经义
六岁以下为小。○吾不能察其幼小。○婴儿病，其头毛皆逆上者，必死。（《灵枢》）
总论
初生半周至两岁为婴儿，三、四岁为孩儿，五、六岁为小儿，七、八岁为龆龀，九岁为童子，十岁为稚
子。（《寿世保元》）
儿在母腹中感受精气，一月胚，二月胎，三月血脉见，四月形体成，五月能动，六月筋骨成，七月毛发
生，八月脏腑具，九月谷神入胃，十月百骸备而生。生后六十日，瞳子成，能笑语，始识人；百日任脉成，能
反复；一百八十日，尻骨成，能独坐；二百一十日掌骨成，能匍匐；三百日髌骨成，能独立；三百六十日膝骨
成，始能移步。○芽儿出腹，筋骨未敛，肌肉未成，如水上之泡，草头之露。夫初生一腊之内，天地八风之邪岂
能遽害，良由在胎之时，母失爱护，或劳动气血相干，或坐卧饥饱相犯，或酒肉冷热相制，或惊恐血脉相乱，
蕴毒于内，损伤胎元，降生之后，故有胎热、胎寒、胎肥、胎怯、胎惊、胎黄，诸病生焉。外因或洗浴、拭口、
断脐、灸囟之不得法，或绷抱惊恐，乳哺寒温之乖其宜，多致噤口脐风，锁肚不乳等证。病至若此，难以治
疗，良可悯也。（《千金方》）
或问∶人之生也，与忧俱生，何处见得？予曰∶落地一声，
但闻哭，不闻笑，非忧而何？然则忧之一字，在婴幼已先得之。但忧之小者不为患，其有丧父失母、悲哀忧虑
而成病者；有断乳思虑而成病者；恹恹忽忽，心烦啼吵，不思乳食，而内热作者是也。至于惊恐，小儿最多，
在母胎时，已先有之。喜则笑，怒则啼，惟喜怒无常，不能为病耳。俗谓小儿无七情，此谬谈也。（许宣治）
有谓小儿易虚易实者，非也。柔脆不耐病痛，固理所当然。然其气水归乎躯壳，病亦在于躯壳，无异于成
人，未尝易虚也，殆药虚之耳。小儿生机勃如，无病则日以长大，病果无害，生机依然，故有似乎易实。然
使其不病则长大，必有胜于既病者，是易实之说亦非也。小儿如嫩草木，克伐不可，补亦不易；草木方萌芽时，
失水则死，伤水亦死，惟频频浇灌，如其量而止为宜。不特用药，即乳食皆当知节。○幼科谓小儿纯阳，当用
凉药。非之者曰∶是稚阳，非纯阳也，宜补阴以配阳。夫既曰稚阳，则阳亦不足可知，而偏于补阴，可乎？阴
阳二气，本无偏胜，小儿躯壳，气水所贯，何异于成人？其所以异于成人者，特气水未充，不能免于柔脆耳。
是以治小儿难于成人，然亦有易于成人者，以其未有人事之斫丧也。病在阳则治阳，病在阴则治阴，焉用纯阳
稚阳之纷纭哉！（《医参》）
有谓小儿纯阳之体，多宜清凉，此说尤误。王节斋曰∶小儿无补肾法。谓男至十六，而肾始充满，既满之
后，妄用亏损，则可用药补之。若受胎之时，禀之不足，则无可补。禀之原足，又何待补？呜呼！此何说耶？
夫小儿谓纯阳者，以其阴气未成，即肾虚也。阴既不足，而不补之，阴绝则孤阳亦绝矣。殊不知钱氏六味丸，
专治小儿，以其纯阳无阴，故取八味丸，裁去桂、附，独补肾水，此义惟薛立斋得之，世医多未悟也。（《张氏医通》）
小儿之病，古谓哑科，以其言语不能通，病情不易测，故曰∶宁治十男子，莫治一妇人；宁治十妇人，莫
治一小儿。此甚言其难也。然以余较之，则三者之中，又以小儿为最易。盖小儿之病，
非外感风寒，则内伤饮食，以至惊风吐泻，及寒热疳痫之类，不过数种。且其脏气清灵，随拨随应，但能确得
其本，则一药可愈。非若男妇损伤，积痼痴顽者比，余故谓其易也。第人谓其难，谓其难辨也。余谓其易，谓
其易治也。设或辨之不真，则诚难矣！然辨之之法，亦不过辨其表、里、寒、热、虚、实，六者洞然，又何难
之有？故凡外感者，必有表证，如发热、头痛、拘急、无汗，或因风搐搦之类是也；内伤者，必有里证，如吐
泻、腹痛、胀满、惊疳、积聚之类是也；热者必有热证，如热渴、烦躁、秘结、痈疡之类是也；寒者必有寒证，
如清冷、吐泻、无热、无烦、恶心、喜热之类是也。凡此四者，即表、里、寒、热之证，极易辨也。然四者之中、
尤惟虚实二字，最为紧要。盖有形色之虚实，有声音之虚实，有脉息之虚实。如体质强盛与柔弱者异也；形色
红赤与青白者异也；声音雄壮与短怯者异也；脉息滑实与虚细者异也。必内察脉候，外观形气，中审病情，而
精察之，又何虚实之难辨哉！必其果有实邪，果有火证，则不得不为治标。然治标之法，宜精简轻锐，适病则
已，毋犯正气，但见虚象，便不可妄行攻击。若见之不真，勿谓姑去其邪，谅亦无害。不知儿体柔嫩，气血未
坚，脏腑甚脆，略受伤戕，萎谢极易；近则为目下之害，远则遗终身之羸。凡此，实求本之道，诚幼科之肯綮
也。○初生儿，以手捻其头，摸其颐颔，不作声者，为无病。以指探其口，虽发声，而从容咂指者，其病轻。
若即发声不咂指，面色青红兼紫者，此落地受寒也，其病重。辨其形色虚实而治之。若牙紧不纳乳，或硬而不
软，其病极重也。此惊邪入足太阳经，及足阳明经而然，须急治之，庶可平复。（张景岳）
心主惊，实则叫哭、发热、饮水而搐；虚则因卧而悸。心热则合面睡，或上窜切牙者，导赤散主之。心气
实而喜仰卧者，泻心汤主之。○肝主风，实则面青、目直、叫哭、壮热、项急、顿闷；虚则切牙、呵欠。肝热则
手循衣领，及乱捻物，泻青丸主之。
壮热、饮水、喘闷，泻白散主之。○肝有风则目连札，得心热则发搐，或筋脉牵系而直视，用泻青丸以治肝，
导赤散以清心。肝热则目赤，或兼青发搐者，亦用前二药。风甚则身反张强直，用地黄丸以补肾，泻青丸以治
肝。○脾主困，实则身热引饮，用泻黄散；虚则吐泻生风，用异功散。面白腹痛，口中气冷，不思饮食，或吐
清水，以益黄散温补脾虚。呵欠多睡者，脾气虚而欲发惊也。○肺主喘，实则闷乱、气急、喘促、饮水；虚则
哽气、出气。肺热则手掐眉目鼻面，用甘桔汤主之。肺盛复感风寒，则胸满气急，喘嗽上气，先用泻白散，以
清肺气，后用大青膏，以散风寒。肺脏怯则唇白，用阿胶散补之。闷乱气粗，喘促哽气者难治，肺虚甚也。○
肾主虚，若胎虚怯，神气不足，目无睛光，面白颅解，此皆难育，虽育不寿；或目畏明下窜者，盖骨重而身缩
也；切牙者，肾水虚而不能制心火也，皆用地黄丸。（钱仲阳）
小儿行迟、齿迟、解颅、囟填、囟陷、五软、五硬、鹤膝、肾疳、齿豁、睛白等证，此皆禀受不足，治以
六味丸加鹿茸。若因精未满，而御女以通其精，多致头眩、作渴、多痰，或发热、腰酸，或自汗、盗汗，二便
涩痛，当用六味、八味及补中汤加减，无不奏效。（薛立斋）
婴儿肌肉柔脆，不耐风寒，脏腑气弱，乳汁难化，内外二因之病自多。然有非风寒竟致外感，不停滞已属
内伤，其故何欤？尝思人在气交之中，春夏地气之升，秋冬天令之降，呼出吸入，与时消息，间有秽浊吸入，
即是三焦受邪，过膜原直行中道，必发热烦躁。幼医但执表散、消导、清火、通便，病轻或有幸成，病重必然
颠覆。钱仲阳云∶粪履不可近襁褓小儿，余言非无据矣。○小儿诸证，如发热无汗，烦躁昏谵之顷，或战汗将止
之时，或吐泻之后，或痉厥渐苏，或便闭适解，或灌药之后，正元气与病邪交战之际，若能养得元气一分，即
退一分病邪。此际其儿，必有昏睡懒言，气怯神弱，身不转动之状，正当养其元神，冀其邪
退正复。乃病家父母，偏于此际，张惶惊恐，因其不语，而呼之、唤之；因其鼾睡，而频叫醒之；因其不动，
而摇之拍之。或因微有昏谵，而必详诘之；或急以汤饮进之；或屡问其痛痒，哓哓不已，使其无片刻安神。如
此必轻变重、重变死矣。更有豪富之家，延医数辈，问候多人，房中聚集，互谈病情，夜则多燃灯烛照之，或
对之哭泣，或信巫不信医，举家纷扰，此非爱之，实杀之也。试以大人之病情体之，抑好安然寂静乎？抑好喧
哗动扰乎？此理概可知也。（《临证指南》）
察色
古称望而知之谓之神。儿医号为哑科，脉来驶疾，指下难明，尤以察色为要，故首叙之。察其面部五色，
以知病源。人身五体，以头为首，首中有面，面中有睛，睛中有神。神者，目中光彩是也。隐显横冲，应位而
见，以应五脏。五色者，青、黄、赤、白、黑是也。五脏之色∶心赤，肝青，脾黄，肺白，肾黑。五脏所主
病证，蕴于内必形于外，故小儿有病，先观其本位形色，以论五行生克吉凶。形色若不相应，然后听声切脉。（《证治准绳》）
左腮属肝，右腮属肺，额属心，鼻属脾，颐属肾。青主惊，红主痰热，黄主食积、 癖，白主泄泻水谷，
黑主肾气受伤。（《小儿直诀》）
望、闻、问、切，固医家之不可少一者也。在大方则然，而小儿惟以望为主，问继之，闻则次，而切则
无矣。《经》云∶切而知之谓之巧。小儿脉体未全，切无可切，而巧亦无所用其巧。问而知之谓之工。小儿未
言时，问之固无可问；即能言时，问之多不以实对，是问不必问，而工亦无所用其工。闻而知之谓之圣。小儿
初病时，声音或不失其常，至病久而气丧声失，闻无可闻，而圣又何见其圣乎？吾故以望为主也。或曰∶五脏
之属，体隐理微，望从何处？曰∶体固隐矣，而发见于苗窍颜色之间者，用无不周；理固微矣，而昭着于四大
五官之外者，无一不显。故病于
内，必形于外，望形审窍，自知其病。舌乃心之苗，红紫，心热也；肿黑，心火极也；淡白，虚也。鼻准与牙
床，乃脾之窍，鼻红燥，脾热也；惨黄，脾败也；牙床红肿，热也；破烂，胃火也。唇亦脾之窍，红紫，热也；
淡白，虚也；黑者，脾将绝也。口右扯，肝风也；左扯，脾痰也。鼻孔，乃肺之窍，干燥，热也；流清涕，寒
也。耳与齿，乃肾之窍，耳鸣，气不和也；耳脓，肾热也；齿如黄豆，肾气绝也。目乃肝之窍，斜视而睛转者，
风也；直视而睛不转者，肝气将绝也。（夏禹铸）
听声
声以候元气之浓薄，即以审病苦之所在，所以古人有隔垣之治也。声重者，伤风；声壮者，实热；声悲者，
藏燥；声焦者，恐怖欲生风候；重浊者，肠胃有积；沉静者，疳积无疑；但哭无啼者惊；多啼不哭者痛；声轻
频者风痫；声缓无气者吐泻；声嘶者，咳嗽喉痛；声促急者，喘迫上气；声迟缓者，泄泻肠鸣。诸如此类，
皆可听而知之者也。（《证治合参》）
看小儿法，以听声为先，察色为次。凡声音清亮者生；有回音者生；涩者病散；而无出声者不寿；忽然大
声而无病者，须细看其身，恐有疮毒；泣不出声者死；泣而无泪者死。（张景岳）
脉法
凡诊小儿，既其言语不通，尤当以脉为主，参以形色声音，则万无一失矣。然小儿之脉，非比大人多端，
但察其强、弱、缓、急，是即肯綮。盖强弱可以见虚实，缓急可以见邪正。四者既明，无论诸证，随病合脉，
左右逢源，所遇皆道矣。（张景岳）
小儿一岁后，可用一指转侧，辨其三部脉之弦、急、浮、沉。四、五岁后，脉七、八至而细数者，为平；
九至者伤；十至者困；六至、五至者，为虚、为寒；弦、紧为风痫；弦急为客忤；其变蒸者，脉必散乱；骨间
有热，脉则沉数；若浮而不调为鬼祟；浮大而数为风热；伏结为物聚；微细为疳积为腹痛；浮而洪，为有
