda practice. The sanchita dosha will be at its stipulated place either with
segregated or desegregated accumulation. The true disease state is at the
second half of Sthaana samshraya to first half of Vyakta avasta.At this juncture
the Nadi reflexions offer a great flexibility to the physician to choose the dosha
eliminative procedures.
History of Pulse:
At first the pulse diagnosis is Ayurvedic described by Saarangadhara
(13th century AD.) and later Bhavamishra (15th century AD.), Yogaratnakara
(16th century AD.), Basavarajeeyam (17th century AD.) etc. dealt the subject करस्य अंगुष्टमूले या धमनी
extensively with additions. Each and every body described their own way but जीवसाक्षिणी
followed a method of exampling the animals, birds or known expressions.
तच्चेष्टया सुखं दु:खं 'ज्नेयं
It is unknown why the Charaka, Sushruta and Vaghata not focused on
this subject. Probably the inner eye of the sages accessible to the patient कायस्य पंडितै:
pathology directly and when such powers are lost we started inventing tools श.सं-३/१
for the understanding. The major Ayurveda treatise offers little terminology
like spandana, praspandana, aspandana; related to the liquid (fluid) dynamics. नाडी धत्ते मरुत्कॊपे
th
Sharangadhara (13 century A.D) - जलौकासर्पयोर्गतिं
First time mentioned about the examination of Nadi with 15 types that कुलिंगकाक मंडूकगतिं
include physiological, Psychological and pathological states of body
पित्तस्य कॊपत:
correlated with those of the birds, reptiles and amphibians. 8 out of 24 palpable
are selected for Nadi pareeksha. हंसपारावतगतिं धत्तॆ
The Radial pulse is referred as “Jeevasakshini” examined one inch श्लेष्मप्रकॊपत:
under the thumb expresses the knowledge of comfort and disease (agony) [sha
श.सं-३/२-३
sam 3/1]. The dosha nadi is described that mimics the various animals, birds
and reptiles. Vata nadi attributed to the movements of leach and serpent. The लाव तित्तिरिवर्तीनां गमनं
pitta nadi express the movement of sparrow, frog and crow and the kapha with सन्निपातत:
swan and pigeon [sha sam 3/2-3] . When it is with tridosha vitiation nadi
reflects the patterns of Lavuka, Tittri and varti birds' movement which we were कदाचिन्मंदगमना
not att all accustomed to identify. The various patterns told are Manda, कदाचिद्वेगवाहिनी
Udwega, sthaanavichuti, stitwa-astitwa, sheetala, atisheetal, ksheena,
द्विदोषकॊपतो 'ज्नेया हन्ति
atiksheena and mrutu nadi [sha sam 3/3-4] .
Various Nadi patterns for the disease identifications are told by च स्थानविच्युता
Sharangadhara like Jwara, Agnimandya, agnideepti, Kshudhita, Trupta, ama, स्तित्वास्थित्वा चलति या
dhatu kshaya, atirakta,etc.Are described.
सा स्मृता प्राणनाशिनी
The specialty of the sharngdhara is “Dootanadi” (Messenger pulse),
which is popular in Andhra province. In this the messenger of the patient pulse अतिक्शीणा च शीता च
is taken and there by the disease of the patient is estimated. जीवितं हंत्यसंशयं
Bhavaprakasha (15th centuryAD)
श.सं-३/३-५
Bhavamishra considered fore told information and specified gender
based Nadi examination. The Nadi is taken for male on right hand and for
female on the left. Three fingers usage and attribution to dosha are described.
National Seminar on “Physiological Concepts Applications in Panchakarma” 37

Disha - 2016
Yogaratnakara (16th centuryA.D)

