Diagnostic Validity of Āyurvedic Pulse Assessment: Maharishi Nādi-Vigyān in Cardiovascular Health

SUMMARY

This study is the first of its kind to systematically investigate the relationship between the clinical practice of Maharishi ᾹyurVeda pulse assessment and cardiovascular health. Given that cardiovascular disease is a major threat to the health of people in many countries, the question of diagnostic validity of a traditional, non-invasive method of health assessment is an important one for prevention and therapeutics. For this reason, we investigated the diagnostic validity of examining the pulse of patients using the technique of Maharishi Nādi-Vigyān compared to an objective measure of blood pressure and to self-reports of other cardiovascular risk factors.

The study sample consisted of 160 participants at a Maharishi ᾹyurVeda clinic in the United States and assessed consistency of diagnoses between Maharishi Nādi-Vigyān and hypertension as measured by blood pressure using a standard sphygmomanometer, and patient self-reports of elevated cholesterol, insomnia, and psychological stress (operationalised in this study as ‘state of mind’). Our findings showed diagnostic validity of 95% for hypertension by Maharishi Nādi-Vigyān compared to objectively measured hypertension. For elevated cholesterol, insomnia, and psychological stress, the agreement was 76%.

Previous studies assessed the reliability of conventional forms of pulse examination in ᾹyurVeda and found relatively low levels of both inter-rater and within-rater reliability, whereas the present study of Maharishi Nādi-Vigyān found generally higher levels. These findings have implications for the use of Maharishi Nādi-Vigyān as a diagnostic approach in the context of holistic, integrated, and preventive healthcare offered by Maharishi ᾹyurVeda.

We conclude the study with a discussion of key theoretical domains which underpin the findings, namely the traditional forms of ᾹyurVeda and Nādi-Vigyān, and the introduction of next generation Maharishi ᾹyurVeda and Maharishi Nādi-Vigyān. Finally, we consider the influence pulse assessment might have on the future of cardiovascular healthcare.

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death in the world (Roth, Mensah, & Fuster, 2020). Hypertension (i.e., high blood pressure or BP) is considered the number one modifiable risk factor for CVD (Smith et al., 2011; Roth et al., 2020; Unger et al., 2020). High BP raises the risk of atherosclerotic CVD, myocardial infarction, stroke, heart failure, left ventricular hypertrophy, chronic kidney disease, retinopathy, other end-organ damage CVD, and mortality (Barnes et al., 1997; Smith et al., 2011; Unger et al., 2020; Whelton et al., 2018).

The lifetime risk of developing hypertension for individuals aged 55–65 years is greater than 90% in developed and developing countries (Benetos, Petrovic, & Strandberg, 2019). More than nine million people die every year from hypertension and its sequelae (Kitt et al., 2019; Roth et al., 2020), and co-morbidity with COVID-19 has also recently been observed (Richardson et al., 2020).

Hypertension levels can be assessed clinically through technology that measures systolic and diastolic blood pressure. There are a variety of measuring devices and standards of objective diagnosis for BP (Stergiou et al., 2018) which date back to the Middle Ages in Europe and elsewhere (e.g., Hérrison’s sphygmometer, Marey’s sphygmograph, and Mahomed’s sphygmograph, cited in Park, O’Rourke, and Suzuki, 2013). The three major types of sphygmomanometers in current clinical use are mercury, aneroid, and digital (Shahbabu et al., 2016).

Other risk factors for CVD include elevated serum cholesterol, insomnia, and psychological stress factors, as well as smoking and diabetes (Roth et al., 2020; Smith et al., 2011; Arnett et al., 2019). For example, elevated levels of serum cholesterol contribute to atherosclerotic CVD, because circulating lipoprotein cholesterol particles can penetrate the endothelium of arterial walls and become oxidized, promote inflammation, and drive injury to the overlying endothelium and surrounding smooth muscle cells. Persistent elevations in circulating [lipoprotein cholesterol particles] have been directly linked to progression from early-stage fatty streaks to advanced-stage, lipid-rich plaques (Wadhera et al., 2016). It has been estimated that “from 1980 to 2000, reduction in total cholesterol accounted for a 33% decrease in coronary heart disease (CHD) deaths in the United States. In other developed countries, similar decreases in CHD deaths (ranging from 19%‒46%) have been attributed to reduction in total cholesterol” (p. 472).

Furthermore, there is a robust association between insomnia, hypertension, and cardiovascular disease (Rozanski, 2017). Indeed,

…chronic insomnia should become part of the routine assessment of patients with elevated [blood pressure] and should be a source for referral, diagnostic evaluation, and treatment….

(Bathgate & Fernandez-Mendoza, 2018, p. 51)

Consistent evidence over many years has also demonstrated the link between psychological stress factors and CVD (Arnett et al., 2019; Holt-Lunstad & Smith, 2016; Rozanski, 2017). These factors include work and marital stress, social isolation, depression, anxiety, pessimism, anger, and hostility. Other risk factors of CVD include overweight and obesity, physical inactivity, and diet (Arnett et al., 2019; Ekelund et al., 2019; Kane et al., 2019; Siervo et al., 2015, Roth et al. 2020; Rozanski, 2017; Smith et al., 2011).

ᾹyurVeda is a sophisticated and comprehensive system of natural healthcare that has its origins in the ancient Vedic civilisation of India (Gupta & Kothainayagi, 2017; Kumar, Deshpande, & Nagendra, 2019). Among several diagnostic techniques, ᾹyurVeda uses Nādi-Vigyān, or examination of the pulse (also referred to in the literature as Nādi Parīkshā) to detect imbalance and disease. However, 20 years ago, researchers claimed that despite its timeless origins, Nādi-Vigyān, one of eight traditional ᾹyurVedic methods of examining a patient for disease and physiologic imbalance, had “become extinct” due to “little research and practice” in contemporary clinical settings (Prasad, Bharati, & Swamy, 2004, p. 1).

In the last two decades, knowledge and practice of Nādi-Vigyān as a “pulse science” have increased (Shrivastava, Misra, & Misra, 2017, p. 445). And while research on its efficacy and suitability in contemporary clinical practice have developed (e.g., Gupta & Kothainayagi, 2017; Kumar, Deshpande, & Nagendra, 2019; Sharma et al., 2017; Singh, 2019), both the quantity and quality of research on Nādi-Vigyān is still in its infancy, with most research being either conceptual (e.g., Dadhich & Pooja, 2016), prognostic (e.g., Rohit et al., 2012), or prospective (e.g., Vasant & Kumar, 2013). However, little empirical research on Nādi-Vigyān can be evidenced in the literature. Nevertheless, examples in which the applicability of Nādi-Vigyān has been explored through case studies and clinical trials include measures of cardiac function (Dattatraya et al., 2014), Type 2 diabetes (More, Joshi, & Nagendra, 2014), and body “constitutional types” (Kurande et al., 2013, p. 37).

In addition to these modest advances in pulse diagnosis research is the seminal contribution of Maharishi Mahesh Yogi, whose efforts have increased the knowledge of Veda and the Vedic Literature in the last 40 years resulting in the reinvigoration of both ᾹyurVeda and Nādi-Vigyān by reconnecting these traditional practices to their source in pure consciousness, in the Unified Field of Natural Law (Maharishi, 1996b, 2006).

Maharishi has reestablished the holistic nature of ᾹyurVeda and shown how the diagnostic techniques used in Nādi-Vigyān have their foundations in, and are carried out on the basis of, the consciousness of the ᾹyurVedic diagnostician as measured by electroencephalographic (EEG) brainwave coherence. Given the significance of cardiovascular health, the present research empirically and theoretically investigates the relationship of what has become known as Maharishi Nādi-Vigyān to cardiac health as practiced in contemporary Maharishi ᾹyurVeda.

The two objectives of the current study were to investigate the diagnostic validity of Maharishi Nādi-Vigyān for 1) hypertension and 2) three other cardiovascular risk factors—serum cholesterol, insomnia, and psychological stress. This study is structured in two parts: Part I presents the methodology, results, and discussion of the two empirical tests of Maharishi Nādi-Vigyān and cardiac health. Part II explores the theoretical foundations of Maharishi Nādi-Vigyān in principles of Maharishi Vedic Science and consciousness-based healthcare.

PART I: EMPIRICAL TESTS OF MAHARISHI NĀDI-VIGYĀN

Clinical Setting.

The study was carried out with patients attending the Maharishi AyurVeda Integrative Health Centre on the campus of Maharishi International University (MIU) in Fairfield, Iowa, during 2018–2019. The Centre offers multi-modality, holistic health care and education through a collaboration with the faculty of MIU’s College of Integrative Medicine and Department of Physiology and Health. The data required to test Objectives #1 and #2 were collected simultaneously from the same patients in one visit. The study was approved by MIU’s Committee for the Protection of Human Subjects and conducted according to its guidelines on clinical research.

Design.

