Treatise

I have heard that the pediatric department was called the "Mute Department" in ancient times, and it is indeed the most difficult to treat. This statement is truly accurate. It is because infants are a group of people whose symptoms are difficult to inquire about and whose pulses are difficult to examine. Moreover, their zang-fu organs are fragile and tender; therefore, rash prescriptions and medicines with excessively harsh cold or hot properties should not be used lightly. I will discuss this in detail below.

While children are still in swaddling clothes, they do not experience internal conflicts among the seven emotions and six desires, nor do they suffer external invasions by severe wind and cold. Why then are pediatric diseases so numerous and severe? Upon examining the etiology, more than half are caused by fetal toxins, while less than one-tenth result from food injury; only one-tenth are due to external invasion of wind-cold. Conditions such as Bianzheng (periodic fever and growth changes), smallpox, macules, palpitations, wind epilepsy, convulsions, phlegm obstruction, red tumors, white alopecia, fontanelle bulging, double tongue, and wooden tongue—do these various conditions not arise from the mother's lack of caution during pregnancy leading to the accumulation of fetal toxins?

When the fetus is in the womb, if the mother is hungry, the fetus is hungry; if the mother is full, the fetus is full. If the mother consumes spicy and palatable foods, the fetal qi follows the heat. If the mother experiences emotional desires internally, the fetal breathing becomes restless. If the mother eats too many fried or roasted foods, indulges in sour and pungent tastes, lacks moderation in her desires, or is prone to mood swings, all these can cause harm to the child. As mothers, if they fail to maintain restraint during pregnancy and cannot provide proper care postpartum, merely indulging the child without preventing problems from arising, giving salty and sour flavors before the child is one hundred days old, or rich and sweet foods before the child reaches one year of age, various diseases will arise from this. Conditions such as vomiting and diarrhea, jaundice, five types of kan syndrome, abdominal distension, abdominal pain, edema, malaria, dysentery, and phlegmatic asthma—are these not caused by excessive dietary injury and improper nursing?

The ancients said that pregnant women should not sleep on their sides, sit on the edge of seats, stand on tiptoes, or eat strange or unwholesome foods. These words hold profound significance. Regarding methods for diet, sexual conduct, nurturing the fetus, and raising young children, one must deeply understand the principle of endless generation inherent in nature. Thus, ancient people lived long lives, and infant mortality was low, which is precisely the reason. I have seen gentle and virtuous women who did not indulge in desires or overeat during pregnancy; their children suffered fewer illnesses and had rare cases of smallpox. Such examples are worthy of emulation.

As pediatricians, when attending to patients, one must observe facial color and demeanor carefully and must not act rashly. For instance, a red forehead indicates heart heat; a red nose indicates spleen heat; a cyan left cheek indicates liver excess; a pale right cheek indicates lung deficiency; and a pale chin indicates kidney deficiency. By combining these observations with the pulse at the three sections of the tiger’s mouth (on the index finger), one can ascertain more than half of the child’s condition. The saying goes: "Care for one’s own young, and extend that care to the young of others." How can we ignore the heart of benevolence expressed in these words?

Regarding Bianzheng (Periodic Fever and Growth Changes):

Newborns have insufficient blood and qi, unharmonized yin and yang, immature zang-fu organs, and incomplete skeletal structures. They undergo Bianzheng, typically presenting with fever every thirty-two days, accompanied by vomiting, sweating, groaning, or refusal to eat. This is a normal sign of growing blood vessels and maturing intelligence and willpower; it requires no treatment and resolves spontaneously. Various scholars argue that this process involves the growth of bones, vessels, zang-fu organs, and spirit/mind. From the day of birth, a change occurs every thirty-two days. Humans have 365 bones in total; excluding 45 small bones in the hands and feet, there are 320 main bones. After birth, ten bones develop daily, completing a cycle of bone formation in thirty-two days. Each change generates one zang or fu organ; after ten changes, the zang-fu system is complete. Each change may trigger deficiency-heat symptoms. However, some infants with robust prenatal qi undergo hidden Bianzheng without fever. This demonstrates that bones and joints become complete through Bianzheng, and fetal toxins dissipate through this process. Should pediatricians not exercise prudence regarding this?

