General discussion about pulse

The pulse is the movement of blood vessels, consisting of compression and expansion, in order to cool the pneuma with a light breath of air. You can consider the pulse either in general or in particular in relation to each disease. Here we will talk about the general rules of the science of the pulse, and we will postpone the specific ones until we discuss specific diseases.

We say: every pulsation is composed of two movements and two moments of rest, for the pulse always consists of compression and expansion, and between each two opposite movements there must necessarily be a moment of rest, for one movement cannot be directly connected with another, after that how the end and limit of his distance had actually arrived. This refers to those phenomena that are explained in physics. And if so, then each pulsation, until it is followed by another, must have four parts: two movements and two periods of rest - the movement of expansion, the period of rest between expansion and compression; the movement of compression and the period of rest between contraction and expansion. The compression movement, according to many doctors, is not felt at all; others, however, consider the compression to be perceptible with a strong pulse because of its strength, with a large pulse because of its height, with a hard pulse because of its strong resistance when palpated, and with a slow one because of the length of the period of its movement. Galen said: “For some time I constantly missed the period of compression, then I began to repeat the probing until I felt its signs, and then, not long later, I perceived it completely. After this, the gates of knowledge of the pulse opened before me, and anyone who probes it as diligently as I do will comprehend what I have comprehended.” However, if this is the case as they say, then in most cases the compression of the pulse is not noticeable.

The reason why the forearm was chosen to palpate the vessel is due to three circumstances: it is easy to reach, people are not ashamed to show it, it is located opposite the heart, close to it. The pulse should be felt when the hand is turned sideways, since the hand lying palm down is wider and raised and less long, especially in thin people, and the hand lying palm up is more raised and longer, but less wide. The pulse should be felt at a time when a person is free from anger and joy, does not make physical effort, does not experience any influences, aggravated satiety or hunger, does not stop his usual lifestyle and does not acquire new habits. You should first test the pulse of a person who is balanced by nature, in excellent health, in order to compare the pulse of another with it.

Next we will say: according to how doctors describe it, there are ten varieties by which doctors recognize the state of the pulse, although it should be considered that there are nine.

The first type is determined by the amount of expansion, the second type - by the quality of the beating artery's impact on the fingers, the third type - by the duration of movement time, the fourth type - by the condition of the artery wall, the fifth type - by the degree of emptiness and filling of the pulse, the sixth type - by warmth and coldness of the palpated place, the seventh variety - according to the time of rest, the eighth variety - according to the evenness and unevenness of the pulse, the ninth variety - according to the presence of any order in the unevenness and the absence of any order. The tenth variety according to the “size” of the pulse.

As for the type of pulse size, it indicates the state of the pulse in its three dimensions, that is, length, width and depth. In this regard, the pulse has nine simple qualities, as well as complex ones that are combined from them.

The nine simple variations of pulse are long, short and steady; wide, narrow and balanced; low, high and balanced. A long pulse is one whose parts are felt to be longer in duration than what you usually feel, either in general, that is, with a truly balanced nature, or usual for a given person, that is, with a balanced nature characteristic of him personally. You have already learned the difference between these two natures earlier.

A short pulse is the opposite of a long one, and a balanced one stands between them. By analogy with this, judge the other six varieties.

As for the complex varieties that are combined from these simple ones, some of them have names, and some do not. A pulse that is longer than normal in length, width, and depth is called large; a pulse that is inferior to normal in these three respects is called small; the balanced one stands between them. A pulse that is superior to normal in its width and elevation of the artery is called thick; inferior in these two respects - subtle; the balanced one stands between them.

As for the variety derived from the quality of a blow to the fingers when moving an artery, there are three types of blow: strong, that is, one that resists palpation when expanded, weak - the opposite of strong, and balanced, standing between them.

The variety, taken according to the duration of time of each pulse movement, has three types: fast, that is, one that completes the movement in a short time, slow - the opposite to it, and balanced, standing between them. The variety, taken according to the quality of the artery, also has three types: soft, that is, one that can easily go inward when pressed, hard - the opposite of it, and balanced. The type of pulse, taken according to the quality of what the arteries contain, has three types: complete, that is, when a significant amount of fluid filling it is felt in the cavity of the artery, and not pure emptiness; empty, the opposite of it, and then balanced. The variety, taken according to the feeling to the touch, has three types: hot, cold and balanced, standing between them.

The variety, taken according to the duration of the resting period, has three types: frequent, that is, a pulse with short perceptible breaks between two beats - it is also called “overtaking” and “condensed”; - rare, the opposite of it - it is also called “lagging” and “sluggish” and, between them, balanced. This period is determined depending on how the compression of the artery is felt; if the compression is not felt at all, then the period of rest is considered to be the time interval between each two dilations; if the compression is perceptible, then the period of rest is determined by the time of the end of both states.

