小儿过岁当切脉,位小一指定三关,浮脉轻取皮肤得,沉脉重取筋骨间,
一息六至平和脉,过则为数减迟传,滑脉如珠多流利,涩脉滞涩往来艰,
三部无力为虚脉,三部有力作实言,中取无力为孔脉,微脉微细有无间,
洪脉来盛去无力,数缓时止促结占,紧脉左右如转索,弦则端直张弓弦,
浮为在表外感病,沉为在里内伤端,数为在府属阳热,迟为在藏乃阴寒,
滑痰洪火微怯弱,弦饮结聚促惊痫,孔主失血涩血少,沉紧腹痛浮感寒,
虚主诸虚不足病,实主诸实有余看,疸疹欲发脉洪紧,大小不匀中恶勘,
一息三至虚寒极,九至十至热极炎,一二十一十二死,浮散无根沉伏难,
表里阴阳虚实诊,惟在儿科随证参。
[注]
过岁者一岁也,有疾则当切脉,但部位甚小,不能以三指诊之,
须用一指以定三关,三关者寸关尺也,
浮脉者,轻取皮肤之上即得,故曰浮也,
沉脉者,重按筋骨之问则见,故曰沉也,
一息者,人之一呼一吸也,
至者,脉之至数也,
一息六至为和平之脉,则曰无疾,
至数若过者,七至八至也,谓之数脉,
至数若减者,四至五至也,谓之迟脉,
滑脉如珠,往来流利,
涩脉滞洪,往来艰难,
三部者脉之浮沉中也,
浮中沉三部无力为虚,浮中沉三部有力为实,
芤脉者,中取无力,微脉者,按之微细,若有若无,
洪脉者,来时虽盛,去时无力,
促脉者,数而时止,结脉者,缓而时止,
紧脉者,左右如转索之象,
弦脉者,端直如张弓弦,此皆言脉之形象至数也,
浮脉病在表,外感风寒也,
沉脉病在里,内伤饮食也,
数脉病在六府,属阳也,
迟脉病在五藏,属阴也,
滑主痰盛,
洪主火热,
微主怯弱之证,
弦主停饮,
结主积聚,
促主惊痫,
芤主失血,
涩主血少,
沉紧主腹痛,
浮紧主感寒,
虚为不足,主诸虚,
实为有余,主诸实,
洪紧者,疽疹欲发也,
大小不匀者,中恶之证也,
一息三至是虚寒之极,
九至十至乃火热太甚,此诸脉所主之病也,
若一息只一至二至,或十一十二至者,皆死脉也,
浮散无根又沉浮,取之不应指者,皆难治之脉也,
凡病之阴阳表里虚实,虽可以诊脉而得,
惟临证时合望闻问三者,细为参考焉。
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小儿满周岁后应当进行切脉诊察,因其脉位较小,需用一指同时诊察寸、关、尺三部(三关)。浮脉是轻取于皮肤表面即可触及的脉象;沉脉是重按至筋骨之间才能触及的脉象。
一呼一吸之间脉搏跳动六次,属于平和之脉;若超过此数则为数脉,少于次数为迟脉。滑脉如珠玉滚动般多流利;涩脉则滞涩不畅,往来艰难。
寸、关、尺三部按之无力为虚脉;三部按之有力为实脉。中取(中等力度)无力为芤脉;微脉极细微弱,似有似无。洪脉来势盛大而去时无力;数而时止为促脉,缓而时止为结脉。紧脉左右弹指如同转动绳索;弦脉端直且长,如同拉开的弓弦。
浮脉主病在表,多为外感病;沉脉主病在里,多为内伤。数脉主病在六腑,属阳热证;迟脉主病在五藏,属阴寒证。滑脉主痰饮,洪脉主火热,微脉主正气怯弱,弦脉主水饮停聚,结脉主气结血瘀,促脉主惊悸癫痫。芤脉主失血,涩脉主血少,沉紧脉主腹痛,浮紧脉主感受寒邪。虚脉主各种虚损不足的病证,实脉主各种实邪有余的病证。痘疹欲发时脉象多洪紧,脉象大小不匀者需诊察是否中恶。
一呼一吸间脉搏仅三至,为虚寒至极;九至十至为热极炽盛。一至二至或十一十二至均为死脉。浮散无根或沉伏难寻的脉象,均难以治疗。
对于表里、阴阳、虚实的诊察,在儿科临床中必须结合具体症状进行综合参考。
[注]
“过岁”即指一岁。小儿有病时应当切脉,但因其脉位非常小,不能用三指分别诊察,必须用一指来确定寸、关、尺三关的位置。所谓三关,即寸、关、尺三部。
浮脉是指轻取于皮肤之上即刻可得,所以称为浮脉。
沉脉是指重按至筋骨之间方才显现,所以称为沉脉。
“一息”是指人的一次呼气与一次吸气。
“至”是指脉搏跳动的次数。
一呼一吸间脉搏跳动六次,属于和平正常的脉象,表示没有疾病。
如果至数超过六次,如七至、八至,称为数脉。
如果至数减少,如四至、五至,称为迟脉。
滑脉像珠子一样,往来流利。
涩脉滞涩,往来艰难。
“三部”是指脉象的浮、中、沉三种取法层次。
浮、中、沉三部按之无力为虚脉;浮、中、沉三部按之有力为实脉。
芤脉是中取无力;微脉是按之极其细微,若有若无。
洪脉是来时虽然盛大,去时却无力。
促脉是数脉且时而停止;结脉是缓脉且时而停止。
