Unani Pulse Diagnosis

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.
Developing sensitivity to the subtle actions and elements of the pulse takes much time
and practice. The capacity to sensitize the fingertips to the pulse variations can be
enhanced 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 hard
table top, so that you do not know the location of the hair. You must then "feel" the hair
through the paper. Once the position of the hair can consistently be identified through a
single sheet, a second sheet is added. This process is repeated until the hair can be felt
through seven thicknesses of paper.
Techniques of Pulse Evaluation

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.

Quality of Expansion

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.
"Animal power" does not precisely mean "sexual power" as it is used in current
psychological 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--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 difficult 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.
The varieties of irregular pulse are classified according to distinctive names. These are
summarized below.
Varieties Of Irregular Pulse

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.
Gazelle Pulse
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.
Waving Pulse
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.
Sawlike Pulse
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.

Antlike Pulse
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.
Rat-tail Pulse
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.
Flickering Pulse
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.
You should also read the discussion on the subjects offever and pain, because they
are also quite significant in various imbalances.