虫；浮而迟，为胃寒。此论脉之大要耳。又当参以三部五脉∶三部者，乃看面上气色，虎口脉纹，寸口一指脉。
五脉者，上按额前，下诊太冲，并前三部，谓之五脉。（薛铠）
帝曰∶乳子而病热，脉悬小者何如？岐伯曰∶手足温则生，寒则死。帝曰∶乳子中风热，喘鸣肩息者，
脉何如？岐伯曰∶喘鸣肩息者，脉实大也。缓则生、急则死。此《内经》之旨。圣人立言，简切而总括无余，
世人不悟，视为汛常，能于此等处着眼，则诊视之要，思过半矣。予之临证诊视，每论吉凶，则多中者，亦不
外此。第意之所至，口莫能宣。窃详《经》所谓大、小、缓、急者，亦发而不露之意。盖大，即浮、洪类也；
小，即沉、细类也；急，即数也；缓，即迟也。何若竟易以浮、沉、迟、数之为得乎？再以节庵之有力、无力，
辨其表、里、虚、实，诚诊视小儿天然不易之妙诀。（陈飞霞）
看指纹
小儿形体既具，经脉已全，便有脉息可辨。自《水镜诀》及《全幼心鉴》等书，有三岁以上，当察虎口，
寅卯辰，风气命，三关之说。其中之可取者，惟曰∶脉从寅关起，不至卯关者，易治；若连卯关者，难治；若
寅侵卯，卯侵过辰者，十不救一。只此数语，亦可用辨吉凶。至若紫为风、红为寒、青为惊、白为疳，及青是
四足惊，赤是水惊，黑是人惊，黄是雷惊之类，岂此一线之色，果能辨悉如此，最属无稽，乌足凭也。（张景岳）
经义
六岁以下称为“小”。○我无法详细察知幼小之人的病情。○婴儿患病，若头发全部逆立向上，必定死亡。（《灵枢》）
总论
出生半周到两岁称为婴儿，三、四岁称为孩儿，五、六岁称为小儿，七、八岁称为龆龀（换牙期），九岁称为童子，十岁称为稚子。（《寿世保元》）
胎儿在母腹中感受精气，一个月形成胚，两个月形成胎，三个月血脉显现，四个月形体长成，五个月能活动，六个月筋骨长成，七个月毛发生出，八个月脏腑具备，九个月谷神进入胃中，十个月百骸完备而出生。出生后六十天，瞳仁成形，能笑能语，开始认识人；一百天任脉（奇经八脉之一，行于腹部正中）成，能翻身；一百八十天骶骨成，能独坐；二百一十天掌骨成，能爬行；三百天髌骨成，能独立站立；三百六十天膝骨成，开始能迈步行走。○婴儿刚出母腹，筋骨尚未收敛，肌肉尚未长成，如同水上的气泡，草头的露珠。刚出生一周之内，天地八风（八方之风）的邪气难道能立刻伤害吗？确实是因为在胎之时，母亲缺乏爱护，或者劳累导致气血相干扰，或者坐卧饥饱不当相互冲犯，或者酒肉冷热相互制约，或者惊恐导致血脉紊乱，蕴毒于体内，损伤了胎元，降生之后，所以有胎热、胎寒、胎肥、胎怯、胎惊、胎黄等病产生。外因如洗浴、擦拭口腔、断脐带、灸囟门等方法不得当，或者怀抱时受到惊恐，哺乳喂养寒温不合适宜，多导致噤口（牙关紧闭）、脐风、锁肚（大便不通）、不乳等证候。病情发展到这种地步，难以治疗，实在令人怜悯。（《千金方》）
有人问：人活着的同时就伴随着忧愁，从哪里可以看出呢？我回答说：落地一声啼哭，只听见哭声，没听见笑声，这不是忧愁又是什么？然而“忧”这个字，在婴幼时期已经先得到了。只是轻微的忧愁不会成为祸患，那些因为丧父失母、悲哀忧虑而生病的；或者断奶后思虑过度而生病的；神情萎靡恍惚，心烦哭闹，不想吃奶吃饭，从而产生内热的，就是这种情况。至于惊恐，小儿最多，在母胎时就已经有了。高兴就笑，愤怒就哭，只有喜怒无常，不能成为疾病罢了。世俗说小儿没有七情（喜、怒、忧、思、悲、恐、惊），这是荒谬的言论。（许宣治）
有人说小儿容易虚也容易实，这不对。身体柔脆不耐受病痛，固然是理所当然。但是小儿的气血归于躯壳，病也在躯壳，与成人无异，并没有所谓的“易虚”，大概是药物导致其虚罢了。小儿生机蓬勃，无病时每天长大，如果病确实无害，生机依然存在，所以看起来像“易实”。然而如果不生病就会长大，一定比生病后长得更好，所以“易实”的说法也是不对的。小儿就像嫩草木，不可克伐（攻伐），补益也不容易；草木刚萌芽时，缺水则死，水多也死，只有频繁浇灌，适量为止才合适。不仅用药如此，就连乳食也都应当知道节制。○儿科认为小儿是“纯阳”之体，应当用凉药。反对的人说：这是“稚阳”，不是“纯阳”，应该补阴以配阳。既然说是稚阳，那么阳气不足也就知道了，偏重于补阴，可以吗？阴阳二气，本来没有偏胜，小儿躯壳，由气和水分贯通，与成人有何不同？之所以与成人不同，仅仅是因为气和水分未充盈，不能免于柔脆罢了。因此治疗小儿比成人难，但也有比成人容易的地方，因为他没有人世人事的斫丧（损害）。病在阳就治阳，病在阴就治阴，哪里用得着争论纯阳还是稚阳呢！（《医参》）
有人说小儿是纯阳之体，多宜清凉，这种说法更是错误。王节斋说：小儿没有补肾的方法。他说男子到十六岁，肾气才开始充满，既满之后，如果妄加亏损，才可用药补之。如果在受孕之时，禀赋不足，那就无可补。禀赋原本充足，又何须等待补益？唉！这是什么说法呢？所谓小儿纯阳，是因为其阴气未成，即肾虚。阴既然不足，而不补它，阴绝则孤阳也会绝。殊不知钱乙（钱氏）的六味地黄丸，专门治疗小儿，因为其纯阳无阴，所以取八味丸（金匮肾气丸），裁去桂枝、附子，独补肾水，这层含义只有薛己（薛立斋）领悟到了，世间的医生大多没有悟透。（《张氏医通》）
小儿的疾病，古代称为“哑科”，因为他们言语不能相通，病情不易推测，所以说：“宁可治十个男子，不要治一个妇人；宁可治十个妇人，不要治一个小儿。”这是极力形容其难处。然而与我比较起来，这三者之中，又以小儿为最容易。大概小儿的病，不外乎外感风寒，或者内伤饮食，以至于惊风、吐泻，以及寒热、疳积、癫痫之类，不过几种。而且小儿脏气清灵，随拨动随即响应，只要能确切找到根本，那么一药即可痊愈。不像男女损伤、积痼（久治不愈的病）、痴顽那样复杂，所以我称其为易。只是人们说其难，是说其难辨别。我说其易，是说其易治疗。假如辨别得不真切，那确实难啊！然而辨别的方法，也不过是辨别表、里、寒、热、虚、实，这六种情况了然于心，又有什么难的？所以凡是外感的，必有表证，如发热、头痛、拘急、无汗，或因风引起的抽搐等；内伤的，必有里证，如吐泻、腹痛、胀满、惊疳、积聚等；热证的，必有热象，如热渴、烦躁、便秘、痈疡等；寒证的，必有寒象，如清冷、吐泻、无热、无烦、恶心、喜热等。以上四种，即表、里、寒、热之证，极易辨别。然而在四者之中，尤其以“虚实”二字最为紧要。因为有形色的虚实，有声音的虚实，有脉息的虚实。如体质强盛与柔弱是不同的；形色红赤与青白是不同的；声音雄壮与短怯是不同的；脉息滑实与虚细是不同的。必须内察脉候，外观形气，中审病情，并精细观察，又有什么虚实难辨的呢！如果确实有实邪，确实有火证，则不得不治标。然而治标的方法，宜精简轻锐，适病即止，不要损伤正气，只要见到虚象，便不可妄行攻击。如果看得不真切，不要说姑且去掉邪气，想必也无害。不知道小儿身体柔嫩，气血未坚，脏腑甚脆，稍微受到伤害，枯萎凋谢极易发生；近则造成当下的危害，远则遗留终身的羸弱。凡此，都是求本之道，确实是儿科的关键所在。○初生婴儿，用手捏其头，摸其下巴，不发声的，为无病。用手指探其口，虽然发声，但从容吮吸手指的，其病轻。如果立即发声但不吮吸手指，面色青红兼紫的，这是落地受寒，其病重。辨别其形色虚实而治疗。如果牙关紧闭不能纳乳，或者牙齿僵硬不软，其病极重。这是惊邪侵入足太阳膀胱经及足阳明胃经所致，须紧急治疗，才可以平复。（张景岳）
心主惊，实证表现为叫哭、发热、饮水而抽搐；虚证表现为因躺卧而心悸。心热则合面睡，或上窜切牙的，用导赤散主治。心气实而喜欢仰卧的，用泻心汤主治。○肝主风，实证表现为面青、目直、叫哭、壮热、项急、顿闷；虚证表现为切牙、呵欠。肝热则手循衣领，及乱捻物，用泻青丸主治。
壮热、饮水、喘闷，用泻白散主治。○肝有风则眼睛连眨，得心热则发搐，或筋脉牵系而直视，用泻青丸以治肝，用导赤散以清心。肝热则目赤，或兼青发搐的，也用前两种药。风甚则身体反张强直，用地黄丸以补肾，用泻青丸以治肝。○脾主困，实证表现为身热引饮，用泻黄散；虚证表现为吐泻生风，用异功散。面白腹痛，口中气冷，不思饮食，或吐清水，用益黄散温补脾虚。呵欠多睡的，是脾气虚而欲发惊。○肺主喘，实证表现为闷乱、气急、喘促、饮水；虚证表现为哽气、出气。肺热则手掐眉目鼻面，用甘桔汤主治。肺盛复感风寒，则胸满气急，喘嗽上气，先用泻白散，以清肺气，后用大青膏，以散风寒。肺脏怯则唇白，用阿胶散补之。闷乱气粗，喘促哽气的难治，是肺虚甚。○肾主虚，若胎虚怯，神气不足，目无睛光，面白颅解（囟门迟闭），这些都难养育，即使养育也不长寿；或目畏明下窜的，盖因骨重而身缩；切牙的，是肾水虚而不能制心火，都用六味地黄丸。（钱仲阳）
小儿行迟、齿迟、解颅（囟门不合）、囟填、囟陷、五软、五硬、鹤膝、肾疳、齿豁、睛白等证候，这都是禀受不足，治疗用六味地黄丸加鹿茸。如果是因精未满，而过早御女泄精，多导致头眩、作渴、多痰，或发热、腰酸，或自汗、盗汗，二便涩痛，当用六味地黄丸、八味地黄丸及补中益气汤加减，无不奏效。（薛立斋）
婴儿肌肉柔脆，不耐风寒，脏腑气弱，乳汁难化，内外二因的疾病自然多。然而有的并非风寒竟致外感，不停滞已属内伤，这是什么缘故呢？我曾思考人在气交之中，春夏地气上升，秋冬天气下降，呼出吸入，与时消息，间有秽浊吸入，即是三焦受邪，过膜原直行中道，必发热烦躁。儿科医生只执着于表散、消导、清火、通便，病轻或许有幸治愈，病重必然颠覆。钱仲阳说：粪履不可靠近襁褓中的小儿，我的话并非没有依据。○小儿各种证候，如发热无汗，烦躁昏谵之际，或战汗将止之时，或吐泻之后，或痉厥渐苏，或便闭适解，或灌药之后，正是元气与病邪交战之际，若能养护得一分元气，即退一分病邪。此时患儿，必有昏睡懒言，气怯神弱，身不转动之状，正当养其元神，期望其邪退正复。然而病患家属父母，偏偏在此际，张惶惊恐，因其不语，而呼之、唤之；因其鼾睡，而频叫醒之；因其不动，而摇之拍之。或因微有昏谵，而必详诘之；或急以汤饮进之；或屡问其痛痒，哓哓不已，使其无片刻安神。如此必轻变重、重变死。更有豪富之家，延请多位医生，问候多人，房中聚集，互谈病情，夜则多燃灯烛照之，或对之哭泣，或信巫不信医，举家纷扰，这不是爱他，其实是杀他。试以大人的病情体会，是喜欢安然寂静呢？还是喜欢喧哗动扰呢？这个道理概可知晓。（《临证指南》）
察色
古称望而知之谓之神。儿科号称哑科，脉来驶疾，指下难明，尤以察色为要，所以首先叙述。察其面部五色，以知病源。人身五体，以头为首，首中有面，面中有睛，睛中有神。神，是指眼中的光彩。隐显横冲，应位而见，以应五脏。五色，即青、黄、赤、白、黑。五脏之色：心赤，肝青，脾黄，肺白，肾黑。五脏所主的病证，蕴于内必形于外，所以小儿有病，先观其本位形色，以论五行生克吉凶。形色若不相应，然后听声切脉。（《证治准绳》）