紧脉是左右弹指,如同转动绳索的意象。
弦脉是端直且长,如同拉开的弓弦。这些都是在描述脉的形象和至数。
浮脉的病位在表,多为外感风寒。
沉脉的病位在里,多为内伤饮食。
数脉的病位在六腑,属于阳证。
迟脉的病位在五脏,属于阴证。
滑脉主痰盛。
洪脉主火热。
微脉主怯弱之证。
弦脉主停饮(水饮停滞)。
结脉主积聚(气滞血瘀形成的包块)。
促脉主惊痫(惊风癫痫)。
芤脉主失血。
涩脉主血少。
沉紧脉主腹痛。
浮紧脉主感受寒邪。
虚脉表示不足,主各种虚证。
实脉表示有余,主各种实证。
洪紧脉,是疽疹即将发出的征象。
脉象大小不匀,是中恶(突然受邪气侵袭)的证候。
一呼一吸间仅三至,是虚寒到了极点。
九至十至,则是火热太过严重。这些都是各种脉象所主应的病症。
如果一呼一吸间只有一至二至,或者十一至十二至的,都是死脉。
浮散无根,以及沉浮取之不应指的脉象,都是难治的脉象。
凡是疾病的阴阳、表里、虚实,虽然可以通过诊脉得知,但在临证时,必须结合望、闻、问三者,仔细加以参考印证。
Pediatric patients over one year of age should undergo pulse diagnosis (pulse palpation). Due to the small size of their pulse position, a single finger is used to assess the three positions: Cun (Inch), Guan (Bar), and Chi (Cubit) simultaneously. The Floating Pulse (Fu Mai) is obtained by light pressure on the skin surface; the Deep Pulse (Chen Mai) is obtained by heavy pressure between the muscles and bones.
Six beats per respiratory cycle constitute a Harmonious Pulse (Ping He Mai); more than six indicates a Rapid Pulse (Shu Mai), while fewer indicates a Slow Pulse (Chi Mai). The Slippery Pulse (Hua Mai) flows smoothly like rolling pearls; the Choppy Pulse (Se Mai) is stagnant and difficult to flow.
Weakness in all three positions (Cun, Guan, Chi) indicates a Deficient Pulse (Xu Mai); strength in all three positions indicates an Excess Pulse (Shi Mai). Weakness upon moderate pressure indicates a Scallion-Stalk Pulse (Kou Mai); the Fine Pulse (Wei Mai) is extremely thin and faint, seeming to exist or not exist. The Surging Pulse (Hong Mai) arrives with force but departs weakly; the Hasty Pulse (Cu Mai) is rapid with intermittent pauses, and the Knotted Pulse (Jie Mai) is slow with intermittent pauses. The Tight Pulse (Jin Mai) feels like a twisting rope from side to side; the Wiry Pulse (Xian Mai) is straight and long, like a drawn bowstring.
