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The Science and Art of Pulse Assessment in Greek (Unani) System of Medicine

Dr. Khalid is a health researcher and science writer with a Ph.D. in clinical research.

The Greek physicians in ancient times undertook substantial research to unravel the intricacies of pulse assessment and its relevance to the scientific investigation of body physiology. Many facts about the structure and function of the human body were uncovered with the advent of the ancient Greek system of medicine. The physicians were thrilled and amazed to study the mechanics of arteries and veins and their attribution to the generation of dozens of pulses indicating the metabolic states. The Greek physicians developed a scientific temper that helped them understand the complexities of pulses and their potential health and disease indications. The diagnostic assessment of complex cardiovascular and neurological disturbances via pulse assessment helped them develop viable remedies to safeguard human life.

The science and art of pulse assessment still hold relevance, and its integration with the modern system of medicine may prove to be a significant milestone to expand quality-adjusted life years of patients with terminal illnesses. The pulse assessment also plays a pivotal role in improving prophylactic management of chronic disease conditions, like congestive heart failure and diabetes. The researchers and physicians should revive the art and science of pulse examination and integrate it with integrative medicine for improving the treatment paradigm of fatal diseases across the globe.

What Is a Pulse?

Pulse in the ancient Greek system of medicine is defined as the activity of an artery that is perceptible by touch and indicates the overall health of the human circulatory system. The constriction and dilatation activities of the pulse trigger a range of compound activities that reveal different physiological or pathophysiological states of the human body.

The pulsatory movements coordinate with oxygen to direct and redirect the essential elements of human life. The arterial movements in the human body have the potential to modify four humors of the human body. Life exists in the entire arteries and veins of the human body. The coordinated movements of arteries and veins not only influence their elements but also control the functionality of the heart to a considerable extent. The term ‘pulse’, however, literally relates to the arterial activity that directly influences the cardiac output.

Interestingly, the functionality of the pulse does not match with the physiology of the heart under any circumstances. The Greek system of medicine considers the heart and arteries in terms of the utensils of life or its protective coverings.

Types of Pulses

The different types of pulsatory activities are mentioned below.

  1. Harkat-e-Ainiyyah (HEA) is a type of pulsatory activity that constantly changes its temperament under the influence of bodily activities. This indicates that the state of walking consistently alters the nature of the human pulses. The intensity, tone, and activity of HEA reveal the state of routine physical activity of the human body. The individuals with a sedentary lifestyle reveal a unique state of HEA as compared to the people who engage themselves in regular physical activities.
  2. Harkat-e-Wazaiyyah (HEW) is a type of pulsatory activity that depends on the functionality of the body organs. HEW facilitates the assessment of the functionality of vital organs, including the liver, kidneys, lungs, and heart.
  3. Harkat-e-Kamiyyah (HEKA) is a type of pulsatory activity that facilitates the assessment of the state of the body’s anatomical structures. HEK variations help to identify the state of hypertrophy and/or hyperplasia of various organs. The increase in the overall size of an organ after its interaction with an antigen is called “Numoww” or “Baleedgi”. However, the expansion of an organ’s surface in the absence of antigenic interaction is recognized as “Takhalkhal”. Such a type of organ enlargement occurs under the influence of homeostatic disturbances that potentially deteriorate the temperature balance of the human body. Similarly, the degeneration of the organs is categorized into two distinct types, including “Zubool” and “Takasuf”. The deterioration of the human body that occurs under the influence of an external factor is known as “Zubool”. For example, the weakness, fatigue, or loss of weight that occurs under the impact of prolonged diarrhea is categorized as “Zubool”. Contrarily, the degeneration or deterioration of the human body in the absence of a known factor is called as “Takasuf”. However, this unknown factor could include temperature variations or environmental changes that might deteriorate the body function in the absence of well-defined mechanisms.
  4. Harkat-e-Keifiyyah (HEKE) is a type of pulsatory activity that materializes due to a marked change in body temperament. The variations in body temperature also impact the intensity of HEKE in different individuals.

Pulse Assessment: An Evidence-Based Analysis

The Greek philosophers, including Avicenna and Alauddin Qarshi, considered the highest contribution of HEW in the pulsatory activities. Contrarily, other Greek physicians considered HEA as the progenitor of pulsatory physiology. HEW reveals the type of cardiovascular mechanism that does not allow the ingredients of life to exit from their anatomical structures. That is the core reason for the fixation of arteries and veins at their individualized locations despite their structural alterations based on the variations in blood flow. However, HEA warrants the complete exit of the life ingredients from their initial location. For example, the flow of blood with oxygen from the heart to various body tissues.

Allamah Alauddin Qarshi advocates the constriction of arteries following the dilatation of the heart and vice versa. The movement of blood from the arteries to various body structures is driven under the impact of HEA that forces the transfer of the elements of life from their original location to their subsequent destinations. This movement is controlled by the constriction and dilatation of the flexible walls of the arteries. The arteries adapt the tendency to forcibly contract as and when they get instilled with blood. Contrarily, they undergo expansion after pushing the blood volume to its next level for repeating the same process. These outcomes reveal the direct control of the heart on the movement or activity of the pulse.

The power of autonomous contraction and expansion of the human heart is known as “Quwwat-e-Haiwaniyah” in Greek medicine. Researchers and scientists, however, do not advocate the complete autonomy of cardiac activities since neurological manifestations impact their functionality in a variety of scenarios. The cardiovascular system functions in close coordination with the nervous and digestive systems and that’s the reason for assessing the pulsatory activity to determine their pathophysiological complications. These findings reveal that any abnormality in the digestive or nervous system could potentially impact the pulsatory activity of the human cardiovascular system. The traumatic conditions also influence pulsatory activity in a variety of ways. The concomitant occurrence of trauma and chronic or acute health condition could trigger a unique pattern of pulsatory activity, where the arteries are forced to dilate for triggering the healing mechanism at the site of trauma despite the requirement of their constriction under the impact of a pre-existing disease.

The consistency of pulsatory activity is interrupted by two equivalent pauses or breaks that occur after each arterial dilatation and constriction. The pause after every arterial dilatation or expansion is recognized as “Sukoon-e-Kharji” or “Sukoon-e-Muheeti”. However, “Sukoon-e-Daakhili” or “Sukoon-e-Markazi” is the pause that occurs after every arterial constriction. The Greek physicians and philosophers believe in the notion that “It's difficult to assess those pulses that emanate under the influence of arterial constriction”. However, they recognize “Nabz-e-Azeem” and “Nabz-e-Sulab” in terms of two prominent pulses that could be measured or felt during arterial constriction. Nabz-e-Azeem is based on its length or height; however, Nabz-e-Sulab is based on its consistency and firmness, and its occurrence is felt in scenarios when it resists the pressure of the physician’s fingers and lacks resilience/flexibility. The Greek physicians also believe in the measurement of arterial constrictions through the assessment of “Nabz-e-Bati” based on the prolonged activity of this pulse.


Kitab-un-Nabz by (Maseehul Mulk) Hakeem Ajmal Khan Sahab

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2022 Dr Khalid Rahman