The study adopted a quantitative method: (A) the diagnostic technique of Maharishi Nādi-Vigyān reported numerically by an expert practitioner (as defined by Dörfler and Eden, 2019); (B) Sphygmomanometry, the standard medical diagnostic technique for measuring blood pressure (Shahbabu et al., 2016); and (C) patient self-reports of hypertension, insomnia, and state of mind. The model in Figure 1 shows the design of the study and its relation to the theoretical foundations of Maharishi Nādi-Vigyān in Maharishi ᾹyurVeda, to be discussed more fully in Part II.

Figure 1:

Model of theory and research.

The study employed a cross-sectional design in two steps. Step 1: after meeting the inclusion criteria, patients signed a consent form. Patients then completed the Maharishi ᾹyurVeda Health Questionnaire to provide basic demographic, lifestyle, and other health-related information (the source of our data on cholesterol, insomnia, state of mind, sedentariness, and diet to test Objective #2). In Step 1, blood pressure using a manual mercury sphygmomanometer (SP) was taken three times between interval rests of about two minutes with the average systolic and diastolic reading recorded by a registered nurse.

Height and weight were also recorded. Blood pressure readings were rated as: 130/80mmg = normal; 130–139/80–89mmg = elevated; 140–159/90–99mmg = Grade 1 hypertension; and 160–179/100–109mmg = Grade 2 hypertension. These hypertension criteria were determined using the 2020 International Society of Hypertension Global Hypertension Practice Guidelines (Unger et al., 2020).

The patient’s body mass index (BMI) was calculated using the following standard formula: kg/m², where kg was the patient’s weight in kilograms and m² was their height in meters squared (Misra & Dhurandhar, 2019). BMI was recorded by the nurse according to the following classification: <18.5 kg/m² (underweight); 18.5–25 kg/m² (normal weight); 25–30 kg/m² (overweight); and >30 kg/m² (obese).

After completing Step 1, the patient rested in a prone position for approximately ten minutes. In Step 2, the expert deployed Maharishi Nādi-Vigyān to evaluate whether the patient had hypertension, high cholesterol, or insomnia, and determined their present state of mind. Findings were then recorded by the diagnostician. This Step 2 was carried out ‘blindly’; that is without interrogation of the patient or consulting medical records.

Participants.

One hundred and sixty individuals (M age = 60.0 years, SD = 14.4) participated in the study and were selected using non-probability opportunity sampling based on the following four inclusion criteria: 1) the patient was between 20 and 80 years of age, irrespective of gender, religion, race, or socioeconomic status; 2) the patient was visiting the Centre for the first time; 3) the patient had not previously been diagnosed for cardiovascular risk factors, such as stress and insomnia, by the Centre; and 4) the patient was unknown to the diagnostician at the time of the study.

Ninety-four patients were females (M age = 58.1 years, SD = 15.2) and 66 were males (M age = 63.0 years, SD = 12.7). Table 1 presents patient demographic data at Step 1 for gender, age, ethnicity, level of education, socio-economic level, occupation, BMI, sedentariness, and diet.

Table 1:

Patient demographic data at Step 1.

Demographic Variable	Number of Patients	Percentage of Total
Gender
Female	94	42%
Male	66	58%
Age
20–29	10	6%
30–39	10	6%
40–49	11	7%
50–59	25	16%
60–69	62	39%
70–79	42	26%
Ethnicity
Caucasian	153	96%
African American	4	2%
Asian	3	2%
Level of Education
High School Graduate	27	17%
University/College Graduate	106	66%
Post-Graduate	17	11%
Doctorate	10	6%
Socio-economic Level
High Income Group	20	12%
Middle Income Group	105	66%
Low Income Group	35	22%
Occupation
Agriculture	6	4%
Service	86	54%
Business	27	17%
Other	41	25%
Body Mass Index
Underweight	32	20%
Normal Weight	48	30%
Overweight	66	41%
Obese	14	9%
Sedentariness
Sedentary Lifestyle	128	80%
Non-sedentary Lifestyle	32	20%
Diet
Non-vegetarian	127	80%
Vegetarian	33	20%

In this study, as shown in Table 1, 20% of patients were underweight, 30% were normal weight, and 50% were either overweight or obese. Average weight at Step 1 was 149 lbs (67.7 kg, SD = 28.5) and average BMI was within normal limits, although on the high end of the normal range at 24 kg/m² (SD = 4.4). Eighty percent of patients self-reported a sedentary lifestyle, and 80% were non-vegetarian.

Instrumentation.

As indicated in Figure 1, there were three types of diagnosis conducted in this study: A, B, and C. The first author was the Maharishi Nādi-Vigyān diagnostician (A), with the exact method used in this diagnostic technique described more fully in Part II.

In Step 1, a sphygmomanometer (SP) meter cuff (B) was wrapped around the patient’s arm with an inflatable rubber bag inside the cuff centered over the brachial artery. Enough air pressure was pumped into the cuff to close the artery. Air pressure was then released by opening the thumb valve. When the pressure in the cuff was equal to the pressure on the artery, the artery opened, and the blood began to return to the part of the artery that was closed. As the blood returned to the artery, pulse sounds began. These sounds could be heard through a stethoscope placed over the patient’s brachial pulse point. The sounds continued for a time while the cuff was deflated slowly, eventually becoming too faint to hear. When the first pulse sounds were heard, the reading on the SP meter measured the systolic blood pressure; the last sound heard was the diastolic blood pressure; both readings were recorded by the nurse.

Patients self-reported (C) the following information in Step 1 via the Maharishi ᾹyurVeda Health Questionnaire: 1) basic demographic data, including age, gender, ethnicity, level of education, socio-economic level, and occupation; 2) lifestyle data, including diet, digestion, appetite, level of sedentariness, incidence of addictive behaviours related to smoking, alcohol consumption, and drug use, present state of mind, and quality of sleep; and 3) health-related information, including basic medical history, known disorders (such as elevated cholesterol), present symptomology, and menstrual history where applicable.

Objective #1 (AB): Diagnostic Validity of Maharishi Nādi-Vigyān for Hypertension by Sphygmomanometry

As shown in Figure 1, Objective #1 sought to determine diagnostic validity between diagnosing hypertension using Maharishi Nādi-Vigyān (A) and the manual sphygmomanometer (SP) meter cuff (B).

Data Analysis.

For the purposes of determining diagnostic validity for hypertension, normal ratings by both the Maharishi Nādi-Vigyān expert and SP device were scored = 0, and ratings of elevated, Grade 1, and Grade 2 were scored = 1. A Cohen’s Kappa coefficient (k) was calculated according to the following criteria (also used by Kurande et al., 2013, and explained by Warrens, 2015): k = 0.01‒.020, slight agreement; k = 0.21‒0.40, fair agreement; k = 0.41‒.060, moderate agreement; k = 0.61‒.080, substantial agreement; and k = 0.81‒.1.0, almost perfect or perfect agreement. The use of Cohen’s k is typically associated with inter-rater or within-rater reliability, but some research, often medical research, uses it to assess validity (e.g., Yore et al. 2007) or ‘agreement’ between measures (e.g., van den Akker et al., 2015). In the present case, Cohen’s k was used to determine diagnostic validity between two different diagnostic measures.

Result.

Cohen’s k of diagnostic validity for hypertension yielded the following results as shown in Table 2. There were 45 instances where both diagnostic methods agreed the patient had hypertension, 107 instances where both diagnostic methods agreed the patient did not have hypertension, seven instances where the Maharishi Nādi-Vigyān expert diagnosed hypertension but the sphygmomanometer (SP) meter cuff did not, and one instance where the sphygmomanometer (SP) meter cuff diagnosed hypertension but the Maharishi Nādi-Vigyān expert did not. Thus, both methods of diagnosing hypertension agreed on 152 diagnoses and disagreed on eight diagnoses, resulting in 95% diagnostic agreement and a coefficient of k = .88, p < .001.

Table 2:

Diagnostic validity findings of Maharishi Nādi-Vigyān and sphygmomanometer (SP) meter cuff for hypertension.

Diagnostic Agreement Between A and B		Diagnostic Disagreement Between A and B
Both A and B agreed the patient had hypertension	Both A and B agreed the patient did not have hypertension	A diagnosed hypertension, but B did not	B diagnosed hypertension, but A did not
45	107	7	1

Objective #2 (AC): Diagnostic Validity of Maharishi Nādi-Vigyān and Three Cardiovascular Risk Factors

As shown in Figure 1, Objective #2 sought to determine diagnostic validity between diagnosing elevated cholesterol, insomnia, and present state of mind using Maharishi Nādi-Vigyān (A) and patient self-report (C).

Data Analysis.

A Cohen’s Kappa coefficient (k) was calculated according to the same criteria as presented above.

Result.