As for the variety taken according to the evenness and unevenness of the pulse beat, the pulse is either even or uneven, and this refers to the similarity of the blow, parts of beats, or any one part of the beat in relation to five qualities: large or small size, strength or weakness , speed or slowness, frequency or rarity, hardness or softness. After all, even in the same person, parts of the expansion of the pulse are sometimes faster due to the great excitement of the nature, or weaker due to weakness. If you like, you can expand this reasoning and keep in mind, with regard to the evenness and unevenness of the pulse, not only the three mentioned varieties, but also all other varieties, but the main attention is paid to these three varieties.

An even pulse in general is an even pulse in all the mentioned respects; if he is equal in one of them, then he is called equal only in this respect, so that we can say: “even in strength,” “even in speed.” The same is true for an uneven pulse: it can be uneven in general or in relation to which it is uneven.

As for the category taken by the presence of order or disorder in the pulse beat, then in this category there are two varieties: the pulse is uneven, ordered and uneven, disordered. Ordered is a pulse whose irregularity preserves a certain order and repeats itself cyclically. An uneven ordered pulse can be of two types: it is either an uneven pulse, ordered in general, when only one irregularity is constantly repeated, or an ordered cyclic one, when there are two cycles of irregularities or more. So, for example, there may be one cycle and another, different from it, but they always return together, one after another, as one cycle, and a disordered, uneven pulse is something the opposite of this. If carefully examined, it turns out that this ninth variety is actually a kind of eighth variety and fits into the category of irregular pulse.

You should know that the pulse has a certain musical nature. Just as the art of music is perfect due to the combination of sounds in a certain ratio of sharpness and severity and the tact circles of the time intervals separating the blows on the strings, such is the quality of the pulse beats. The relationship between the speed and frequency of their tempo is a rhythmic relationship, and the relationship between their qualities in terms of strength and weakness and merit is a kind of combinational relationship. Just as the tempos of the beat and the dignity of sounds are consonant and sometimes dissonant, so the irregularities of the pulse are ordered and sometimes disordered. And I will also say that the ratios of the qualities of pulse beats in terms of strength and weakness and in merit can be consistent, or they can be discordant and even dissimilar, and then this goes beyond the category of determining any order of pulse irregularities.

Galen believes that the tangible virtue of the ratio of the rhythm of the pulse is the dignity expressed by one of the following ratios found in music, which were mentioned above. This may be the ratio of “a whole to a whole plus five,” that is, the ratio of a triple value to an ordinary value, for such a ratio is the ratio of a double value to an ordinary value with the addition of half of the double value. This is what is called a “relationship with five.” Either it can be a "relation with the whole", that is, a doubling, or a "relation with five", that is, an increase by half, or a "relation with four", that is, an increase by one third; or an increase of one quarter. Then the change is no longer felt.

I think it's very important to establish this relationship by feel. This is easiest for a person who by trade is accustomed to dealing with degrees of time and relationships of sounds and has the ability to study music theoretically and compare what has been done in practice with what is known from theory. Such a person, when he pays attention to the pulse, will perhaps feel these relationships by touch.

I will also say: highlighting a special category of ordered and disordered pulse, 6 which is one of the ten categories, although useful, is incorrect when dividing, because this category fits into the section of uneven pulse and is, as it were, one of its types.

As for the category taken by rhythm, this variety is determined by comparing the magnitudes of the ratios of four periods of time inherent in two “movements” and two “stops”. If the sensation is not able to establish all these values, then this variety is determined by comparing the ratio of the time of expansion of the arteries to the time elapsed between two expansions, and in general the ratio of the period of movement to the time of rest. Those people who enter into this area a comparison of the time of movement with the time of another movement and the time of a period of rest with the time of another period of rest, introduce one area into another. However, such an introduction is also permissible and not impossible, but it’s just not good.

The rhythm of the pulse is the quality to which the mentioned musical relations are applied. We say: the pulse is either of a good rhythm or of a bad rhythm. There are three types of bad rhythm pulse. One of them is the pulse of a changing rhythm and a transitional rhythm, that is, a pulse whose rhythm is a rhythm inherent in an age adjacent to the age of the owner of the pulse being studied; Thus, children have the rhythm of the pulse of young men.

The second type is a pulse that is distant in age, such as when children have the rhythm of the pulse of old people, and the third is a pulse that goes out of rhythm, that is, a pulse that is different in its rhythm from the pulse of any age. Pulse out of rhythm often indicates a significant health disorder