In using pulse reading as a tool for early diagnosis, we will frequently refer to a phenomenon known as gandhakal or, "indicator of critical time". Felt at the fifth level or dhatu pulse, this is an irregular quality of beat noted at a particular dhatu. The gandhakal may have either a vata, pitta or kapha quality. It is also possible to note a tridoshic gandhakal, which consists of three irregular beats endowed with the respective qualities of vata, pitta and kapha spikes. This tridoshic gandhakal is an important indicator of a malignancy or other tridoshic disorder in the relevant dhatu.

Pulse reading as a tool for the early diagnosis of breast cancer
A fifty-year-old yoga teacher presented with a diagnosis of calcifications in the left breast. She had been having a mammogram every six months to monitor the calcifications. Currently, her physician had suggested a biopsy, as the calcifications appeared to be changing. She was reluctant to have the biopsy and was concerned about the frequency of mammography, a potentially carcinogenic investigation. Pulse reading indicated a prakruti of V3 P2 K2 with a vikruti of V4 P3 K2. There was a kapha spike in the rasa dhatu, consistent with fibrocystic breast changes (As an upadosha of rasa dhatu, the breast tissue is read at this level.). There was no gandhakal in this or any dhatu. The absence of either generalized tridoshic provocation or a gandhakal indicated that there were no malignant or pre-malignant changes and the pulse reading was consistent with fibrocystic changes in the left breast. She was given a stanya shodan and vata-pacifying regime. Because pulse reading showed no evidence of malignancy, she was able to proceed with a three-day pancha karma.

After the pancha karma, she had a breast thermograph, a less invasive procedure than mammogram. This showed, "focal areas of hyperthermia at two o'clock in the left breast that warrants clinical correlation and close monitoring." A month later she finally decided to go ahead with biopsy. This showed "fibrocystic changes and moderate epithelial hyperplasia. There is no microcalcification." These benign changes were exactly as indicated in the pulse reading, which had provided less ambiguous information than either the mammogram or the thermograph. Further, the accuracy of the pulse reading had permitted her to do pancha karma with the confidence that there was no malignancy.

A forty-eight-year-old divorced single mother presented with two lumps between the axilla and the right breast. She had previously seen an Ayurvedic practitioner unfamiliar with pulse diagnosis, who had recommended a strenuous course of pancha karma. This situation was of grave concern as it is not standard practice to administer pancha karma in the presence of an active malignancy. She had not seen a medical doctor. Pulse reading showed a prakruti of V2 P3 K1 with a vikruti of V3 P4 K2. There was a tridoshic gandhakal in the rasa dhatu and in majja dhatu, as well as a gandhakal in mamsa. This was a particularly ominous reading.  Both the overall tridoshic vikruti as well as the rasa gandhakal pointed to a malignancy of the breast tissue. The majja gandhakal indicated potential micro-metastasis to the CNS and the mamsa gandhakal suggested that the cancer was of an infiltrating nature. She was referred for immediate breast biopsy.

Biopsy, which showed malignancy, was immediately followed by lumpectomy. The pathologist's diagnosis was "Infiltrating ductal carcinoma, poorly differentiated, T2 N1 MX." She decided to do six months of chemotherapy, followed by radiation.

Following the chemotherapy, she presented for pulse diagnosis. This indicated vikruti of V3 P4 K2 with a tridoshic gandhakal in the rakta dhatu. Although some possible metastasis had been seen in the liver on CAT scan prior to chemotherapy, the CAT scan for the liver was now clear and tumor markers were normal. Nonetheless, pulse diagnosis pointed to a recurrent liver metastasis. After she took a course of anti-tumor herbs, this dissipated to a kapha gandhakal. Six months later ultrasound showed a spot on the liver too small to biopsy.The oncologist dismissed the likelihood that anything severe would develop in the liver within the next several months.

Tragically, she presented three months later, following an emotionally draining trip overseas to visit family, with a strong tridoshic gandhakal in the rakta dhatu and tridoshic provocation of the liver on organ pulse reading. There was now a large tumor in the liver, which rapidly led to her demise. The potential indicated months ago in the rakta pulse, though not in the CAT scan, had manifested.

Pulse Diagnosis in early detection of intra-cranial lesions
In the fall of 2000, a group from Alandi Ashram visited Rocky Mountain National Park, where two of our number were struck by lightening. One, a twenty-two-year-old male, prakruti V3 P1 K2, received a severe gash to his head. At Estes Park Hospital, the MD was concerned about the patient's altered state of consciousness and suspected an intra-cranial bleed. Pulse reading was performed and revealed a kapha gandhakal in the majja dhatu, a reading highly indicative of the formation of a subdural hematoma, since it suggested the onset of a benign space-occupying lesion of the brain. CAT scan was performed but detected nothing. For the next 35 days he had worsening throbbing headaches. He was referred to a medical clinic with a request for a repeat CAT scan. This was denied on the basis that the original CAT scan showed no abnormality. On the thirty-fifth day he had vikruti V4 P2 K2 with vata pushing pitta to the head. There was a kapha gandhakal in the majja dhatu. Later that day, he blacked out at work. The CAT scan was finally done and did indeed indicate a subdural hematoma pressing on the brain. Surgery was performed just in time to save his life. It is noteworthy how much more accurate both clinical observation and pulse reading were than the initial CAT scan. The hematoma was initially too small to be seen on CAT scan but was clearly indicated on Ayurvedic pulse reading. Over time, the slow bleed continued, eventually creating a mass large enough to be seen on CAT scan—and large enough to compress the brain-stem, with life-threatening impact.