Cohen’s k of diagnostic validity for elevated cholesterol, insomnia, and state of mind yielded the following results as shown in Table 3. For elevated cholesterol, there were 23 instances where both Maharishi Nādi-Vigyān diagnosed and the patient reported they had elevated cholesterol, 109 instances where both Maharishi Nādi-Vigyān diagnosed and the patient reported they did not have elevated cholesterol, 14 instances where Maharishi Nādi-Vigyān diagnosed elevated cholesterol but the patient did not report it, and 14 instances where the patient reported elevated cholesterol but Maharishi Nādi-Vigyān did not diagnose it. Thus, Maharishi Nādi-Vigyān and patient self-reports agreed 132 times on elevated cholesterol and disagreed 28 times, representing 82.5% agreement and a coefficient k = .50.

Table 3:

Diagnostic validity findings of Maharishi Nādi-Vigyān, elevated cholesterol, insomnia, and state of mind.

Diagnostic Agreement Between A and C		Diagnostic Disagreement Between A and C
Both A and C agreed the patient had elevated cholesterol	Both A and C agreed the patient did not have elevated cholesterol	A diagnosed elevated cholesterol, but C did not	C diagnosed elevated cholesterol, but A did not
23	109	14	14
Both A and C agreed the patient had insomnia	Both A and C agreed the patient did not have insomnia	A diagnosed insomnia, but C did not	C diagnosed insomnia, but A did not
61	49	23	27
Both A and C agreed the patient had an unsettled state of mind	Both A and C agreed the patient did not have an unsettled state of mind	A diagnosed a settled state of mind, but C did not	C diagnosed a settled state of mind, but A did not
54	58	28	20

For insomnia, there were 61 instances where both Maharishi Nādi-Vigyān diagnosed and the patient reported they suffered from insomnia, 49 instances where both Maharishi Nādi-Vigyān diagnosed and the patient reported insomnia, 23 instances where Maharishi Nādi-Vigyān diagnosed insomnia but the patient did not report it, and 27 instances where the patient reported insomnia but Maharishi Nādi-Vigyān did not diagnose it. Thus, Maharishi Nādi-Vigyān and patient self-reports agreed 110 times of insomnia and disagreed 50 times, representing 69% agreement and a coefficient k = .37.

For state of mind, there were 54 instances where both Maharishi Nādi-Vigyān diagnosed and the patient reported an unsettled state of mind, 58 instances where both Maharishi Nādi-Vigyān diagnosed and the patient reported settled state of mind, 28 instances where Maharishi Nādi-Vigyān diagnosed an unsettled state of mind but the patient did not report it, and 20 instances where the patient reported an unsettled state of mind but Maharishi Nādi-Vigyān did not diagnose it. Thus, Maharishi Nādi-Vigyān and patient self-reports agreed 112 times on state of mind and disagreed 48 times, representing 70% agreement and a coefficient k = .40.

This data therefore demonstrated there was a 73.5% average agreement between diagnosis by Maharishi Nādi-Vigyān and self-report measures of elevated cholesterol, insomnia, and state of mind, resulting in an average coefficient k = .46, p = .001, or moderate agreement, across all three cardiovascular risk factors.

DISCUSSION

Objective #1.

When compared to earlier attempts to test inter-rater reliability of Nādi-Vigyān (i.e., Kurande et al., 2012, 2013), the present finding for hypertension is significant. In this test, diagnostic agreement between subjective diagnosis of Maharishi Nādi-Vigyān and objective diagnosis of the SP meter cuff was nearly perfect. Perhaps this was due to the expertise of the practitioner who had more experience in pulse examination compared to the practitioners cited in earlier studies.

However, the finding is even more significant given that the earlier inter-rater research used limited numbers of patients to test reliability (i.e., 17 and 20 subjects respectively). Indeed, the potential for error was increased dramatically in the present study of 160 patients but the greater error potential, which could have occurred, was not observed. The present finding may also confirm the importance of conducting pulse diagnosis from a deep level of consciousness, i.e., the junction point between Ṛishi, Devatā and Chhandas and Vāta, Pitta, and Kapha, where the subtlest level of the physical body first emerges and manifests as Vāta, Pitta, and Kapha, as predicted by Maharishi ᾹyurVeda and discussed in Part II.

Objective #2.

The diagnostic validity of Maharishi Nādi-Vigyān and the three cardiovascular risk factors was significant. Despite the average agreement being lower than that observed in Objective #1, higher levels of agreement were unlikely given the precision of Maharishi Nādi-Vigyān diagnosis was being tested against self-reported behaviours. Compelling recent evidence explains, for example, why correlations between self-report behaviours and actual measured behaviours of the same variable can be weak (Dang, King, & Inzlicht, 2020).

Thus, three possible explanations may account for the lower agreement percentage in Objective #2: 1) the Maharishi Nādi-Vigyān diagnosis of elevated cholesterol, insomnia, and/or state of mind was correct but some patients did not report them accurately; 2) patients reported their conditions accurately but the Maharishi Nādi-Vigyān expert did not; or 3) some combination of these two explanations. This study has not determined if, or to what degree, any or all these phenomena occurred. Without conducting a lipid profile to test a patient’s cholesterol levels, without keeping a sleep diary or using a polysomnogram to measure activity during sleep, and without taking a mental health screening test, the self-reported measures of elevated cholesterol, insomnia, and state of mind and their relation to accurately measuring them through the pulse must be taken as preliminary and with caution.

Nevertheless, the data provided to meet Objective #2 suggest a moderate degree of reliability between diagnosis of the CVD risk factors and patient self-reports. The fact that the expert was apparently able to accurately diagnose subjective states of insomnia and state of mind in the majority of patients was not without significance.

PART II: THEORETICAL FOUNDATIONS OF MAHARISHI NĀDI-VIGYĀN

The basis for this research was informed by the principles and practices of Maharishi ᾹyurVeda as systematically identified and explained by Maharishi (International Maharishi AyurVeda Foundation, 2015; Maharishi, 1996a; Maharishi Ayurveda Foundation, 1999). These principles and practices have their basis in Maharishi Vedic Science, the science of complete knowledge, which is presented in the 40 aspects of Veda and the Vedic Literature.

Specifically, Maharishi ᾹyurVeda has its foundations in the six Saṁhitās or ‘collections’ of Vedic Literature related to healthcare and long life: Charak Saṁhitā; Sushrut Saṁhitā; Vāgbhatt Saṁhitā; Mādhav Nidān Saṁhitā; Shārngadhar Saṁhitā; and Bhāva-Prakāsh Saṁhitā. These six bodies of knowledge represent the main sources of authority for Maharishi ᾹyurVeda. The six Saṁhitās in turn have their source in Ṛik Veda and are the Upa-Vedas (or subsidiary Vedas) to it, thereby making Maharishi ᾹyurVeda epistemologically connected to the deepest and most profound level of knowledge and its organizing power as systematically explained in Maharishi Vedic Science. The methodological foundations¹ of Maharishi ᾹyurVeda and its application to the practice of Maharishi Nādi-Vigyān is that source of this knowledge exists at the deepest, most fundamental level of nature, the home of all the laws of nature. Hence, this level is described as the total potential of Natural Law.

The following introduction to theoretical foundations considers four topics related to this study: 1) basic theory and research of ᾹyurVeda; 2) the relation of ᾹyurVeda to Nādi-Vigyān as a method of diagnosis; 3) a brief survey of Maharishi ᾹyurVeda and accompanying research findings; and 4) the application of Maharishi ᾹyurVeda in Maharishi Nādi-Vigyān.

1). ᾹyurVeda.

Dattatraya et al. (2014, p. 25) define ᾹyurVeda (आयुर्वेद), the science of long life or lifespan (Ᾱyu), as a “comprehensive and traditional science which deals with the protection and preservation of total health and cure of disease states by means of integrating body, mind, and spirit”, Joshi (2014, p. 781) classifies it as “traditional Indian medicine”, and A. K. Singh (2016, p. 356) describes it as “probably…the oldest repository of human knowledge regarding the human body, body systems, their functioning, diseases and related ailments, and medicinal herbs that can be used in treatment of diseases and ailments”. According to the literature on ᾹyurVeda, the two most common textual sources of this traditional knowledge are Charak Saṁhitā and Sushrut Saṁhitā (e.g., Galib et al., 2011). In addition to detection of imbalance and disease, ᾹyurVeda has developed one of the world’s most sophisticated pharmacopeia of medicinal plants (Mukherjee et al., 2017).

According to Sharma et al. (2017, p. 1402), ᾹyurVeda uses three main forms of clinical assessment for the diagnoses and prognoses of disease based on the principle of “proper diagnoses form the basis of effective treatment, whereas ignorance of disease or improper diagnosis leads to inefficient treatment” (Charak Saṁhitā, 10.5). These assessment forms are referred to as Darshana, Prashana, and Sparshana, and comprise what Gouda, Raju and Seema (2016, p. 63) and others (e.g., Kurande et al., 2013, p. 1) call Trividhā Rōgī Parīkshā, the threefold examination of the patient and his/her disease(s). Each type of clinical assessment of disease is used both separately and synergistically to form a complete or holistic understanding of the patient’s physical and mental condition [for a more detailed classification and analysis of disease (Rōgī, रोगि) from the perspective of ᾹyurVeda, see Verma, Aragwal and Gehlot, 2018].