左腮属肝，右腮属肺，额属心，鼻属脾，颐属肾。青色主惊，红色主痰热，黄色主食积、癖块，白色主泄泻水谷，黑色主肾气受伤。（《小儿直诀》）
望、闻、问、切，固然是医家不可少的一项。在大人方面是这样，而小儿惟以望为主，问继之，闻则次，而切则几乎没有。《内经》说：切而知之谓之巧。小儿脉体未全，切无可切，而巧也无所用其巧。问而知之谓之工。小儿未说话时，问固无可问；即使能说话时，问之多不以实对，是问不必问，而工也无所用其工。闻而知之谓之圣。小儿初病时，声音或不失其常，至病久而气丧声失，闻无可闻，而圣又何见其圣呢？所以我以望为主。有人说：五脏所属，体隐理微，望从何处？回答说：体固隐矣，而发见于苗窍颜色之间者，用无不周；理固微矣，而昭着于四大五官之外者，无一不显。所以病于内，必形于外，望形审窍，自知其病。舌乃心之苗，红紫，是心热；肿黑，是心火极；淡白，是虚。鼻准与牙床，乃脾之窍，鼻红燥，是脾热；惨黄，是脾败；牙床红肿，是热；破烂，是胃火。唇亦脾之窍，红紫，是热；淡白，是虚；黑者，是脾将绝。口右扯，是肝风；左扯，是脾痰。鼻孔，乃肺之窍，干燥，是热；流清涕，是寒。耳与齿，乃肾之窍，耳鸣，是气不和；耳脓，是肾热；齿如黄豆，是肾气绝。目乃肝之窍，斜视而睛转者，是风；直视而睛不转者，是肝气将绝。（夏禹铸）
听声
声音用来候察元气的浓薄，进而审察病苦之所在，所以古人有隔垣之治（隔着墙也能治病，形容医术高明，能通过听声诊断）的说法。声音重的，是伤风；声音壮的，是实热；声音悲的，是脏燥；声音焦的，是恐怖欲生风候；声音重浊的，是肠胃有积；声音沉静的，是疳积无疑；只哭无声的是惊；多啼不哭的是痛；声音轻频的是风痫；声音缓而无气的是吐泻；声音嘶哑的是咳嗽喉痛；声音促急的是喘迫上气；声音迟缓的是泄泻肠鸣。诸如此类，都可以通过听而知晓。（《证治合参》）
看小儿的方法，以听声为先，察色为次。凡是声音清亮的生；有回音的生；涩的病散；而没有出声的不长寿；忽然大声而无病的，须细看其身，恐有疮毒；泣不出声的死；泣而无泪的死。（张景岳）
脉法
凡是诊察小儿，既然言语不通，尤当以脉为主，参以形色声音，则万无一失了。然而小儿的脉，不比大人多端，只要察其强、弱、缓、急，这就是关键。因为强弱可以见虚实，缓急可以见邪正。这四者既明，无论诸证，随病合脉，左右逢源，所遇皆道了。（张景岳）
小儿一岁后，可用一指转侧，辨其三部脉之弦、急、浮、沉。四、五岁后，脉七、八至而细数者，为平脉；九至者伤；十至者困；六至、五至者，为虚、为寒；弦、紧为风痫；弦急为客忤；其变蒸（小儿生长发育过程中的生理现象）者，脉必散乱；骨间有热，脉则沉数；若浮而不调为鬼祟；浮大而数为风热；伏结为物聚；微细为疳积为腹痛；浮而洪，为有虫；浮而迟，为胃寒。这是论脉的大要。又当参以三部五脉：三部者，乃看面上气色，虎口脉纹，寸口一指脉。五脉者，上按额前，下诊太冲，并前三部，谓之五脉。（薛铠）
黄帝问：乳子（吃奶的婴儿）而病热，脉悬小者何如？岐伯答：手足温则生，寒则死。黄帝问：乳子中风热，喘鸣肩息（呼吸时肩膀耸动）者，脉何如？岐伯答：喘鸣肩息者，脉实大也。缓则生、急则死。这是《内经》的宗旨。圣人立言，简切而总括无余，世人不懂，视为寻常，能于此等处着眼，则诊视之要，思过半矣。我临证诊视，每论吉凶，则多中者，亦不外此。只是意之所至，口莫能宣。窃详《经》所谓大、小、缓、急者，也是发而不露之意。盖大，即浮、洪类也；小，即沉、细类也；急，即数也；缓，即迟也。何不竟易以浮、沉、迟、数之为得乎？再以节庵（李中梓号）之有力、无力，辨其表、里、虚、实，诚诊视小儿天然不易之妙诀。（陈飞霞）
看指纹
小儿形体既具，经脉已全，便有脉息可辨。自《水镜诀》及《全幼心鉴》等书，有三岁以上，当察虎口，寅卯辰，风气命，三关之说。其中可取的，只曰：脉从寅关起，不至卯关者，易治；若连卯关者，难治；若寅侵卯，卯侵过辰者，十不救一。只此数语，也可用以辨吉凶。至于若紫为风、红为寒、青为惊、白为疳，及青是四足惊，赤是水惊，黑是人惊，黄是雷惊之类，岂此一线之色，果能辨悉如此，最属无稽，乌足凭也。（张景岳）
Jing Yi (Scriptural Principles)
Children under six years of age are referred to as "small" (xiao). ○ I am unable to meticulously observe the conditions of infants and young children. ○ If an infant with illness has all their head hair standing upright, death is certain. (*Ling Shu* / Spiritual Pivot)
General Discussion
From half a week after birth to two years old is called "infant" (ying er); three to four years old is called "hai er"; five to six years old is called "xiao er" (child); seven to eight years old is called "tao chen" (period of changing teeth); nine years old is called "tong zi"; ten years old is called "zhi zi". (*Shou Shi Bao Yuan*)
The fetus receives essence and qi in the mother's womb: at one month it forms as a "pei" (embryo); at two months as a "tai" (fetus); at three months blood vessels appear; at four months the physical form is established; at five months it can move; at six months bones and sinews are formed; at seven months hair grows; at eight months internal organs are complete; at nine months the "gu shen" (spirit of grain/nutrition) enters the stomach; at ten months the hundred bones are prepared, and the child is born. Sixty days after birth, the pupils are formed, capable of smiling and speaking, beginning to recognize people; at one hundred days, the Ren Mai (Conception Vessel) is formed, capable of turning over; at one hundred eighty days, the sacral bone is formed, capable of sitting alone; at two hundred ten days, the metacarpal bones are formed, capable of crawling; at three hundred days, the patella is formed, capable of standing independently; at three hundred sixty days, the knee bones are formed, beginning to take steps. ○ When a baby first leaves the womb, the bones and sinews have not yet consolidated, and muscles have not fully developed, like bubbles on water or dew on grass. Within the first week after birth, how could the pathogenic factors of the Eight Winds (Ba Feng) from heaven and earth immediately cause harm? It is truly because during gestation, the mother failed to provide proper care, such as excessive labor disturbing the blood and qi, improper sitting/lying or hunger/fullness causing conflict, inappropriate consumption of alcohol/meat or hot/cold foods creating imbalance, or fright disrupting the blood vessels. These factors accumulate toxins internally, damaging the fetal origin (Tai Yuan). After birth, diseases such as Tai Re (Fetal Heat), Tai Han (Fetal Cold), Tai Fei (Fetal Obesity), Tai Qie (Fetal Weakness), Tai Jing (Fetal Fright), and Tai Huang (Fetal Jaundice) arise. External causes include improper methods for bathing, wiping the mouth, cutting the umbilical cord, or moxibustion on the fontanelle, or fright from holding/carried, or inappropriate temperature management during breastfeeding. These often lead to conditions such as Jin Kou (Lockjaw/Unclosable mouth), Qi Feng (Umbilical Wind), Suo Du (Locked Belly/Constipation), and refusal to nurse. When disease reaches this stage, treatment is difficult, which is truly pitiable. (*Qian Jin Fang* / Essential Prescriptions Worth a Thousand Gold)