Pulse Diagnosis General Discussion

According to ancient methods: Pediatric conditions are difficult to diagnose using the standard cun-guan-chi positions of the Lung meridian at the wrist. For infants aged one to six years, known as "yinghai," diagnosis relies solely on the three-section pulse on the second phalanx of the index finger (left for boys, right for girls) to determine the severity and prognosis of the disease. The first section is named the Wind Gate (Feng Guan); absence of pulse indicates no illness, while presence indicates mild illness. The second section is named the Qi Gate (Qi Guan); presence of pulse indicates serious illness, but it remains treatable with medicine. The third section is named the Life Gate (Ming Guan); presence of pulse indicates critical illness, a dire prognosis with nine deaths for every one survival, and is generally incurable. Children aged seven or eight are called "chen"; those aged nine or ten are called "tiao." At this stage, one can use a single finger to palpate the cun, guan, and chi positions behind the palm. A normal pulse beats seven or eight times per breath cycle. For children aged eleven to fourteen, called "tongzhi," a normal pulse beats five or six times per breath cycle. A rapid pulse indicates heat; a slow pulse indicates cold; a floating pulse indicates deficiency or wind; a deep pulse indicates excess, accumulation, or pain. A floating and rapid pulse indicates milk epilepsy or palpitations; a deficient and soft pulse indicates slow convulsions; a tight and solid pulse indicates wind epilepsy; a firm and革 (ge) pulse indicates constipation; a deep and wiry pulse indicates food stagnation or abdominal pain; a tight and wiry pulse indicates急促 breathing or wind-cold; a surging and rapid pulse indicates heat; a hidden and knotted pulse indicates food injury; a soft and fine pulse indicates parasitic kan syndrome. If the breathing is rapid and the pulse is intermittent, scattered, or irregular, death is imminent and untreatable. Practitioners of pediatrics must devote themselves diligently to this field.

Below are illustrations and annotations of the three-section pulse on the index finger:

1. Pulse at the Wind Gate is easy to treat.
2. Pulse at the Qi Gate indicates serious illness.
3. Pulse at the Life Gate indicates a fatal prognosis.

Cyan pulse across all three gates indicates fright from four-legged animals. Red pulse across all three gates indicates fright from water. Black pulse across all three gates indicates fright from humans.

If the pulse traverses all three gates continuously, it signifies an extremely critical condition leading to death; other patterns are treatable.

A cyan pulse at the Wind Gate resembling a fishbone indicates early-stage fright and is easy to treat. A black pulse is difficult to treat. A cyan pulse at the Qi Gate resembling a fishbone indicates kan syndrome with body heat and is easy to treat. A cyan pulse at the Life Gate resembling a fishbone indicates deficiency with wind pathogen transmitting to the spleen, making it difficult to treat.

A cyan-black pulse at the Wind Gate resembling a hanging needle indicates water fright and is easy to treat. A red pulse at the Qi Gate resembling a hanging needle indicates kan syndrome combined with lung heat, which is still treatable. Any pulse at the Life Gate resembling a hanging needle, regardless of color, indicates a fatal prognosis. Furthermore, a hanging needle pattern spanning all three gates indicates slow convulsions, which is difficult to treat.

A water-character-shaped pulse at the Wind Gate indicates wind-pathogen entering the lungs, causing cough and facial redness. A water-character-shaped pulse at the Qi Gate indicates phlegm-fluid above the diaphragm and deficiency-stagnation. A water-character-shaped pulse at the Life Gate indicates extreme kan syndrome complicated by fright; if spanning all three gates, it is untreatable regardless of color.

An 'Yi' character-shaped pulse at the Wind Gate indicates lung wind-fright and is easy to treat. An 'Yi' character-shaped pulse at the Qi Gate indicates serious wind-fright. An 'Yi' character-shaped pulse at the Life Gate, if cyan-black, indicates slow convulsions and is difficult to treat.

A curved-worm-shaped pulse at the Wind Gate indicates kan syndrome with accumulation, chest discomfort as if pushed horizontally, and abdominal distension like an inflated pig bladder. A curved-worm-shaped pulse at the Qi Gate indicates fecal impaction in the large intestine. A curved-worm-shaped pulse at the Life Gate indicates heart pain transmitting to the liver, which is difficult to treat.

A ring-shaped pulse at the Wind Gate indicates liver kan-accumulation. A ring-shaped pulse at the Qi Gate indicates kan pathogen entering the stomach with vomiting, which is untreatable. A broken ring shape at the Life Gate is a dire, untreatable prognosis.

This pattern at the Wind and Qi Gates is easy to treat; if spanning the Life Gate, it is difficult to treat.

This pattern appearing on the hand, face, left/right abdomen/flanks, or left/right cheeks indicates a fatal prognosis.

A pulse curving inward indicates Qi Kan.

A pulse curving outward indicates Wind Kan.

A pulse slanting to the right indicates Cold Damage (Shanghan) with body heat, anorexia, and absence of sweat.

A pulse slanting to the left indicates Wind Injury (Shangfeng) with body heat, anorexia, and presence of sweat.

A double-hook pulse indicates Cold Damage (Shanghan).

Three curves resembling a long worm indicate injury from hard objects.