Khajuria et al. (2019, p. 75) define Darshana (दर्शन) to mean the observation of a patient through “ocular perception or inspection”. Darshana can relate to observing the patient’s gait, stance, and posture when sitting or standing up, color of the patient’s hair and eyes, color and features of the patient’s tongue, facial expressions and voice, enlarged or shrunken parts of the body, and so on. More profoundly, the Darshana of ᾹyurVeda is also embedded in the Darshanas or eight systems of Indian Philosophy, of which Nyāya (न्याय), Sāṅhkya (संख्या), and Vaiseshik (वैशेषिक) are the most relevant because they relate to learning through inference (Nyāya), theories of transformation and cause and effect (Sāṅhkya), and the number of materials and substances which compose creation, including the physical body (Vaiseṣhik), thus making them of particular importance in the diagnosis and prognosis of physiologic imbalance and disease.

Prashna (प्राशन) means inquiry or questioning of the patient for the purpose of diagnosis, such as asking how the patient feels, what symptoms they are experiencing, what is the direction of their symptoms or disease, what is the progression of their disease, whether they are sleeping well at night, what they eat, how they feel after eating, how much they exercise, their outlook on life, their mental condition, and so on.

Sparshana (स्पर्शन), sometimes referred to as the palpation method typically preceded by Darshana, means the tactile experience of touch and can include assessing the patient’s body temperature, and most commonly involves feeling the skin for roughness, dryness, heat and cold, moisture, etc. (Rohit et al., 2012, p. 194). Sparshana can include any or all of the following diagnostic methods: touching the eyeballs to assess intraocular pressure; testing of reflexes; examination of swelling and rigidity of organs; palpation of glands and tumors (in ᾹyurVeda called Gulmalgranthi); and palpation and percussion of fluid retention (ascitis qalodara).

These three broader methods of diagnosis can then be divided into eight main categories of examination, or Asthasthānaparīkshā: 1) Nādi (pulse examination); 2) Mutra (urine examination); 3) Mala (stool examination); 4) Jivha (tongue examination); 5) Shabda (voice examination, i.e., sound of speech); 6) Sparsha (skin examination); 7) Drik (eye examination); and 8) Akrti (examination of general appearance) (Pathak & Rana, 2017; Rani, Singh, & Gaur, 2018; Uranw, Sasmal, & Bharadwaj, 2020). The practice of pulse examination (Nādi) is what Rani et al. (2018, p. 261) call “the oldest” of these eight diagnostic techniques in ᾹyurVeda (for example, Singh [2019, p. 181] maintains evidence of its use in ancient Egypt, Greece, and Arabia), although Maharjan and Ajantha (2020, p. 2) suggest accurate historical descriptions of Nādi-Vigyān lack a “systemic description of methodology”. It is to this diagnostic category we now turn.

2). Nādi-Vigyān.

Park et al. (2013, p. 1) maintain evidence of diagnoses using the arterial pulse can be found in ancient China and Egypt, dating back at least to 1600BC. According to Shārngadhar Saṁhitā, “the artery pulsating at the base of the thumb indicates life. Happiness and misery, including balanced and imbalanced states of the physiology, should be known from its movements” (Pūrva Khaṇda, 3.1). Thus, Khajuria et al. (2019, p. 79) maintain that “each cell in our body possesses its own intelligence. It is the communication of this intelligence in the form of vibrations that is studied in Nādi-Vigyān. Nādi-Vigyān understands the vibratory frequency of the pulse as various levels on the radial artery”.

These vibrations are felt by the Nādi-Vigyān practitioner in a sitting position on the left wrist of a sitting female and right wrist of a sitting male (Guguloth, Yadav, & Vasam, 2017) [although Vikas, Danisha and Nidhi (2016) point out there are actually eight main places in the human body, in addition to the radial artery (Angushta mūla), where the Nādi can be detected].

“The hand [of the diagnostician] should be free, slightly fixed at the forearm and should be comfortably in his position”, according to Guguloth et al. (2017, p. 1280). “A physician should gently palpate [the] pulse of [the] patient with the three fingers of the physician[‘s] right hand, namely index finger, middle finger and ring finger in central area located at the base of the thumb. The index finger is comfortably placed nearest the thumb and the other two fingers are placed next to it. In this way pulse should be examined…” (p. 1280). Just below the palm there is raised bony form at the wrist called the radial crest. The physician feels the radial crest with the index finger, and then gently slides the index finger half a centimeter below the radial crest in a slanting direction by slipping the index finger into the radial groove. Notwithstanding this description, Dattatraya et al. (2014, p. 25) propose that the specific practice of Nādi-Vigyān has “always been a matter of controversy”.

In ᾹyurVeda, there are three main types of vibrations called Dosha (दोष). The Doshas are called Vāta (वात), Pitta (पित्त), and Kapha (कफ), and because the “heart is the root of all blood vessels, so the dosha[s] are transmitted by the blood vessels to the whole body” (Rani et al., 2018, p. 261). Thus, the vibratory qualities of Vāta, Pitta, and Kapha can be felt throughout the body but are most dominant and readily discernible in the radial pulse. It is the speed (Vega), stability (Sthiratva), movement (Gati), and other characteristics of the pulse that determine the level of balance or imbalance in the body (Kumar, Deshpande, & Nagendra, 2019), with Vāta having the qualities of a movement of snake, Pitta the qualities of a jump of frog, and Kapha the qualities of a stable swan (Kallurkar et al., 2015), felt respectively by the index finger, the middle finger, and the ring finger.

The register of the Doshas and their possible combinations and groupings in the body at every level of the pulse—from the surface, subDosha, Dhātu (or tissue level), and deepest level of the pulse (such as Vāta‒ Pitta, Pitta‒Vāta, Kapha‒Pitta, etc.)—is referred to as the Deha Prakriti (देह प्रकृति) or constitutional nature of the body and is significant in the diagnosis of balance and imbalance by the Vaidya (i.e., doctor) or practitioner.

Collectively, in ᾹyurVeda Vāta, Pitta, and Kapha are referred to as Tridosha (त्रिदोष), the threefold nature of the body (Kishor & Pooja, 2020), and according to Rani et al. (2018, p. 266), the three Doshas “are associated with three types of pulse pattern variability (PPV), such as seasonal changes, physical strength, post-lunch [qualities], breathing process[es, and] metabolic process[es]”. Mathew and Jumuna (2014, p. 177) point out that “according to ancient literature, any element in the body brings about a change in the constitution of these [three Doshas].” Sushrut Saṁhitā (21.8) thus states: “The vital humours [of Vāta, Pitta, and Kapha] maintain the integrity of the animated organism by creating, assimilating, and diffusing strength in the same way as the moon, the sun, and the winds maintain the integrity of the terrestrial globe.”

As noted above, an extensive research program on the nature and effectiveness of Nādi-Vigyān has been conducted in the last 20 years; this research has been summarized in Table 4. For example, Mathew and Jamuna (2014, p. 177) examined what they called “arterial pulse variants (for example, pulses alternans, bisferiens pulse, and bigeminal pulse) [which] are basically used in cardiac disorder detection. Alternative medical practitioners carefully examine pulses at different depths, each connected with specific parts of the body and each believed to register even the slightest physiological based changes.”

Table 4:

Summary of Nādi-Vigyān research by topic, dependent variable, finding, and author(s).

Topic	Dependent Variable	Finding	Author(s)
Using pulse sensors for disease diagnosis	Arterial pulse at depth and surface	Distinct waveforms of pulse for each Vāta, Pitta, and Kapha Dosha	Gaddam (2015); Joshi (2004, 2005, 2014); Kallurkar et al. (2015); Mathew & Jamuna (2014); Thakkar & Thakkar (2015)
Repeatability of using Nādi-Vigyān to detect imbalances and different body constitutions	Physiologic imbalances and Dhosha type of patients	Moderate to substantial inter-diagnostic test-retest reliability in a double-blind, controlled study of 17 patients	Kurande et al. (2012)
Inter-diagnostic reliability of pulse (Nādi), tongue (Jivha), and body constitution (Prakriti) assessments	Quality of the pulse, tongue, and body constitution	Slight to fair inter-diagnostic reliability between the diagnoses of 20 patients by 15 ĀyurVeda physicians	Kurande et al. (2013)
Using Nādi-Vigyān and pressure sensors to detect non-diabetic, pre-diabetic, and Type 2 diabetic patients	Incidence of diabetes	Approximately 86% consistency between the two diagnostic methods	More, Joshi, & Nagendra (2014)
Pattern of biochemical findings in different types of Dosha	Histotrophic, endomorphic, viscerotonic, vasotrophic, mesomorphic, somatotonic, neurotrophic, ectomorphic, and cerebrotonic biochemical groups	Different biochemical groups associated with each of the different Doshas	Kar, Upadhyay, & Ojha (1994)
Relationship of heart rate variability according to the three Doshas	Very low frequency (VLF), low frequency (LF), and high frequency (HF) heart rates, as measured by electrocardiogram (ECG)	Each of the three Doshas display significantly different heart rate frequencies, particularly in VLF and LF	H. Singh (2016)
A case study of diagnosis and treatment of rheumatoid arthritis (Amavata)	Swelling, joint tenderness, and pain due to rheumatoid arthritis	After diagnosis by Nādi-Vigyān and a variety of ĀyurVedic treatments and medicines, significant reductions in swelling, joint tenderness, and pain occurred	Lekshmi, Krishnakumar, & Chacko (2012)

Their research included the use of piezoelectric sensors to detect and electronically record the presence of Vāta, Pitta, and Kapha at these two levels of the pulse (i.e., superficial and deep) of ten subjects between five and 70 years of age to determine: 1) pulses alternans, which is an arterial pulse waveform showing alternating weak and strong beats indicative of left ventricular systolic impairment; 2) bisferiens pulse, which is an aortic waveform with two peaks per cardiac cycle, and is a sign of aortic problems such as aortic stenosis, aortic regurgitation, and hypertrophic cardiomyopathy; and 3) bigeminal pulse, also called premature ventricular contraction, which is a pulse characterised by two beats close together followed by a pause, an early warning symptom of cardiomyopathy.