Yogaratnakara included different Sites and methods of pulse
examination and prognostic / diagnostic methods.
Basavarajeeym
Basavarajeeyam is a famous Ayurveda text of Andra Pradesh. It
possesses much information regarding Nadi. The text includes all the former
knowledge and added more valuable information. The Nadi of Gender
sensitivity is because the Nabhikurma position is up righted in the female,
the left hand is chosen for the examination of nadi.
Basically three areas are chosen for nadi examination. They are
Hasta (wrist), kantha (neck) and Nasa (Nasal). The Nadi commonly
observed as Kapha nadi in the morning, Pitta nadi in the noon and Vata nadi
सुव्यक्तता निर्मलत्वं in the evening. The diseased nadi is differentiated from the normal nadi.
स्वस्थानस्थितिरेवच Physical and pathological conditions such as - Agni, Ama and Dosha states
are understood by Hasta Nadi. The KanthaNai describes the psychological
अचंचलममंदत्वं सर्वसां
and exogenous (Agantuja) causes and the Nasa Nadi affirms the death and
लक्षणं शुभम् Shalakya (eye and ENT) vyadhi. Pada nadi describes the life span and
बसवराजीयं- १अ health.
It is myth to see nadi only in the morning times. Nadi can be
observed at any time. But there are few conditions in which nadi may not be
observed perfectly. After exercise, food consumption, conjugation, or bath,
the nadi becomes influenced and does not reflect its originality. Thus these
times are contraindicated for nadi examination.
Basavaraju describes the Shubha nadi as the Nadi in its own place
without any fluctuation or dullness flows regular in all vessels is Shubha
Nadi [Basvarajeeya 1 cha] .
Vaidyachinthamani
Vaidyachintamani is another Telugu Ayurveda contribution to nadi
examination. He compiled all the contents of previous authors like Ajeerna
Nadi, Dosha nadi, etc.
Ravana Thantra
Time of Ravana is questionable as he in his treatise Nadi Pareeksha
th
included methods described after 13 century. His contributions are - Nadi
after taking certain diets along with prognosis, physiological, Psychological
and pathological conditions and diseases.
Panchakarma:
Panchakarma is a procedural part of Ayurveda therapeutics
established for the Dosha elimination from the Body either from oral or
rectal route (GI system). In due course the Panchakarma extended to get rid
of the Physical and Psychological Dosha accumulated by environmental or
Dietetic misbehaviors. Five karma (Vamana, Virechana, Niruha, Nasya,
Rakta mokshana) are told as “Shodhana” / (Eliminative) “Langhana” in
nature based on “Bahudosha Nirharana” (many or huge elimination). But
out of these five procedures only two are fully capable of elimination
(Poorna Shodhana), as there are no Brumhana variations in them. They are - .
“Vamana” (Upper GI cleanser)
“Virechana” (lower GI cleanser)
The other three are partial for elimination as they are used for
Brimhana and also in different variations. The Dosha and Karma

Disha - 2016
attributions are -
For Vata Vasti (Basti)
For Pitta Virechana
For Kapha Vamana
The selection of patient for the karma is commonly based on Disease or
indications described in textbooks. But many times the expected results are not
observed at the “Karma” which is not suitable for the situation. We observe
“Fitness” of patient of patient; indications and contraindications while
procedure initiation. Still the variations are reported. Thus the selection of
Panchakarma through “Nadi Parrekshana” comes on the discussion.
To achieve the optimum results we need sound knowledge of
What is Nadi Pareekshana,
How it is classified
What is the procedure of initiation?
How to interpret the knowledge
What is pulse (Nadi) wave?
Pulse is an objective criterion for diagnostic or prognostic conditions
through the waves of blood transported in the vessels. It explains the
hemodynamic of the ejection systole of the heart. The wave dynamics depends
upon the stroke volume and contents along with the obstructions caused in the
path way. The contents of the blood are either nitrogenous waste material or the
chemical constituents deposited in the blood because of the pathology. The
pulse offers even much more information also like the estimation of the
disease, treatments and prognosis.
Classification of pulse on new dimensions:
No specific classification of the Nadi is found in the textbooks. The
classification of Nadi Parreksha can be based on utility or type of pulsations.
Based on the utility it is classified as
– Predictive Nadi diagnosis for Prakruti assessment proportionate
– Diagnostic Nadi diagnosis disease understanding by different static
principles of movements described in the text
– Dynamic Nadi diagnosis used for understanding disease &
prescribing medicine or procedure
Predictive Nadi diagnosis
The predictive Nadi system is commonly practiced by many
physicians. In this they try to observe the different animals, insects, reptiles and
birds movements in the pulse to diagnose the patient.
The Index finger is used for Vata dosha to diagnose with the
movements resembling either snake or Earth Worm. Most of the time in the
examination, the anxiety is reflected instead of Vata dosha knowledge. The
Middle finger use for Pitta to understand with the movement resembles Frog or
Crow. In the same way Ring finger is used for Kapha to know with the
movements of Swan or Pigeon.
Diagnostic Nadi diagnosis
The diagnostic Nadi is a static description of the rate, rhythm and pulse
dynamics based upon the various examples given from text to know a disease or
condition. As they are based on Gati momentum different examples are given
that replicate examples to be remembered with constant touch of nadi