Two curves resembling hooks indicate injury from cold objects.

A pulse with one end forming a ring and a single leg indicates injury from cold.

Spots on the face indicate recurrence of the condition.

Large pulses and green veins on the head/face or abdomen indicate food toxicity and fright-accumulation, which are difficult to treat.

A chaotic worm-like pulse indicates common kan syndrome; parasitic kan, roundworm kan, and food-stagnation kan are also treatable.

For any pulse that is micro and thin, indicating wind-qiu, the appropriate method is to first eliminate kan, then remove parasite accumulation, thereby fattening the child. This is a good method.

Appendix: Tang Shi’s General Judgment on Observing Child’s Spirit and Color

When examining pediatric patients, one should first observe physical signs, spirit, and color, and then palpate the pulse. Liver disease manifests as a green face; Heart disease as a red face; Spleen disease as a yellow face; Lung disease as a white face; Kidney disease as a black face. One must first distinguish the physical signs of the five zang organs, then assess constitutional strength, prenatal qi, and deficiency/excess states, clarifying root and branch before treating. Nothing will remain uncured.

Songs on Facial Signs and Symptoms (Seven Verses)

Dysentery causes furrowed brows; fright causes reddened cheeks; thirst brings red lips; toxic heat blurs the eyes.
If horizontal green veins appear at the Shan Gen (root of the nose), this disease implies two episodes of fright. Red and black hues with fatigue signal vomiting and diarrhea; red color with night crying never stops.
Green veins on the left Taiyang point suggest one episode of fright, requiring careful analysis. Red indicates slight dryness-heat from Cold Damage; black-green suggests injury from excessive breastfeeding.
Excessive green veins on the right side are unnecessary to mention; if present, frequent fright is inevitable. Red-red indicates wind drawing the eyes; black-green leads to death within three days.
Nails cyan and dark, lips cyan, and adverse reversal signal impending recovery or worsening. Sudden crow-like voice and urgent heart qi indicate certain death.
Roundworms exiting the anus show three types: coming from mouth/nose is unbearable. If white worms mix with black, even spiritual pills cannot ease the illness.
Sores and pain in limbs are inauspicious; downward qi rushing to the heart with slippery intestines, panting, sweating, and cool body, clutching the chest/diaphragm—all lead to disaster.

Inner Eight Sections of Brocade (Four Verses)

Pure red indicates peace, no need for alarm; red mixed with black brings unrest. Further red chaos with cyan is worse; expelling wind-phlegm lightens the illness immediately.
Slight red indicates external fright; if like rice grains, it is hard to manage. Scattered red often results from anger-induced chaos; further convulsions are hard to calm.
In the first month after birth, abdominal pain with furrowed brows is called "Coiling Intestine Qi," accompanied by crying and groaning. Eyes rolling back upward indicate Heaven-Hanging Wind.
In the first month after birth, emaciated body, bald head, and sparse hair are due to Ghost King Prenatal Qi.

Outer Eight Sections of Brocade (Ten Verses)

First observe cyan eyes in the child; next check if the back is cold as ice. For Yang males, convulsions on the left are harmless; convulsions on the right are alarming. For females, convulsions on the right are treatable; convulsions on the left are serious. Crooked mouth and eyes ultimately cause harm; even immortal pills cannot cure them.
Red veins in the eyes are hard to measure; numbers vary greatly. Chaotic lines under the eyes are feared most; red veins piercing the pupil are detested.
Fontanelle swelling definitely indicates wind; this sign is most ominous. Sudden sinking into a pit like a cup foot means death within seven days.
Black and dry nose bridge with uncontrollable thirst, black face and cyan lips mean life cannot be saved. Large belly with green veins are bad omens; straight lines on the abdomen are additionally disliked.
Suddenly seeing purple with cyan between eyebrows indicates wind arising immediately. Cyan-red fragments suggest wind rising; kan syndrome and diaphragm qi forms will appear.
Chaotic lines interlaced with purple fearing cyan require urgent medical help to avoid death. Excessive purple plus body heat indicates internal organs generating evil wind.
Less purple, more red indicates fright from livestock; equal purple and red indicates kan formation. Purple spots shaped like rice grains allow evaluation of Cold Damage with food retention.
Scattered purple indicates wind transmitting to the spleen; purple-cyan with thirst indicates wind epilepsy. Deep-hidden purple is hard to treat; dispersing wind-phlegm restores life.
Light black is treatable, bringing life back from death; red-red indicates Cold Damage with phlegm-stagnation. Red-cyan indicates spleen affected by wind pathogen; cyan-black spleen wind causes slow convulsions.
Continuous red with light red lines indicate the nursing mother is unsuitable. Sudden absence of pulse in both hands confirms offending evil disturbing the spirit.