Mathew and Jamuna (2014) revealed three different pulse waveforms for each of Vāta, Pitta, and Kapha, and showed how each level of pulse under each of the three fingers can represent a specific part of the body. For example, the superficial pulse in Vāta measures the colon, but at depth measures the lungs; the superficial pulse in Pitta measures the gallbladder, but at depth measures the liver; and the superficial pulse in Kapha measures the pericardium, but at depth measures overall heart circulation.

Confirming his earlier research (Joshi, 2004, 2005), Joshi (2014), too, found distinct waveform patterns for Vāta, Pitta, and Kapha in 170 females and 265 males, including measures of blood pressure. These waveforms have been further examined by Gaddam (2015) and Thakkar and Thakker (2015) using pressure sensors and by H. Singh (2016) using an electrocardiogram (ECG). However, according to Ashtānga Hṛidayam, though present all over the body, Vāta is found mainly below the umbilicus; Pitta is found mainly between the heart and umbilicus; and Kapha is found above the heart (ते यापनोऽप नायोरधोमयोर्व संया: ॥ र्वयोऽहोराभु तानां तेऽतमयादिा: मात ।, Sūtrasthān, 1.7).

Ten years ago, research also began appearing in the published literature which explored the inter-diagnostic reliability of Nādi-Vigyān. For example, Kurande et al. (2012) examined reliability with an expert Nādi-Vigyān practitioner in Denmark who tested and re-tested imbalances in the pulse and the Deha Prakriti of 17 healthy individuals in a double-blind, clinically controlled trial in which the sequence of diagnoses was random and the expert did not see the patients when diagnosing them. Results from this research indicated there was moderate to substantial agreement between the first set of diagnoses on the two variables when compared to the second set of diagnoses.

Further, using pairwise Cohen’s Kappa coefficients for type of pulse, condition of tongue, and Deha Prakriti, Kurande et al. (2013) measured the inter-diagnostic reliability of Nādi-Vigyān when conducted by 15 ᾹyurVedic doctors with between three and 15-years’ experience. Type of pulse was generally categorised in 20 patients as either Vāta, Pitta, and Kapha; tongue examination included identifying whether the tongue of patients had no coating (Niram jivha), a thin coating (Alpa sama), or a thick, sticky coating (Sama jivha); and Deha Prakriti was classified according to the tenfold set of possible Deha Prakriti combinations outlined by Kurande et al. (2013, p. 5).

However, the researchers found little evidence of inter-diagnostic reliability between the doctors, with type of pulse ranging from poor to slight, condition of tongue slight to fair, and Deha Prakriti as fair to moderate, indicating the apparent highly subjective nature of this form of diagnosis. Rani et al. (2018, p. 266) have concluded that the

pulse is mainly a subtle expression of universal consciousness [the meaning of which the authors do not explain] pulsating through a person’s constitution which carries blood through the body along with nutrients to the cellular level. Ayurved[a] has rich experience in pulse-based diagnosis, as traditional Ayurvedic practitioners were expert in pulse-based diagnosis which is efficient and accurate diagnosis by fingers without any equipment. The backbone of Ayurveda depends on the method of sensation of variation by these three waveforms and discrepancies in them.

In summary, ᾹyurVeda is said to represent one of the world’s oldest, extant systems of preventive, diagnostic, prognostic, and therapeutic healthcare. It utilizes a threefold clinical examination and assessment process of patient and disease consisting of eight main techniques, of which feeling the patient’s arterial pulse is considered one of the most fundamental.

However, ᾹyurVeda and rigorous research into it has, over time, also become fragmented and its holistic and integrating qualities compromised; historical analysis supports such a conclusion (Vasant & Kumar, 2013). Recent research in both ᾹyurVeda and Nādi-Vigyān confirms their somewhat inconsistent status, although more rigorous research is beginning to emerge (e.g., Tubaki & Tarapure, 2020). With regard to research alone, Ramaswamy (2018, p. 250) concluded that “research in Ayurveda is fragmented and often not deep in its own foundational theories or in its interface with modern science”. The introduction of Maharishi ᾹyurVeda aimed to correct this situation by showing the foundational connection of ᾹyurVeda to pure consciousness. The resurgence of worldwide interest in, and re-commitment to, ᾹyurVeda as a holistic system of complete healthcare (e.g., Mumara, 2010) is testament to the success of Maharishi’s global effort.

3). Maharishi ᾹyurVeda.

Beginning in the early 1980s, Maharishi, founder of MIU in the United States, Maharishi Vedic University in Europe, and Maharishi Ved Vigyān Vishwa Vidyā Peetham in India, began an initiative to restore the complete knowledge and experience of ᾹyurVeda (International Maharishi AyurVeda Foundation, 2015) with the stated goal of reviving

the system in its comprehensive and integrated form—with the help of leading Vaidyas of our time, and in accordance with the classical texts. Most especially, [Maharishi’s] intent was to restore the role of consciousness to its central position—both theoretically and through practical techniques.

(Sharma, 1993, p. 236)

Sharma, citing Charak Saṁhitā, went on to point out it is perhaps

no surprise that this restoration of Ayurveda in our time has been undertaken by a Maharishi…. In the Charaka Samhita, such leadership is said to be the usual situation: ‘Ayurved, the science of life, has been taught by the Maharishis who are devoted to righteousness (Dharma) and the welfare of the people, and not their earnings and enjoyment’

(Chikitsasthānam, 1.4.57). (p. 236)

Maharishi’s two main contributions to the restoration of the completeness of ᾹyurVeda can be summarised as: 1) his identification that the source of ᾹyurVeda is in the field of pure consciousness, Ᾱtmā (आत्मा), the unbounded, unified state of intelligence underlying all physical creation; and 2) as part of his restoration and systematic reorganization of the 40 aspects of Veda and the Vedic Literature, Maharishi was able to relocate the place of ᾹyurVeda within the totality of Vedic knowledge, and thereby reorganize and illuminate its various components, creating what is now known as Maharishi ᾹyurVeda (महषिॅ आयुर्वेद) or the Maharishi Vedic Approach to Health. These two contributions are represented schematically in the model of research shown in Figure 1.

At the heart of Maharishi’s teaching is the understanding of pure consciousness—an unmanifest, unbounded, eternal field of pure creative intelligence, pure wakefulness, from which all physical creation emerges. Pure consciousness is, according to Maharishi (1996a, pp. 17–19), “the most basic element in life; our body, our behavior, and our environment are all expressions of consciousness. Consciousness is fundamental to life. It is the prime mover of life. Every word that we speak and every action that we perform is an impulse of consciousness.” Pure consciousness is therefore described as the ‘Self’ of everyone and everything.

According to the Vedic tradition, pure consciousness, being self-sufficient, is described as the ‘Self established in itself’ (Tadā drashtuḥ swarūpe avasthānam, तदा द्रष्टुः स्वरूपेऽवस्थानम,, Yoga Sūtra, 1.3). It is transcendental, unseen, hidden, silent, and self-referral, but at the same time the prime mover of life because all tendencies or reverberations of the Self emerge from ‘within the self-referral state and yet remain within the state of pure consciousness’ (Vṛitti sārūpyam itaḥ atra, वृतिसारूप्यमितरत्र, Yoga Sūtra, 1.4). Other names given to pure consciousness by Maharishi are Transcendental Consciousness (Turiya chetana, टुरिय चेतन), Being, Yoga (योग), pure intelligence, and pure existence (Swayambhu, स्वयम्भु). From Maharishi’s (1996a, p. 19) perspective, “all life emerges from and is sustained in consciousness”. As he explained when he first began enunciating the relationship of pure consciousness to the manifest, physical world of time and space:

Underneath the subtlest layer of all that exists in the relative field is the abstract, absolute field of pure Being [pure consciousness], which is unmanifested and transcendental. It is neither matter nor energy. It is pure Being, the state of pure existence. This state of pure existence underlies all that exists.