Someone asked: "Human life arises together with sorrow/worry; where is this evident?" I replied: "Upon landing, there is only one cry; no laughter is heard. Is this not sorrow? Thus, the character 'you' (sorrow/worry) is already present in infancy and childhood. However, minor sorrow does not become a affliction. Those who become ill due to the loss of parents, grief, and anxiety; or those who become ill due to weaning and excessive thinking; presenting with listlessness, irritability, crying, and lack of appetite for milk and food, thereby generating internal heat—these are examples. As for fright, it is most common in children, having been present since the fetal stage. Joy leads to smiling, anger leads to crying; only when joy and anger are unpredictable do they fail to constitute disease. The popular saying that children do not possess the Seven Emotions (Qi Qing) is absurd." (Xu Xuanzhi)
Some say children are prone to both deficiency and excess, which is incorrect. Their fragile constitution makes them intolerant of pain and illness, which is logical. However, their qi and fluids reside within the body shell, and illness also resides in the body shell, just like adults; there is no inherent 'prone to deficiency.' It is likely that medications induce deficiency. Children have vigorous vital energy; without illness, they grow daily. If an illness is truly harmless, their vital energy remains intact, so it appears 'prone to excess.' Yet, if they did not get sick, they would grow better than those who did; thus, the theory of 'prone to excess' is also incorrect. Children are like tender grass and trees; they cannot withstand harsh purging, nor is tonification easy. When plants are just sprouting, lack of water causes death, and too much water also causes death; only frequent watering, stopping when sufficient, is appropriate. This applies not only to medication but also to milk and food intake, which must be regulated. ○ Pediatrics claims children are of a 'Pure Yang' (Chun Yang) constitution and should use cooling herbs. Critics argue: "This is 'Tender Yang' (Zhi Yang), not 'Pure Yang'; one should tonify Yin to harmonize Yang." If it is Tender Yang, then Yang is insufficient; is it appropriate to偏 (deviate towards) tonifying Yin? Yin and Yang qi naturally have no dominance. The child's body shell is permeated by qi and fluids, just like an adult. The difference lies only in the fact that qi and fluids are not yet full, making them fragile. Therefore, treating children is harder than adults, but also easier, because they have not suffered damage from worldly affairs. If disease is in Yang, treat Yang; if in Yin, treat Yin. Why debate Pure Yang vs. Tender Yang! (*Yi Can*)
Some claim children are of a Pure Yang constitution and mostly benefit from cooling therapies; this view is even more erroneous. Wang Jiezhai said: "There is no method for tonifying the Kidney in children." He stated that males reach kidney fullness at sixteen; only after fullness, if recklessly depleted, can medicine be used to tonify. If conception was deficient in endowment, there is nothing to tonify. If endowment was originally sufficient, why wait for tonification? Alas! What kind of theory is this? The term 'Pure Yang' for children refers to the fact that their Yin qi is not yet formed, i.e., Kidney deficiency. Since Yin is insufficient, failing to tonify it will lead to Yin exhaustion, and then the solitary Yang will also perish. Little do they know that Qian Yi's Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) is specifically for children. Because they are 'Pure Yang without Yin,' he took Ba Wei Wan (Eight-Ingredient Pill), removed Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root), and solely tonified Kidney Water. Only Xue Lizhai understood this meaning; most physicians in the world have not realized it. (*Zhang Shi Yi Tong* / Zhang's Medical Compendium)
