Flickering pulse

    Your first finger feels the pulse as small, the middle finger feels it large and swollen, and the last finger feels it small again. This signifies weakness of the arterial wall and destruction of tissues around the artery. The cause is extreme disability, 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--the diminished metabolic force that is responsible for fully assimilating nutrients in the body. The word lift that we use in everyday language is the result of two activities working harmoniously: one is the constant life of the spirit; the other is 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 life force. The word nafas also means soul, spirit, essence, and breath. The nafas is the breath or thread of life that runs through all human beings, and is the one element 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 most important nourishment to human life, much more important than any other substance, for there is a connection between our own breath, the life force, and the 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. The connection between light and our life, our breath, is demonstrated by the scientific knowledge of the West as well; for through the process of photosynthesis, light catalyzes in the transformation of the chlorophyll of plants into oxygen, which is then taken into the lungs as the sustaining life force. Indeed, our breath is simply another manifestation of the pure light of the sun and of the universe. Yet how unconsciously we engage in our breaths!

    Realizing that breath is the carrier of the life force, we must discover a method for evaluating the efficiency of this process. The key to this is the pulse. 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 all of 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. The intimacy of the interrelationship of these factors is conveyed by using the same word for all three.

    In determining the relative harmony of this life force within the body, the Hakim performs an evaluation of the pulse. The system of pulse diagnosis evolved by the Chinese was studied by Avicenna, who incorporated its most salient features into the Unani system. While pulse evaluation can become quite complex, and does require extensive personal instruction in order to master 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 and contracts, whereby the "breath" of the innate life force becomes subjected to the influence of the indrawn air. Every beat of the pulse consists of two movements 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 little flesh 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 be higher and exaggerated in degrees of excess. If the patient is a male, read from the left hand; if a female, use the right hand. Both patient and examiner should be in a calm state, without having performed exercise or eaten within one hour before the reading.

    In pulse evaluation, the examiner's middle finger must be placed exactly at the junction of the carpus with the lower end of the radius. The other two fingers 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 utilize what is known as "two-element" evaluation. This is obtained by taking the first and second factors of the pulse. The length, width, and depth comprise the first element. The second element is obtained by comparing that pulse with one of a bird or some other animal, so that the patient's pulse can be judged against a norm in nature. There is also a "three-element" evaluation, which combines the readings from the wrist, the forefinger, and the tips of the four other fingers to arrive at a composite of the complete internal functioning of the body. However, I present here only the single-element evaluation.

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

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 the similarities between the two systems are remarkable.

    The quality of expansion and contraction is measured according to the length, width, and depth of the artery carrying the blood. A long pulse is one that 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 a normal pulse. The cause of a short pulse is lack of internal heat, often accompanied 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 describing the pulse measures because it implies that there is neither too little nor too much 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 wide pulse 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 being less in width than a normal pulse, and its cause is an insufficiency of moisture in the blood.

    The third factor in this initial assessment of the pulse regards depth. An eminent 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 is excess heat. A lowered pulse can be felt as having dropped down away from the surface of the skin of the wrist and below the point considered as moderate. The cause of lowered pulse is lack of internal heat.

    Thus, with this initial evaluation, we arrive at nine basic pulse types, or possibilities, 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 possible variations of the pulse. For the sake of interest, the twenty-seven variations are reproduced in Table 6.

Quality of Impact

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

Duration of Cycle

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

    This movement of speed and undulation is sometimes compared to the movement 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 pulse along the forearm in some individuals who have eminent arteries.

Duration of Pause

    There are three modes: successive, different, moderate. Successive pause means that the pulse not only moves across the measuring point in less time than a normal pulse, but also successively slows (and this slowing may run in cycles). This is not simply an opposite measurement of the quality ascertained in 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 is the presence of the highest possible degree of animating life force, which is an imbalance, not health.