Everything is the expression of all this pure existence or absolute Being which is the essential constituent of all relative life. The one eternal, unmanifested absolute Being manifests itself in many forms of lives and existences in creation.

(Maharishi, 1966, p. 27)

Maharishi describes pure consciousness as the “unified field of all the laws of nature” (1996b, p. 100), the field of Natural Law (i.e., Dharma, धमॅ), which is the source of the fundamental building blocks of physical creation, an insight confirmed by contemporary scientific theory (e.g., Hagelin, 2015).

The building blocks to the subsequently expressed laws of nature and physical universe are referred to in the language of Vedic Science as Ṛishi (ऋषि), Devatā (देवता), and Chhandas (छन्दस), which have their counterparts as the subtle qualities of Vāta, Pitta, and Kapha in Maharishi ᾹyurVeda (Wallace, 1993, p. 75), to be described more fully below.

Maharishi (1995, p. 234) has stated that the purpose of investigating the “Vedic Structure” of Natural Law is “to establish it as that theory of administration which lays open the total administrative skill of Natural Law—the infinite organising power of Natural Law, that is eternally administrating creation and its orderly evolution with the quality of automation, nourishing everything and everyone”.

Having established the existence and character of pure consciousness, Maharishi (1995, p. 2) goes on to point out that this field of “pure singularity” of intelligence is fully awake within itself and administers itself and physical creation while always remaining self-referral. This principle of silent administration through Natural Law is described as the “Principle of Least Action”, by which the total potential of Natural Law, the home of all the laws of nature as we observe them operating silently throughout the universe, is the fundamental operating principle of nature’s administration.

Through its own “infinite organising power [Natural Law] administers the orderly evolution of all its diversified expressions in a perfectly integrated and balanced state” (Maharishi, 1995, p. 4). In this sense, Natural Law, is the source of everything in creation, including human, social, and environmental life, administering life not through action but through “least action”, through what Maharishi (1995, p. 3) calls “self-interaction” or “Self-Rule”.

Thus, Maharishi locates the home of Natural Law in the unbounded, silent, unchanging, state of pure consciousness, and describes it as a “self-sufficient” (Maharishi, 1986, p. 26), eternal continuum of consciousness responsible for administering the universe. Maharishi (1995, p. 238) has pointed out that this continuum of Natural Law is structured in the form of the DNA (likened to a small circle) in every cell of the body, is the same totality of Natural Law that has structured the whole human physiology (likened to a bigger circle), and it is the same totality of Natural Law that has structured the physiology of the ever-expanding universe (likened to the circle of infinite diameter)—the totality of Natural Law is expressed at every level.

In the Vedic Literature, this circularity of Natural Law is explained to be “smaller than the smallest [and] bigger than the biggest (Aṇoraṇīyān Mahato-mahīyān, अणोरणीयान् महतो महीयान्, Katha Upanishad, 1.2.20), and is therefore present at every level, and in every point, of physical creation.

Maharishi begins his more detailed examination of self-referral by explaining that the holistic home of Natural Law, being an unbounded field of consciousness is aware, awake. It is eternally aware of itself; it is awake to its own existence. In this state, pure consciousness is conscious of itself, and is therefore simultaneously the observer (the subjective knower or Ṛishi), the process of observation (the process of knowing or Devatā), and the object of observation (the known or Chhandas) (Maharishi, 1986, p. 67). Thus, consciousness, at the non-physical level of Natural Law, is both the subject and object of its own knowing, of its own existence. It is simultaneously a silent field of unadulterated Being, or pure existence, and a dynamic field of unbounded, self-referral consciousness, fully awake and referring only to itself in a continuously circular motion (as shown in Figure 2, left).

Figure 2:

The relationship of Ṛishi, Devatā, and Chhandas to themselves and in their togetherness as the Saṁhitā of Natural Law, with each element interacting with itself and with each other on the level of consciousness (left) (Maharishi, 1986, p. 40), and how this phenomenon simultaneously occurs on the level of matter, on the level of the human body and environment, as Vāta, Pitta, and Kapha (right).

The self-referral relationship of Ṛishi, Devatā and Chhandas to each other refers to what Maharishi calls “the whisper of the unified field to itself”, which he defines as “the Veda, the field of ‘pure knowledge’” (Maharishi, 1986, p. 40). Maharishi (1995, p. 410) has located several descriptions of this phenomenon in the Vedic Literature, including the phrase “curving back upon my own nature, I create again and again; creation and the administration of creation are both a natural phenomenon on the basis of my self-referral consciousness” (Prakṛitiṃ svām avashtabhya visṛijāmi punaḥ punaḥ bhūta-grāmam imaṃ kṛitsnam avashaṃ prakṛiter vashāt, प्रकृतिं स्वामवष्टभ्य्ह विसृजामि पुनः पुनः भूतग्रामपममिं कृत्स्त्रमवशं प्रकृतेवॅशात्,, Bhagavad-Gītā, 9.8). In their unified state, the three conceptual features of Ṛishi, Devatā and Chhandas in the one unbounded field of pure consciousness are called Saṁhitā (or “togetherness”, संहिता, Maharishi, 1995, p. 358).

Maharishi explains it is the dynamic relationship of these three aspects of knowledge interacting with each other and with their unified value in Saṁhitā (what he calls the ‘self-interacting reality of nature’ and the ‘three-in-one structure of pure knowledge’ [Maharishi, 1986, p. 40]) that gives rise to the creative impulse of Natural Law to stir and express itself as the diverse laws of nature and subsequently as material creation (Maharishi 1995b, p. 358). Thus, Maharishi (2006, lesson 5, chart 5.14) states: “The pure, holistic value of consciousness moves and transforms itself into a holistic expression of itself.” He (1996b, p. 122) goes on to explain that

Health means WHOLENESS—’whole’ is more than the collection of parts. The perfect approach to health requires caring for the whole and parts at the same time. In this sense the word is ‘balance’—balance between the holistic value of life and the individual values of life—balance between consciousness and its expression, the physiology—balance between different qualities of consciousness and their divisions and subdivisions, and also balance between all the various expressions of consciousness, the different parts of the physiology.

but

Prevailing health care systems do not consider health in this way, and that is why they fail to serve the purpose of health. Maharishi Vedic Approach to Health utilizes pulse reading—self-pulse reading—which not only indicates the degree of balanced functioning of the system, but in itself is a balancing process on the very fine level of relationship between the whole and parts—it not only measures the degree of balance, but contributes a balancing influence from the very level of consciousness where the parts are connected with the whole (Measurement Theory, Physics); it creates balance from the fundamental level of relationship.

(Maharishi, 1996b, p. 122)

According to Charak Saṁhitā, the “Doshas are three: Vāta, Pitta and Kapha. In their balanced state they maintain the body. When imbalanced they afflict the body with imbalances and diseases” (Vimānasthān, 1.5). Moreover, “The body of every living being is always the abode of Vāta, Pitta, and Kapha. One should know whether they are in natural (balanced) or unnatural (imbalanced) condition” (Charak Saṁhitā, Sūtrasthān, 18.48). Along with other features of an individual’s pulse, these imbalanced states of the body (the word ‘Dhosha’ actually means an impurity, because “as consciousness makes the transition from subjective to objective creation, it becomes ‘grosser’ or more impure” [Wallace, 1993, p. 75]) are what Maharishi Nādi-Vigyān (and other aspects of Maharishi ᾹyurVeda) detects and assesses. Wallace (1993, p. 75) points out that the three Doshas “remind us of the three-in-one structure of pure consciousness, in which the three components—knower, process of knowing, and known—are called Rishi, Devata and Chhandas. In fact, [Vāta, Pitta, and Kapha] are the finest material expressions in the body respectively of Rishi, Devata, and Chhandas”. As illustrated in Figure 2, it is this junction point between Ṛishi, Devatā, and Chhandas on the level of consciousness and Vāta, Pitta, and Kapha on the level of the body that the fully trained and experienced expert in Maharishi Nādi-Vigyān feels in the patient’s pulse. Thus, in Maharishi ĀyurVeda, Maharishi Nādi-Vigyān represents a level and degree of sophisticated diagnosis unlike any other found in contemporary ĀyurVedic practice.

As noted above in Part I, in addition to Charak Saṁhitā and Sushrut Saṁhitā, Maharishi has identified four other key sources of knowledge contained in Maharishi ᾹyurVeda as: Vāgbhatt Saṁhitā; Mādhav Nidān Saṁhitā; Shārngadhar Saṁhitā; and Bhāva-Prakāsh Saṁhitā. According to Maharishi, each of these six authoritative sources of Maharishi ᾹyurVeda reflect a different aspect of pure consciousness: Charak Saṁhitā (Ṛishi), Sushrut Saṁhitā (Devatā), and Vāgbhatt Saṁhitā (Chhandas) in the outward or analysing tendency of pure consciousness to express itself into matter; and Mādhav Nidān Saṁhitā (Chhandas), Shārngadhar Saṁhitā (Devatā), and Bhāva-Prakāsh Saṁhitā (Ṛishi) in the inward or synthesising tendency of pure consciousness to refer back to itself in the Saṁhitā of Ātmā. This looping phenomenon of consciousness is shown in Figure 1.