Childhood illnesses were anciently called the "Mute Department" (Ya Ke) because speech is not fluent, and symptoms are hard to predict. Hence the saying: "Better to treat ten men than one woman; better to treat ten women than one child." This exaggerates the difficulty. However, comparing them, among the three, children are actually the easiest to treat. Generally, childhood illnesses are either external contraction of Wind-Cold or internal injury from diet, leading to Wind Convulsion, vomiting/diarrhea, cold/heat disorders, Gan accumulation, or epilepsy—only a few types. Moreover, children's organ qi is clear and agile, responding immediately to intervention. If the root cause is accurately identified, one prescription can cure. Unlike adults with injuries, chronic stubborn diseases, or mental confusion, I consider them easy. People say they are difficult because they are hard to differentiate. I say they are easy because they are easy to treat. If differentiation is inaccurate, then indeed it is difficult! But the method of differentiation is simply distinguishing Exterior, Interior, Cold, Heat, Deficiency, and Excess. If these six are clear, what is difficult? For external contractions, there must be Exterior signs, such as fever, headache, stiffness, absence of sweat, or wind-induced convulsions. For internal injuries, there must be Interior signs, such as vomiting/diarrhea, abdominal pain, distension, Gan accumulation, or masses. For Heat, there must be Heat signs, such as thirst, irritability, constipation, or abscesses. For Cold, there must be Cold signs, such as coldness, vomiting/diarrhea, absence of fever, absence of irritability, nausea, or preference for warmth. These four categories (Exterior, Interior, Cold, Heat) are very easy to identify. Among these, 'Deficiency' and 'Excess' are the most critical. There is Excess/Deficiency in appearance, voice, and pulse. Constitution strength differs from weakness; red complexion differs from cyanotic/pale; strong voice differs from short/timid voice; slippery/solid pulse differs from weak/thin pulse. One must internally examine the pulse, externally observe form and qi, centrally assess symptoms, and carefully distinguish them. How can Deficiency/Excess be hard to discern! If there is truly Excess pathogen or Fire syndrome, treating the branch (symptoms) is necessary. However, branch treatment should be concise, light, and sharp, stopping when the disease resolves, without harming healthy qi. Once deficiency signs appear, aggressive attack must cease. If misjudged, thinking that removing pathogens temporarily is harmless is wrong. Children's bodies are tender, qi and blood are not firm, and organs are fragile; slight injury leads to rapid decline. Near-term harm is immediate; long-term harm is lifelong debility. This is the way of seeking the root, truly the key point of pediatrics. ○ For newborns, pressing the head and touching the jaw without sound indicates no illness. Probing the mouth; if sound is produced but sucking finger is calm, illness is mild. If sound is immediate but no sucking, and face is cyanotic-red-purple, this is cold contracted at birth; illness is severe. Treat according to form, color, deficiency, and excess. If teeth are tight refusing milk, or hard/unyielding, illness is extreme. This is due to pathogenic fright invading the Foot-Taiyang Bladder Meridian and Foot-Yangming Stomach Meridian; urgent treatment is required for recovery. (Zhang Jingyue)