The Floating Pulse indicates Exterior syndrome (Biao Zheng), typically due to External Contraction (Wai Gan); the Deep Pulse indicates Interior syndrome (Li Zheng), typically due to Internal Injury (Nei Shang). The Rapid Pulse indicates involvement of the Six Fu Organs (Liu Fu) and belongs to Yang-Heat (Yang Re); the Slow Pulse indicates involvement of the Five Zang Organs (Wu Zang) and belongs to Yin-Cold (Yin Han). The Slippery Pulse indicates Phlegm-Dampness (Tan Yin); the Surging Pulse indicates Fire-Heat (Huo Re); the Fine Pulse indicates Qi Deficiency and weakness (Qie Ruo); the Wiry Pulse indicates Fluid Retention (Ting Yin); the Knotted Pulse indicates Accumulation and Stagnation (Ji Ju); the Hasty Pulse indicates Fright and Epilepsy (Jing Xian). The Scallion-Stalk Pulse indicates Blood Loss (Shi Xue); the Choppy Pulse indicates Blood Deficiency (Xue Shao); the Deep-Tight Pulse indicates Abdominal Pain (Fu Tong); the Floating-Tight Pulse indicates Cold Invasion (Gan Han). The Deficient Pulse indicates various deficiency syndromes (Zhu Xu); the Excess Pulse indicates various excess syndromes (Zhu Shi). A Surging-Tight Pulse suggests impending eruption of carbuncles or rashes (Ju Zhen); irregular pulse sizes suggest Zhong E (Sudden Evil Attack).
Three beats per respiratory cycle indicate extreme Deficiency-Cold (Xu Han); nine to ten beats indicate extreme Heat (Re Ji). One or two beats, or eleven to twelve beats per cycle, are Death Pulses (Si Mai). Floating and scattered pulses without root, or Deep and hidden pulses that do not respond to palpation, are difficult to treat.
Diagnosis of Exterior/Interior, Yin/Yang, and Deficiency/Excess in pediatrics must be integrated with clinical symptoms for comprehensive assessment.
[Note]
"Guo Sui" refers to being over one year old. When pediatric patients are ill, pulse diagnosis is necessary, but because the pulse position is very small, it cannot be assessed with three fingers separately. Instead, one finger must be used to determine the three positions: Cun, Guan, and Chi. These three positions refer to the Cun, Guan, and Chi locations.
The Floating Pulse is obtained by light pressure on the skin surface, hence named "Floating."
The Deep Pulse is revealed by heavy pressure down to the bone level, hence named "Deep."
"One Xi" refers to one exhalation and one inhalation.
"Zhi" refers to the number of pulse beats.
Six beats per respiratory cycle represent a Harmonious Pulse, indicating health.
If the beat count exceeds this (e.g., seven or eight beats), it is called a Rapid Pulse.
If the beat count decreases (e.g., four or five beats), it is called a Slow Pulse.
The Slippery Pulse resembles pearls, flowing smoothly.
The Choppy Pulse is stagnant, with difficult flow.
"The Three Positions" refer to the levels of light, moderate, and deep pressure.
Weakness at all three levels indicates a Deficient Pulse; strength at all three levels indicates an Excess Pulse.
The Scallion-Stalk Pulse is weak at moderate pressure; the Fine Pulse is extremely thin upon pressing, seeming to exist or not exist.
The Surging Pulse arrives strongly but departs weakly.
The Hasty Pulse is rapid with occasional stops; the Knotted Pulse is slow with occasional stops.
The Tight Pulse feels like a twisting rope.
The Wiry Pulse is straight and long, like a taut bowstring. These descriptions refer to the shape and rhythm of the pulse.
The Floating Pulse indicates Exterior disease, such as External Wind-Cold invasion.
The Deep Pulse indicates Interior disease, such as Internal Dietary Injury.
The Rapid Pulse indicates disease in the Six Fu Organs, belonging to Yang.
The Slow Pulse indicates disease in the Five Zang Organs, belonging to Yin.
Slipperiness indicates abundant Phlegm.
Surging indicates Fire-Heat.
Fineness indicates weakness syndromes.
Wiryness indicates retained fluids.
Knottedness indicates accumulations.
Hastiness indicates fright and epilepsy.
Scallion-stalkness indicates blood loss.
Choppiness indicates blood deficiency.
Deep-tightness indicates abdominal pain.
Floating-tightness indicates cold invasion.
Deficiency indicates insufficiency, governing various deficiency syndromes.
Excess indicates surplus, governing various excess syndromes.
Surging-tightness indicates the impending eruption of sores or rashes.
Irregular pulse size indicates Zhong E syndrome.
Three beats per cycle indicate extreme Deficiency-Cold.
Nine to ten beats indicate excessive Fire-Heat. These are the diseases associated with these pulses.
One or two beats, or eleven to twelve beats per cycle, are Death Pulses.
Pulses that are floating and scattered without root, or those that do not respond to deep or shallow palpation, are difficult to treat.
Although Yin/Yang, Exterior/Interior, and Deficiency/Excess can be diagnosed via pulse taking, clinicians must carefully correlate these findings with observation, listening/smelling, and inquiry during practice.