Disha - 2016
examination. Some times there is no full length information regarding the said
condition is available. This type of knowledge is Aptopadesha and can be
obtained only through a teacher well versed with technique and teaching. Few
of them can be correlated with the present day condition pulse patterns. Many
examples are there such as -
• Krumi gathi parasites , worms
• Pippilika gathi terminal illness
• Mayura gathi arterial hypertension
• Kukkuta gathi diabetes , albuminuria
• Ushtra gathi aortic stenosis
• Gaja gathi elephantiasis, lymphatic obstruction
• Girija gathi heart block
• Vishama gathi pulsus alterans , atrial fibrillation
• Damaru gathi fatal illness , renal failure , shock
• Padma gathi perfect health , enlightenment
Prasad's Dynamic Nadi diagnosis
This Prasad's Dynamic Nadi Diagnosis (PDND) is an invention of me
with various experiences encountered in the past 35 years. This is a blind fold
method that is observed to assess the condition and inter relation of the Dosha
for its quantification, involvement of Organ and sub Dosha or system along
with dhatu involvement, etc. Here the classical model is validated and the
DND is subjected for validation.
Basic wave of acceleration pulse wave is the first part of Nadi
examination. The radial pressure pulse contains all the basic information from
which the ascending aortic pulse is generated. All that is determined
quantatively from the aortic pulse can be inferred from the radial. Duration of
systole and diastole are measured directly from the radial pulse, and its change
with ageing and with drugs can usually be followed in the same way as the
aortic, though it is more difficult to identify infections in late systole on the
radial pulse. Analysis of the radial pulse alone may be adequate for many, and
certainly improves on sphygmomanometric measurement of brachial systolic
and diastolic pressure alone [3].
In a blood vessel the flow is in a rhythm hitting the two walls with a
velocity. The taping that hits the finger evaluates the Dosha “tara- tama
anupalabdi” (degrees of variation) is made with the intensity of the hit to the
finger. As shown in figure-x Pravruddha (a) (full), heena (e) (decreased), and
madhyama (c) (medium) tones are observed. This could be even in checked in
percentages also.
As per the figure, the N for normal pulse observed is with full volume and
stroke where in the D is diastolic failure and S stands for systolic failure. As per
the pulse recording is considered the normal is abnormal in the nadi and that
denotes the status of the Dosha. In Nadi readings, the N is pravruddha, D is
Madhyama and the S becomes the Alpa dosha. Time Duration between two
strokes at the finger gives duration of specific dosha movement from its
Sthaana (b) (dosha place) to reach Dooshya (c)(disease place) as shown in
figure.
As the Urdhwa (Vamana) and Adho (Virechana) Doshahara methods
are followed in Panchakarma to eliminate the respectively Kapha and Pitta