A forty-five-year-old office manager presented with a twenty five-year history of benign pituitary tumor with raised prolactin levels. Although benign, a space-occupying lesion of this nature can press on the optic chiasm causing tunnel vision and eventual blindness. She had previously taken bromocryptine to control it.  As she was uninsured, she did not wish to see an endocrinologist unnecessarily. Pulse reading indicated prakruti V3 P2 K2 with vikruti V4 P2.5 K2.5. There was both vata and kapha gandhakal in the majja dhatu. We felt that this situation justified immediate presentation to an endocrinologist, as her pituitary tumor had obviously recurred. Tests showed a raised prolactin level, verifying that the pituitary tumor had recurred. She was treated with bromocryptine, which gradually reduced both her prolactin level and the gandhakal. Within three months there was no further gandhakal and her prolactin levels were also normal.

A sixty-year-old disabled man presented with a history of seizures. MRI and CAT scan had apparently indicated mild hydrocephalus and no treatment had been recommended. He was on SSI for a diagnosed personality disorder. Pulse reading showed prakruti V1 P3 K3 with vikruti V2 P4 K4. There was a kapha gandhakal in the majja dhatu. Although he was undoubtedly a very difficult character, it was evident from the pulse findings that he had a brain disorder not a personality disorder. Herbal methods were utterly insufficient to relieve the symptoms of hydrocephalus and the gandhakal persisted as an indicator of the severity of his condition. Upon experiencing a further seizure he saw another neurologist who recommended immediate neurosurgery for insertion of a shunt. Following the shunt insertion there was no further gandhakal and his personality normalized.  Once again, Ayurvedic pulse reading was an accurate indicator of the severity of a disorder of intra-cranial pressure.

Pulse diagnosis and Colon Cancer
A sixty-year-old bookkeeper presented after a stool test indicated blood in the stool. She had been a smoker most of her adult life. Colonoscopy had been recommended and she was wondering whether to proceed with this. Pulse diagnosis showed prakruti V1 P3 K3 with vikruti V1.5 P3.5 K 3.5. There was no gandhakal. Based on this pulse reading, there was no evidence of any current or imminent tumor. However, with generalized tridoshic provocation, there was a possibility that a malignancy could eventually develop. She was advised to proceed with colonoscopy, with the prediction that this would reveal a small polyp, which could eventually become malignant. Colonoscopy was performed and revealed two small polyps, which were excised. These were benign polyps, which had a one per cent chance of eventually becoming malignant. In this example, pulse reading had a value in indicating the usefulness of colonoscopy in this case, while allaying needless fears while results were awaited.

A fifty-eight-year-old yoga teacher presented complaining of shortness of breath. She was worried about her lung capacity or heart. On examination, her extreme pallor was immediately apparent. Her prakruti was V3 P2 K2 with a vikruti of V4 P2 K2. There was a prominent gandhakal in both rasa and rakta dhatus. It was difficult to determine whether this was kapha or tridoshic in quality. It was concluded, based on the pallor, her age and the gandhakal that she was bleeding from a rectal polyp or carcinoma. Even though she did not show tridoshic provocation of prakruti, the likelihood was, given the strength of gandhakal and the amount of apparent blood loss, that the source was a colon cancer.

She was recommended for immediate full blood count and fecal occult blood testing. Her hemoglobin came back at 7.5, indicating severe anemia and occult blood was positive. Colonoscopy was performed, revealing a colon cancer, which was excised. There was no indication of any metastasis. Although any diligent practitioner of any form of medicine would probably have reached the same conclusion based on clinical criteria alone, without the help of pulse reading, she remains convinced that Ayurveda saved her life. This has increased her willingness to follow through with Ayurvedic treatments. This case history also illustrates the importance of supporting pulse diagnosis with clinical criteria to obtain the most accurate diagnosis possible.

Needless Fears Allayed
A fifty one-year-old body worker, prakruti V1 P3 K3, had been receiving Ayurvedic support for some years for help with hypertension, raised triglycerides and hypothyroidism. He now presented with exopthalmos in the left eye. He was scheduled for MRI and had been told by his MD that there was a significant likelihood that the exopthalmos was due to a malignant tumor. The fear thus generated was tending to increase his blood pressure and hence the likelihood of a stroke. His vikruti was V2 P3 K4, with kapha in the thyroid pulse and no gandhakal in any dhatu. Based on this pulse reading he was assured that  malignancy was unlikely, since there was neither tridoshic provocation in the vikruti nor any  gandhakal. Thyroid pathology was indicated by this and previous pulse readings and was the likely cause of the exopthalmos. In confirmation of this conclusion, MRI showed "fusiform enlargement of the inferior rectus muscles bilaterally, left greater than right. Distribution of the disease suggests Graves opthalmopathy is the most likely etiology." In other words, the exopthalmos was indeed due to the thyroid condition and not to a tumor. Punarnava eyewash was recommended for this condition, with good results.

Conclusion
These examples, culled from among many similarly striking case histories, give an indication of the value of Ayurvedic pulse reading in determining when symptoms give genuine cause for alarm. Needless fears may be allayed and life-saving treatment initiated as a result of skillfully applied pulse diagnosis. Although analysis of this depth and accuracy clearly requires a good degree of both skill and experience in using the technique, this is something that can be acquired by any diligent person. No extra-ordinary siddhis or clairvoyant powers are required, nor are any invasive procedures. Thus the well-skilled Ayurvedic practitioner is able to make a significant contribution to the safe, non-invasive diagnosis of cancer, space-occupying lesions and other serious disorders.