The Heart governs fright. Excess manifests as crying/shouting, fever, drinking water, and convulsions; Deficiency manifests as palpitations while lying down. Heart Heat manifests as sleeping face-down or grinding teeth; treated with Dao Chi San (Guide Out Red Powder). Heart Qi Excess manifesting as preference for supine position; treated with Xie Xin Tang (Drain the Heart Decoction). ○ The Liver governs Wind. Excess manifests as green face, straight eyes, crying/shouting, high fever, neck stiffness, chest oppression; Deficiency manifests as teeth grinding and yawning. Liver Heat manifests as hands rubbing clothes or randomly picking objects; treated with Xie Qing Wan (Drain Green Pill). High fever, thirst, wheezing/oppression; treated with Xie Bai San (Drain White Powder). ○ Liver Wind causes eye twitching; combined with Heart Heat causes convulsions, or tendon binding with fixed gaze. Use Xie Qing Wan to treat Liver, and Dao Chi San to clear Heart. Liver Heat causes red eyes or cyanosis with convulsions; use the same two formulas. Severe Wind causes opisthotonos and rigidity; use Di Huang Wan (Rehmannia Pill) to tonify Kidney, and Xie Qing Wan to treat Liver. ○ Spleen governs lethargy. Excess manifests as body heat and thirst; treated with Xie Huang San (Drain Yellow Powder). Deficiency manifests as vomiting/diarrhea generating Wind; treated with Yi Gong San (Yi Gong Powder). Pale face, abdominal pain, cold breath, poor appetite, or vomiting clear fluid; treated with Yi Huang San (Benefit Yellow Powder) to warm and tonify Spleen Deficiency. Frequent yawning and sleepiness indicate Spleen Qi Deficiency predisposing to fright. ○ Lungs govern panting. Excess manifests as restlessness, rapid breathing, panting, thirst; Deficiency manifests as sighing and shallow breathing. Lung Heat manifests as scratching eyebrows/eyes/nose/face; treated with Gan Jie Tang (Licorice and Magnolia Bark Decoction). Lung Excess combined with Wind-Cold invasion causes chest fullness, rapid breathing, coughing with reverse qi; first use Xie Bai San to clear Lung Qi, then Da Qing Gao (Great Blue Ointment) to disperse Wind-Cold. Lung Deficiency/Qi weakness causes pale lips; treated with E Jiao San (Donkey-Hide Gelatin Powder). Restlessness, coarse breathing, panting, and sighing are difficult to treat, indicating severe Lung Deficiency. ○ Kidneys govern Deficiency. Fetal Deficiency/Qi weakness, insufficient spirit, dull eyes, pale face, open fontanelles—all indicate difficult rearing and short lifespan. Eyes fearing light and looking down indicate heavy bones and curled body; teeth grinding indicates Kidney Water Deficiency failing to control Heart Fire; all treated with Di Huang Wan. (Qian Zhongyang)
Conditions such as delayed walking, delayed teething, open fontanelles (Jie Lu), bulging fontanelle, sunken fontanelle, Five Softs, Five Hardnesses, Crick Knee, Kidney Gan, loose teeth, white eyes, etc., are all due to insufficient endowment. Treat with Liu Wei Di Huang Wan plus Lu Rong (Deer Antler). If seminal essence is not full, but sexual activity depletes it, it often leads to dizziness, thirst, phlegm, fever, sore back, spontaneous sweating, night sweats, and painful/difficult urination/stool. Treat with Liu Wei Di Huang Wan, Ba Wei Di Huang Wan, and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with modifications; efficacy is assured. (Xue Lizhai)
Infants have tender muscles, intolerant to Wind-Cold; weak organ qi, difficult to digest milk; thus, diseases from both internal and external causes are common. However, some cases are not caused by Wind-Cold exterior contraction, nor by food stagnation interior injury. Why? Humans exist in the intersection of qi. In spring/summer, earth qi rises; in autumn/winter, heaven qi descends. Inhalation and exhalation fluctuate with time. Occasionally, turbid qi is inhaled, affecting the San Jiao (Triple Burner). Passing through the Mo Yuan (Membrane Source) directly into the central pathway, it causes fever and irritability. Pediatricians often stick to exterior-releasing, digestion-promoting, fire-clearing, or bowel-unblocking methods. Mild illness may luckily resolve; severe illness will surely collapse. Qian Zhongyang said: "Footwear should not approach swaddled infants." My words are well-founded. ○ In various pediatric conditions, such as fever without sweat, irritability, delirium, during the cessation of chills-and-sweating, after vomiting/diarrhea, during gradual recovery from spasms/coma, after relief of constipation, or after administering medicine—this is the moment when healthy yuan qi battles pathogenic evil. If one can nourish one part of yuan qi, one part of pathogenic evil retreats. At this time, the child exhibits lethargy, reluctance to speak, weak qi and spirit, and immobility. One should nourish the primordial spirit, hoping for evil retreat and healthy qi restoration. However, anxious parents, frightened and