Disha - 2016
with its bahudosha avasta, the symptomatology plays an important role to

understand. Urdhwa Dosha Nirharana Vamana for Kapha (Bahu dosha) is
understood with Hrullasa (salivation). Here the salivation is due to excess of
heavy metallic biological or molecular waste with the characteristics of sticky
in nature. When the dosha is alpa the kapha depicts the indigestion
(agnimandya) and acid peptic disorder (Amlodgara). At bahudosha condition
the vamana with Madanaphala pippali and in alpadosha jeemootaka, Ikshwaku
etc or madanaphala in small quantity are prescribed.
The other morbid dosha Pitta indicated for Adho Dosha Nirharana is
Virechana. In case of Pitta Bahu dosha, the burning sensation at anal region
(Guda Daaha) is observed. Whenthe pitta is a minimal level (alpa) in imparts
the vata place with apana Vayu (flatus) there by requires Anulomana.
Procedure of Dynamic Nadi
• Sit comfortable (both patient and doctor)
• First place your right hand on the radial artery (Jeeva sakshini)
• Select right hand for male and left hand for female
– Record your readings
• Take patients both hands in to your hands placed three fingers
on the Jeeva Sakshini
– Record your readings
Interpretation of PDND
• Each finger is divided in to two halves
• The half toward the patients hand represents the Urdhwa Dosha
and the other part towards the shoulder represents the Adho dosha
• When pulse is found more than 60% of intensity at former it is
subjected for Vamana and for later it is Virechana

Disha - 2016
Interpretation:
The Nadi examination even though preferred to take at early morning
on empty stomach for the selection of Shodhana therapy any time acceptable.
The only precaution and care to be taken is that the patient is comfortable at the
time of Nadi taking. The patient should not undergo either excitement or
nervousness. It is to be noted at what time the Nadi is recorded, so that the Natal
Nadi predominance is attributed to the Nadi recorded. Another important point
of observation in the individual finger is that the pulse observed may crossover
the both halves of the finger such time the generalised principle of the dosha is
applied.
The Nadi for eg: observed with the (X) (BY crossover) (C) denotes the
Adhovata, Adhopitta and urdhwakapha. This condition describes the
symptoms of loss of appetite, heart burn, pain in left hand, headache,
salivation, etc. suggestive of involvement of Samana and Apana vata; and
Sadhaka and Bhrajak pitta; and Kledaka kapha. The diagnostic part is with
involvement of heart with sodium increase in the blood causing peripheral
vaso constriction and decreased motility of intestines and lack of gastric juices
secretion.
The interpretation part is crucial in Nadi Pareeksha. It may not be able
to understand the technique of Nadi with one example. It does require skill
learnt through a trained teacher as Swami Vivekananda said “You have to
grow from the inside out. None can teach you, none can make you. There is no
other teacher but your own soul”.
Arise! Awake! And stop not until the goal is reached.
References:
[1] Carolyn D. Berdanier (ed.); Handbook of Nutrition and Food. p. 1491-1492
[2] Peter Koch, December 1, 2012, http://www.heilkunde-
ayurveda.de/diagnosestellung/#Pulsdiagnose
[3] Michael F. O'Rourke, Alfredo Pauca & Xiong-Jing Jiang, Pulse wave
analysis, 2001, Blackwell Science Ltd Br, J Clin Pharmacol, 51, p507-522


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Disha - 2016

Direction to Future - Concepts to reach Application

36 National Seminar on “Physiological Concepts Applications in Panchakarma”

National Seminar on “Physiological Concepts Applications in Panchakarma” 37

Yogaratnakara (16th centuryA.D)

38 National Seminar on “Physiological Concepts Applications in Panchakarma”

National Seminar on “Physiological Concepts Applications in Panchakarma” 39

40 National Seminar on “Physiological Concepts Applications in Panchakarma”

with its bahudosha avasta, the symptomatology plays an important role to

National Seminar on “Physiological Concepts Applications in Panchakarma” 41

42 National Seminar on “Physiological Concepts Applications in Panchakarma”

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