Nadi Pariksha (Pulse Examination)
The pulse should be examined in the morning on empty stomach in a calm and peaceful atmosphere. Patient and physician should sit comfortably facing each other, preferably at the same height; it is advisable to examine the pulse of the patient in sitting position.
Generally radial pulse is examined just below the styloid process on the wrist. In males the pulse of the right hand and females the left hand is examined. It is so because the main organ responsible for findings of the pulse (Nadi) is Kurma and its position differs in males and females. It is situated around Nabhi (umbilicus/center) in downward position in males and in upward position in females. The pulse is to be examined on the right side of Kurma. So due to this difference in position, pulse is examined on the right hand of males and left hand of women. Further the right side of a male and left side of a female is considered as auspicious, favorable and good.
The physician should sit on the right side of the patient and hold the right hand of male or left hand of female at wrist with his right hand while supporting the arm of the patient at the elbow with his left hand. The arm of the patient should be kept fully extended. Then the physician should keep three fingers i.e. index, middle, and ring of his right hand on the radical pulse just adjacent to the styloid process situated just below the root of thumb. The position of the fingers should be such that index finger lies adjacent to the process. The fingers of physician should be half flexed so that he may gently press the pulse with the tips of the fingers. Then the physician should examine the pulse by applying gentle and equal pressure of his three fingers on the pulse. The physician should not the rate, volume, pressure and character of movement of the pulse. The pulse should be examined three times with full concentration prior to reaching the final diagnosis.
First of all the physician should try to ascertain beneath which finger, he is feeling the pulse. Then he should count the pulse rate for one minute dividing into four quarters of 15 seconds. The rate, volume and rhythm of pulse should be carefully observed separately in all the four quarters. The condition of the wall of the artery may also be helpful in diagnosis. In addition, force, tension, fullness or emptiness, character of pulse and condition of wall of vessel should also be examined in each case. After examining the patient, the physician must wash his hands.
Nadi of Healthy person: The learning physician must first be able to identify the normal features of pulse and then practice on a large number of apparently healthy persons, and then only he can appreciate the path gnomonic changes in pulse.
The pulse of a healthy person is said to have the movement like that have a swan or elephant. Along with it the face of the patient also looks cheerful.
Nadi in Different States of Mind
Happy person : Pulse is steady (Sthira)
Saturated (Tripta) : pulse is steady ( Sthira)
Hungry Persons : Pulse is tremulous (chapala)
During Sexual urge and anger the pulse is fast (Vegavati)
Pulse is weak (Kshina) in worry, fear, sorrow and disgust.
Vata Pulse: The pulse is felt below the index finger. The pulse seems to have tortuous movement like that of a snake or leach. The pulse is comparatively fast and of low volume. Its rate, volume and rhythm vary in the four quarters of a minute. The artery may feel hard.
Pitta Pulse: In Pitta dominance, the pulse is felt below the middle finger. The pulse seems to have a jumping movement like that of swan or pigeon. The pulse is slow in rate and full involve. The volume and rhythm are steady in all the four quarters of a minute. The fingers on the pulse may feel slight coolness.
Sannipata Pulse: When all three Dosha re dominant, the pulse is felt below all the three fingers with a very fast rate. The pulse seems to have movement like that of quail (Lava). Francolin partridge (Titara) and Batera).
Dual Dosha Pulse: The pulse of two combined Dosha has the characteristic of both the involved Dosha. For instance the pulse of Vata Pitta may be felt below both index and middle fingers and may be of full volume but its rate, rhythm and volume may vary in the quarters of the minute. Similarly in dominance of both Pitta and Kapha, the pulse is felt below both middle finger and ring finger and so on.
Pulse in Fever: In fever, the pulse becomes fast and is felt hot to touch. Pulse in Psychological conditions: In condition of anger and excitement, pulse becomes fast.
Pulse in Digestion: In the state of poor digestive power, the pulse becomes very slow and low in volume. In Ama it becomes heavy. In a person whose digestive power is good, the pulse is felt light and fast. In a hungry person the pulse is felt inconsistent in rate, rhythm and volume in the four quarter of a minute. In a person with satiety, the pulse is consistent.
Pulse in Dhatu Kshaya: In the state of diminished tissues, the pulse becomes very slow and low in volume.
Precautions for Pulse Examination : the pulse should be examined under the following conditions.
In the morning ideally up to 10 am, but can be examined at any time in an emergency.
Examined preferably when the patient is sitting in up upright position.
The patient should be calm.
On an empty stomach, but the patient should not be hungry or thirsty.
Pulse should not be examined immediately after bath, exercise, massage, sex or while the patient is sleeping.