Nader (2014) has importantly provided evidence that these six aspects of Vedic knowledge are also present in the cellular structure of the human body: Charak Saṁhitā, representing the balancing, holding together, and supporting qualities of consciousness, is in cells with characteristics of “multicellular organisation which depends on cohesion between cells” and in a “constant state of equilibrium as a measure of strength of an interaction between two molecules” (p. 86); Sushrut Saṁhitā, representing the separating quality of consciousness, is in cells with characteristics of “selective cleavage of a protein [which] generates a distinctive set of peptide fragments” (p. 87); Vāgbhatt Saṁhitā, representing the communication and eloquence qualities of consciousness, is in cells with characteristics of “membrane transport proteins” (p. 88); Mādhav Nidān Saṁhitā, representing the diagnosing quality of consciousness, is in cells which, among other characteristics, “cannot construct their membrane-bounded organelles de novo”; Shārngadhar Saṁhitā, representing the synthesising quality of consciousness, is in “single cells [which] can associate to form colonies” (p. 90); and Bhāva-Prakāsh Saṁhitā, representing the enlightening quality of consciousness, is in cells with characteristics of cell-to-cell “communication [which] controls the spatial pattern of multicellular organisms” (p. 91).

Such a one-to-one correspondence between Veda and the human physiology can be seen in, for example, the eight amino acid peptides of the DNA which correspond to the eight divisions of Vyākaraṇ and the 24 separate DNA molecules in the human body which correspond to the 24 syllables of the first Ṛicha of the first Sūkta of Ṛik Veda (Nader, 2014). Indeed, Nader has found that every level of the human physiology,

from the DNA to the cell to the organ systems, has the same structure and function as the holistic, self-sufficient, self-referral reality expressed in the Veda and Vedic Literature. In fact, all 40 aspects of the Veda and the Vedic Literature have been found to correspond perfectly in structure and function, with the human anatomy and physiology. This exact correspondence between the human physiology and Veda shows that the Veda is the blueprint of creation, the Constitution of the Universe.

(Maharishi, 2006, lesson 16, chart 16.6)

A significant and growing body of empirical and case study research has been published on Maharishi ᾹyurVeda in the last 25 years. For example, one of the most comprehensive studies found that Maharishi ᾹyurVeda reduced both systolic and diastolic blood pressure, multiple forms of cholesterol, heart rate, triglycerides, and weight (Elder et al., 2006). Earlier investigations had examined Maharishi ᾹyurVeda in the context of rehabilitation from alcoholism (O’Connell, 1994; O’Connell & Alexander, 1994) and drug and alcohol abuse (Sharma, Dillbeck, & Dillbeck, 1994).

Research on 28 patients with fibromyalgia in Norway at a Maharishi Ayurveda Health Centre found after six months Maharishi ᾹyurVeda positively impacted working ability (p < 0.002), pain (p < 0.001), tiredness (p < 0.001), morning tiredness (p < 0.001), stiffness (p < 0.005), and depression (p < 0.001) compared to matched controls (Rasmussen et al., 2009). Evidence of this impact was again observed by the same authors at 24 months (Rasmussen et al., 2012). For those who completed the full treatment program of Maharishi ᾹyurVeda, including regular practice of the Transcendental Meditation technique, reductions in fibromyalgia were of the order ‒95%. Brooks (2019) has also recently examined Maharishi ᾹyurVeda in the context of mental health, and Delfiner (2019) has explored the topic from the perspective of motherhood.

4). Maharishi Nādi-Vigyān.

Maharishi Nādi-Vigyān (महषिॅ विज्ञान) essentially follows the standard approach to Nādi-Vigyān but with the added dimension of the development of the wholeness of consciousness of the practitioner. Thus, many of the features of Maharishi Nādi-Vigyān are consistent with, and in some cases share the same basic procedural techniques of, pulse examination as practiced more generally in ĀyurVeda.

However, according to Maharishi (1996b, p. 122), “Reading the quality of the pulse is the only means for proper diagnosis of the condition of the whole and its relation to the parts. The quality of the pulse is the indicator of the degree of health or ill-health—the balanced relationship of the whole with the part”. Maharishi explains that this relationship of part to whole is not only a diagnosis of parts of the body to the whole body but is “between the wholeness of consciousness and its expression, the physiology—between the 40 qualities of consciousness and their divisions and subdivisions and corresponding areas in the physiology”. Maharishi (1996b, p. 122) therefore states that:

Pulse reading is not only a diagnosis of the balanced or imbalanced functioning of the physiology as it is influenced by diet and daily routines, but it is also an indicator of the entire environmental influence on the individual—from the influence of the close environment of his home to the cosmic influence of planets, stars, and galaxies. All these influences contribute to his balanced or imbalanced functioning: how much he is able to live life according to the Laws of Nature that govern life on both levels—consciousness and physiology—and on all levels of his existence, individual and cosmic. This field of pulse reading is [therefore] a very complete field of knowledge of health, which is unavailable in the field of modern medicine.

“A balanced pulse feels good”, Maharishi explains;

it is even, smooth, clear, lively, harmonious, integrated, vital, and powerful. It has all the qualities of fully lively Ojas [the final metabolic product of a well-functioning and balanced digestive system], indicating that the state of the physiology is the material expression of the self-referral state of consciousness—Saṁhitā of Ṛishi, Devatā, and Chhandas, the togetherness of the knower, process of knowing, and known. Vāta, Pitta, and Kapha are felt as pulsating together. The three are in terms of one, one is in terms of three.

The three are all clearly expressed, each in its own place, manifesting its balanced qualities. The balanced qualities of Vāta are felt in the index finger, the balanced qualities of Pitta in the middle finger, and the balanced qualities of Kapha in the ring finger. The feeling of wholeness dominates in the pulse and simultaneously this wholeness is in terms of three different balanced values.

(Maharishi, 2006, lesson 8, chart 8.5)

In addition to determining the nature of balance and imbalance, detection of imbalances at an early stage, detecting the cause of imbalance, and maintaining health and restoring balance by enlivening the body’s inner intelligence, the Maharishi Ᾱyurvedic doctor also diagnoses the status of each patient’s digestive system through the principle of Pachakapitta (Moharana & Roushan, 2019), or nature of imbalance and cause of imbalance, through Maharishi Nādi-Vigyān.

In Maharishi ᾹyurVeda, particularly in the textbooks of Charak Saṁhitā and Sushrut Saṁhitā, the digestive system is referred to as a ‘digestive fire’ or Agni (अगनि), because it is the internal ‘fire’ of the body which converts food into energy by breaking down solids and liquids into nutrients. Maharishi ᾹyurVeda identifies four main types of Agni: Vishamāgni; Tīkshnāgni; Mandāgni; and Samāgni, although Poojary and Banu (2018) cite a total of 13 Agnis, of which the four main types can be classed together as states of Jāṭharāgni.

Vishamāgni represents an unpredictable digestive system (Vishama means ‘irregular’). In such a condition, a person can alternately feel satiated after eating a meal, with a feeling of being well nourished and satisfied, but at other times, can feel bloated, heavy, lethargic, and uncomfortable. In Maharishi ᾹyurVeda, Vishamāgni is associated with an excess in Vāta Dosha because, like the wind, it is unpredictable and causes symptoms such as feelings of bloat and gas, rumbling in the abdomen, often accompanied by constipation or alternate periods of constipation and loose stool (i.e., diarrhoea).

Tīkshnāgni occurs when the digestive fire is burning too intensely and too quickly (Tīkshna means ‘sharp’). In such a condition, a person must eat on time or may become irritable, and is often hungry, even between meals. Such a person might be going to the toilet after every meal, particularly if the meal involves hot, spicy food or contains a lot of onion and garlic. When a person’s Agni is too strong, their stomach secretes extra acid, causing hyperacidity and heartburn (a symptom of both acid reflux and gastroesophageal reflux disease), potentially leading to the formation of stomach ulcers. Tīkshnāgni is associated with an excess in Pitta Dosha because, like a raging fire, it is fast, strong, sharp, hot, and upwardly directed, and causes symptoms such as loose stool, heartburn, dyspepsia, loss of energy, and sharp appetite, and may be associated with dysentery.

Mandāgni occurs when the digestive fire is low and weak, and hence metabolism and digestion are especially slow (Manda means ‘slow’). In such a condition, irrespective of the amount of food one consumes, a person feels full for several hours after eating a meal. Hence, Agni digests the least amount of food in the greatest amount of time. Feelings of tiredness, or even exhaustion, can accompany a large meal followed by an urge to sleep. Mandāgni is associated with an excess in Kapha Dosha because, like the earth, it is heavy, slow, and dense, and causes symptoms such as a tendency toward easy weight gain, low appetite, feelings of slow digestion, and sticky stool.