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

Emptiness or Fullness

    The pulse is full (or "high"), when it seems to be overfull of humor and needs to be allowed out; an empty (or "low") pulse is flattened and opposite in character. 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, so that the fingers seem to fall on empty space. The cause of the full pulse is thickening of the blood. The empty pulse gives a "clammy" feeling at the point of feeling the pulse. A moderate state is the condition of balance between the two.

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--Lowered
Long--Narrow Eminent Long--Narrow--Lowered
Long--Moderate--Eminent Long--Moderate--Lowered
Short--Wide--Eminent Short--Wide--Lowered
Short--Narrow-Eminent Short--Narrow--Lowered
Short--Moderate--Eminent Short--Moderate--Lowered
Moderate--Wide--Eminent Moderate--Wide--Lowered
Moderate--Narrow--Eminent
Moderate--Narrow--Lowered
Moderate-- Moderate-- Eminent Moderate--Moderate- Lowered
Long--Wide--Moderate Long-- Narrow-Moderate
Long-- Moderate-- Moderate Short--Wide--Moderate
Short--Narrow--Moderate Short--Moderate-Moderate
Moderate--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 taking the pulse and by reflecting upon the temperature of the surface "moisture" of the matter being eliminated by the pores of the skin. Both hot and cold pulse are easily determined. The former is caused by excess internal heat, and its opposite by the lack of internal heat. The moderate temperature falls between these two.

Regularity

    This guide synthesizes all of the preceding evaluations into one measure. By taking all of these factors into account, one can note the general pulse condition.

    The modes of equality are regular or irregular. Regular means that it is moderate in all of the above factors. Likewise, it would be called irregular if excessive in all of the factors. However, if it is regular in six aspects and irregular 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 the patient, the last two factors allow the examiner to adopt more critical measurements, which reflect the conditions of specific imbalances within particular organs.

Order and Disorder

    The pulse may be irregularly ordered or irregularly disordered. These two forms 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 circulation simply means the number of beats that occur within one second, and the interval between beats. For example, one circulation might be considered thus: two beats per second, with an interval of onequarter second between beats.

    The irregular different pulse has similar variations in the interval, but does not 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 is appropriate for the age and emotional development of that person. If the pulse is beating in accordance with the norms, it is said to be benign. If it is out of rhythm, it is said to be malignant (though not meant in the sense of malignant tumors or cancers). Malignant pulses are of three types. A similar rhythm is that which resembles an age rhythm that follows immediately in development sequence, such as a child having the pulse rhythm of a young man.

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

1. Gazelle pulse: Expansion is interrupted and lasts for a longer duration than 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 heat of fever. It is commonly observed in pericarditis.

2. Waving pulse: Beats follow in a rolling manner, one upon the other, like waves. 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 a weakness of the vital power. The significance of this pulse is that a form of the healing crisis (see Chapter 9) by perspiration or diarrhea is imminent.

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

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

5. Rat-tail pulse: This pulse alternates between excessive and insufficient dimensions. It often begins in an excessive mode, reverts to insufficient, then breaks midway and returns to excessive. It is a sign of malignancy and is caused by a very weak life force.

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

7. Cordlike pulse (twisted pulse): This feels like a band of thread or cord that has become twisted. There is an evident tension. The "twisted" sensation may only be for one part of the pulse and not the second beat. The cause is due to 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 recognize the site, severity, and intensity of interior disease conditions. However, the basic texts on the pulse run into many volumes (the Chinese classic text on the pulse is in twenty-five volumes), and I stress again that some formal personal instruction by an experienced Hakim would be necessary to verify one's impressions of the pulse.

    There are several factors that provide the inherent pulse. These factors are the 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 provide variation in the pulse, but together they are responsible for the normal pulse in any person.

    There are a host of nonessential factors that may produce changes in the pulse. These include such things as age, season, changing temperament, bathing, exercise, gymnastics, sexual intercourse, pregnancy, foods, intoxicants, medicines, emotional states, pain, secretiveness, habits, and putrefactions.