panicked, call out when silent, wake frequently from snoring sleep, shake and pat when immobile. Due to slight delirium, they interrogate excessively; rush to give liquids; repeatedly ask about pain/itching, incessantly, denying the child any peace. This turns mild illness to severe, and severe to fatal. Wealthy families hire multiple doctors, visit frequently, crowd rooms discussing illness, burn many lamps at night, cry before the child, trust shamans over doctors, causing household chaos. This is not love, but killing. Consider adult patients: do they prefer quiet tranquility or noisy disturbance? This logic is obvious. (*Lin Zheng Zhi Nan* / Guide to Clinical Practice)
Observing Color
Ancient texts state: "Knowing through observation is called Divine." Pediatrics is called the Mute Department; pulses are rapid and hard to distinguish under fingers, so observing color is crucial, hence discussed first. Observe the five colors of the face to know the disease source. Of the five body parts, the head is chief; in the head is the face; in the face are the eyes; in the eyes is Shen (Spirit). Shen refers to the luster in the eyes. Its manifestation corresponds to positions and reflects the Five Zang Organs. The five colors are Cyan, Yellow, Red, White, Black. Colors of the Five Zang: Heart Red, Liver Cyan, Spleen Yellow, Lung White, Kidney Black. Diseases governed by the Five Zang, stored internally, must manifest externally. Thus, for childhood illness, first observe the color and form of the corresponding location to discuss the auspiciousness/misfortune of Five Elements generation/restriction. If color/form do not correspond, then listen to voice and feel pulse. (*Zheng Zhi Zhun Sheng* / Standardized Treatment)
Left cheek belongs to Liver, right cheek to Lung, forehead to Heart, nose to Spleen, chin to Kidney. Cyan indicates Fright; Red indicates Phlegm-Heat; Yellow indicates Food Accumulation/Pi Mass; White indicates Diarrhea of undigested food; Black indicates Kidney Qi Injury. (*Xiao Er Zhi Jue* / Direct Rules for Children)
Inspection, Listening/Smelling, Inquiry, and Palpation are indispensable for physicians. For adults, this holds true. For children, Inspection is primary, Inquiry secondary, Listening/Tertiary, and Palpation negligible. *Jing* says: "Palpating to know is called Skillful." Children's pulse bodies are incomplete; palpation has no target, so skill is useless. "Inquiring to know is called Artisan." Before speaking, inquiry is impossible; even when speaking, answers are often untrue; so inquiry is unnecessary, and artisan skill is useless. "Listening to know is called Sage." Early illness, voice may be normal; late illness, qi fails and voice is lost; listening has no target, so sagehood is unseen. Therefore, I prioritize inspection. Someone asks: "Organs are hidden, principles subtle; where does inspection begin?" Reply: "Though hidden, manifestations in orifices and colors are comprehensive; though subtle, appearances in limbs and senses are evident. Disease inside must manifest outside; observing form and examining orifices reveals the disease. Tongue is the sprout of Heart; Red/Purple indicates Heart Heat; Swollen/Black indicates Extreme Heart Fire; Pale/White indicates Deficiency. Nose tip and gums are orifices of Spleen; Red/Dry nose indicates Spleen Heat; Dull Yellow indicates Spleen Failure; Red/Swollen gums indicate Heat; Ulcerated gums indicate Stomach Fire. Lips are orifices of Spleen; Red/Purple indicates Heat; Pale/White indicates Deficiency; Black indicates Spleen nearing extinction. Mouth pulling to right indicates Liver Wind; pulling to left indicates Spleen Phlegm. Nostrils are orifices of Lung; Dryness indicates Heat; Clear runny nose indicates Cold. Ears and Teeth are orifices of Kidney; Tinnitus indicates Qi disharmony; Ear pus indicates Kidney Heat; Teeth like soybeans indicate Kidney Qi extinction. Eyes are orifices of Liver; Strabismus with moving eyeballs indicates Wind; Fixed gaze with non-moving eyeballs indicates Liver Qi nearing extinction." (Xia Yuzhu)
Listening to Sound