According to Poojary and Banu (2018, p. 843), the fourth main type of Agni, Sāmāgni, is the only one of the four types which is considered ‘normal’; “all others are considered as abnormal”. Sāmāgni occurs when the digestive fire is even, steady, and without disturbance (‘Sāma’ means balanced or even). In this condition, when a person eats a meal, s/he feels comfortable thereafter, with none of the aforementioned effects of bloat, gas, heartburn, lethargy, and so on. Sāmāgni is therefore associated with balance in all three Doshas and relates to the proper digestion and assimilation of food by the body, a condition which improves quality of the Dhatus. Symptoms of Sāmāgni include no digestive discomfort after eating, radiant skin, shining eyes, and healthy daily bowel movements. In conclusion, Poojary and Banu (2018, pp. 843–844) maintain that in order “to avoid the disease manifestation and to retain the healthy state, one should always concentrate on [the] state of Agni and its management”.

The status of each patient’s gut responsiveness (i.e., the responsiveness of the digestive tract) is also determined in Maharishi AyurVeda. According to Divyashree, Kahalekhar and Rashmi (2020, p. 52), “Koshta refers to the state of the abdomen or alimentary tract and is usually determined by the behaviour of the bowel habits”. In Maharishi ᾹyurVeda, particularly in the textbooks of Charak Saṁhitā and Sushrut Saṁhitā, the gut response is referred to as Kostha (कोष्ट), because the word relates to both the hollowness of the thoracic cavity as well as bowel movements as they relate to both Deha Prakriti and Agni.

Maharishi ᾹyurVeda identifies three main types of Koshta: Krūra Kostha; Mṛidu Koshta; and Madyama Koshta. Divyashree et al. (2020, p. 52) maintain that one’s Koshta varies according to one’s Deha Prakriti. For example, Krūra Koshta generally relates to Vāta Prakriti, Mṛidu Koshta relates to Pitta Prakriti, and Madhyama Koshta relates to Kapha Prakriti. When all three Koshta are in equal proportion, one is said to experience Sāma Koshta.

Krūra Koshta occurs when Vāta is dominant in the alimentary canal, which reduces the liquid content of the stool and results in elimination of hard stools (the word ‘Krūra’ means harsh or disagreeable). Krūra Koshta therefore causes difficulty in elimination (i.e., constipation). The Laghu (light) and Ruksha (dry) qualities of Vāta reduce softness, stickiness, and oiliness of the stool, however these two qualities are required in harmony with others for proper elimination thereby preventing loose stools; in Krūra Koshta the qualities of lightness and dryness are elevated.

Mṛidu Koshta occurs when Pitta is dominant in the alimentary canal, increasing the liquid content due to Drava (liquid), resulting in semi-solid discharge of fecal matter (the word ‘Mṛidu’ means soft). People with Mṛidu Koshta are more prone to loose or semi-solid stools, increased frequency of defecation, and diarrhea.

Madhyama Koshta occurs when Kapha is dominant in the alimentary canal, resulting in the passage of soft and solid stools, which is desirable and ideal (the word ‘Madhyama’ means middle or central). The optimum level of Kapha keeps both Vāta and Pitta under control and prevents loose and hard stools. When Kapha qualities are excessive in the alimentary canal, increased mucus content is observed in the stool.

The exact procedures employed in Maharishi Nādi-Vigyān to detect the character of a patient’s pulse, the wholeness of the pulse and Dosha predominance and their nature (i.e., balance or imbalance), Agni, and Koshta are the subject of a 16-lesson course on Nadi Vigyān or self-pulse diagnosis (Maharishi, 2006). In this course, Nadi Vigyān is explained in the context of the surface and deep pulse, six tastes (Rasas), seasonal qualities of Vāta, Pitta, and Kapha, Agni, and Ojas, the final product of digesting food and its assimilation into its nutritive essence (Ᾱhār Ras) after which it is assimilated into the body to produce energy through a sequence of seven stages of tissue (or Dhātu) development as plasma, blood, muscle, fat, bone, bone marrow, and reproductive tissue, among many other features of the pulse. Of the Dhātus alone, Charak Saṁhitā declares:

individuals possessed of the excellence of all the Dhātus are endowed with great strength and happiness; ability to resist difficulties; self-confidence in all enterprises; virtuous acts; a firm and well-built body; correct gait; a resonant, melodious, and big voice; happiness, power, wealth, enjoyments, honour, slowness of the ageing process, resistance to disease, and a large number of long-lived children with similar qualities

(Vimānasthān, 8.111).

CONCLUSION

The two empirical tests described in this study represent the first to explore the diagnostic validity of pulse examination using Maharishi Nādi-Vigyān for the classification of hypertension and other cardiovascular risk factors. The first test confirmed that the subjective diagnosis of hypertension using Maharishi Nādi-Vigyān was consistent with objective diagnoses using a sphygmomanometer meter cuff. Agreement between the subjective and objective approaches to measuring hypertension was a significant 95%.

Similarly, the second test confirmed the subjective diagnosis of elevated cholesterol, insomnia, and state of mind using Maharishi Nādi-Vigyān was predominantly consistent with the self-report of patients on these three measures of cardiac health. Despite the potential for error due to the well-established unreliability of self-reports and the large number of participants analysed in this study, agreement between the two approaches was 73.5%.

Modern medical practitioners examine the pulse for a variety of reasons, but mostly for checking the heart’s rate, rhythm, and regularity—a common method, for example, in the diagnosis of atrial fibrillation. However, in Maharishi Nādi-Vigyān, as demonstrated in this study, a trained diagnostician can use the pulse to check not only the heart’s rate, rhythm and regularity, but also blood pressure, cholesterol levels, insomnia, and state of mind, and can be extended to provide insight into the body’s total intelligence at different levels of the pulse nature, and the state of the patient’s digestive system (i.e., Agni) and the responsiveness of their alimentary canal (i.e., Koshta). At the very least, these measures when taken together can lead to precautionary health advice when coupled with objective tests of weight, BMI, hypertension, elevations in circulating lipoprotein cholesterol particles, insomnia, and so on.

The practical significance of these findings for clinicians certainly relates to the holistic nature of Maharishi ᾹyurVeda, but has more productively be broken down by Maharishi into three main benefits. Firstly, Maharishi Nādi-Vigyān can be used for the detection of imbalances in the body at an early stage, before they manifest as disease, following the principle that “if imbalance is detected, acted upon, and corrected at an early stage, successive stages of imbalance will be prevented, and health will be restored. Recovery at an early stage is easy; prevention is better than cure” (Maharishi, 2006, lesson 16, chart 16.11, left).

Secondly, Maharishi Nādi-Vigyān can be used to detect the cause of imbalance in the body, and can thereby allow the physician to “take steps to correct the root cause of problems, which is most effective for preventing diseases” (Maharishi, 2006, lesson 16, chart 16.11, centre). The reason for this ability to detect the fundamental cause of imbalance in the body at its deepest level is illustrated in Figure 2.

Thirdly, and most subtly but perhaps also most importantly, Maharishi Nādi-Vigyān can maintain and restore balance by “enlivening the body’s inner intelligence” (Maharishi, 2006, lesson 16, chart 16.11, right). To validate this principle, Maharishi points out that according to quantum measurement theory (Wigner, 1983), attention enlivens the object of attention. In the case of Maharishi Nādi-Vigyān, he argues the balanced and integrated attention of the physician on the patient’s pulse, specifically when consciousness is established on the basis of Saṁhita of Ṛishi, Devatā and Chhandas at the level of Natural Law, when the mind is in a state of calm alertness, “stimulates natural balancing mechanisms in the body and helps to rectify any growing imbalance. In this way, [diagnosis of the pulse] contributes directly to maintaining good health, restoring balance, and alleviating disorder” (Maharishi, 2006, lesson 16, chart 16.11, right). In Maharishi’s analysis, this phenomenon is particularly true for Maharishi Nādi Vigyan where the patient learns to diagnose his/her own pulse, but it is perhaps equally reasonable to conclude that when the attention of the diagnostician is directed to the imbalance and the restoration of balance, as identified through the patient’s pulse, the same or a similar phenomenon occurs.

As discussed in Part II, Maharishi ᾹyurVeda is a complete and integrated approach to healthcare, including sophisticated elements for the prevention, diagnosis, prognosis, and treatment of disease. Therefore, not only do the present findings support the diagnostician’s ability to diagnose and predict physiologic and psychologic imbalances and disease, but provide a reliable method of working toward preventing and treating hypertension and restoring cardiac health. Thus, Maharishi (2006, lesson 16, chart 16.8) concludes that pulse examination

is the Vedic way of detecting the state of balance or imbalance in the physiology. In the pulse we feel how the physiology is functioning, and since the physiology is Veda and the Vedic Literature, we are basically feeling on the level of touch the fine aspects of the vibrations of the Vedic sounds. If some of the Vedic sounds are not available to us in our physiology, because the structures that correspond to them are not very pure or alert, then this can be felt in the pulse.