Sound monitors the thickness/thinness of yuan qi and locates suffering. Hence ancients had "treating across walls" abilities. Heavy voice indicates Wind Injury; Strong voice indicates Excess Heat; Sad voice indicates Organ Dryness; Hoarse/Broken voice indicates Terror impending Wind Syndrome; Turbid voice indicates Intestinal/Stomach Accumulation; Quiet voice indicates Gan Accumulation without doubt. Crying without wailing indicates Fright; Wailing without crying indicates Pain; Light/Frequent voice indicates Wind Epilepsy; Slow/Airless voice indicates Vomiting/Diarrhea; Hoarse voice indicates Cough/Throat Pain; Rapid/Urgent voice indicates Panting/Reverse Qi; Sluggish/Slow voice indicates Diarrhea/Bowel Sounds. All such cases can be known by listening. (*Zheng Zhi He Can* / Combined References for Treatment)
Method for examining children: Listen to sound first, observe color second. Clear/bright voice indicates survival; Echoing voice indicates survival; Rough voice indicates dispersing illness; No voice indicates short life; Sudden loud voice without illness requires checking body for sores/toxins; Crying without sound indicates death; Crying without tears indicates death. (Zhang Jingyue)
Pulse Method
When diagnosing children, since speech is unclear, pulse is primary, supplemented by color, form, and sound, ensuring no error. However, children's pulses are not as varied as adults'. Observating Strength, Weakness, Slowness, and Rapidity is the key. Strength/Weakness reveals Deficiency/Excess; Slowness/Rapidity reveals Pathogen/Healthy Qi. Understanding these four allows handling any condition, fitting pulse to disease, achieving mastery. (Zhang Jingyue)
After one year of age, use one finger to roll side-to-side, distinguishing String-taut, Urgent, Floating, and Deep pulses in the three positions. After four/five years, a pulse of 7-8 beats per breath, fine and rapid, is Normal; 9 beats indicates Injury; 10 beats indicates Exhaustion; 6 or 5 beats indicate Deficiency/Cold; String-taut/Tight indicates Wind Epilepsy; String-taut/Urgent indicates Guest Chou (Sudden Fright); During Bian Zheng (physiological growth changes), pulse must be scattered/disordered; Heat in bones results in Deep/Rapid pulse; Floating and irregular indicates Ghost Influence; Floating/Large/Rapid indicates Wind-Heat; Hidden/Knotted indicates Mass Accumulation; Fine/Weak indicates Gan Accumulation/Abdominal Pain; Floating/Huge indicates Parasites; Floating/Sluggish indicates Stomach Cold. This is the general principle of pulse diagnosis. Also refer to Three Positions and Five Pulses: Three Positions are facial color, Tiger's Mouth pulse pattern, and Cun Kou (radial artery) one-finger pulse. Five Pulses add pressing forehead anteriorly and diagnosing Tai Chong (Liver 3) inferiorly, combined with the previous three. (Xue Kai)
Emperor asked: Infant with fever, pulse suspended and small—what happens? Qibo answered: Hands and feet warm means survival; cold means death. Emperor asked: Infant with Wind-Heat, panting, wheezing, shoulder breathing—what is the pulse? Qibo answered: Panting/wheezing/shoulder breathing indicates Large/Solid pulse. Slow means survival; Urgent means death. This is the intent of *Nei Jing*. Sages spoke concisely and comprehensively. Worldly people misunderstand, treating it as ordinary. Focusing here covers half the diagnostic essentials. My clinical experience confirms this. The *Jing*'s terms Large, Small, Slow, Urgent imply Floating/Huge, Deep/Fine, Rapid, Sluggish respectively. Why not simply use Floating, Deep, Sluggish, Rapid? Adding Li Zhongzi's (Jie'an) Strong/Weak distinction for Exterior/Interior, Deficiency/Excess is indeed the natural, unchangeable secret of pediatric diagnosis. (Chen Feixia)
Inspecting Finger Veins
Once physical form and meridians are complete, pulse can be distinguished. Books like *Shui Jing Jue* and *Quan You Xin Jian* mention inspecting Tiger's Mouth after age three, using Yin/Mao/Chen branches, Wind/Qi/Life gates, and Three Passes theory. The useful part states: Pulse starting at Yin pass, not reaching Mao pass, is easy to treat; reaching Mao pass is difficult; invading Mao and exceeding Chen pass is ten deaths for one cure. These few words suffice for prognosis. Claims that Purple is Wind, Red is Cold, Cyan is Fright, White is Gan, or specific colors indicate specific types of fright (Four-footed, Water, Human, Thunder) are baseless. Can a single line of color really distinguish all this? It is absurd and unreliable. (Zhang Jingyue)