凡儿禀受。脏腑气血。荣卫形体。虽有生皆全。然于未语之前。变蒸之际。则血气未充。肤革未固。筋骨未
坚。脉状未成。若有病也。难为诊切。又难访问。以是贤圣言婴小之病难治者。以无承据也。故立其观视形色之
法焉。儿自生。积五百七十六日。大小变蒸数毕。则气血荣。精神异。筋骨壮。脉理全。然后方可诊切。又能言
问也。或以谓小儿之阴。与壮老不同者。是不达延医之大体也。凡脉之长短迟速。在因形以别之。不必拘于至
数。经言小儿脉多雀斗。要以三部为主。其脉小数小细者平也。诸家所言甚众。今择其当者具之。孙真人
云。小儿之脉。固难分表里。今撮其要者。不出数条。其总目歌曰。小儿有病须凭脉。一指三关定其息。（小儿
臂短。难以布其三指以分三关也。以一指诊之）浮洪风热数为惊。虚冷沉迟实有积。
浮脉为风。秋得之曰平。余时得之。主伤风寒。头疼壮热。或夜热昼凉。咳嗽嚏喷。鼻塞清涕。呕逆不食。
〔歌曰〕浮为风兮秋日平。余中风寒头目疼。壮气夜极鼻清涕。嚏喷咳嗽吐食频。
洪脉为热。夏得之曰平。余时得之。主风热壅盛。身体温壮。疮疡血泄。
〔歌曰〕洪为应候夏时和。余须发热壮温多。风壅作惊或疮
肿。有时泄下血滂沱。
数脉为惊。春得之曰平。余时得之。主惊风抽掣。脉数小者。多睡惕跳。直视怕怖。盗汗非时。切牙吐
舌。微吐喘息。脉数大者。一两日间。必发搐搦也。
〔歌曰〕数为惊候春日长。余时小数睡惊扬。喘息直视舌频吐。大数潮搐发沉殃。
沉迟为虚冷。冬得之曰平。余时得之。主脾胃虚弱。泄泻滑肠脱肛。吐痢不止。日渐 羸。以成脾困。或作
疳劳。
〔歌曰〕沉迟之脉冬日安。余时脾胃弱虚言。泄泻滑肠肛脱出。吐痢 羸瘦变疳。
实脉为积滞。四时得之。皆主食伤积聚。面黄腹胀。发焦烦渴。吐 腹痛。
〔歌曰〕实脉含伤积滞言。壮热腹胀发毛干。吐痢肚疼或为癖。四时无异一般看。
实鉴四时脉。谓者弦夏洪。秋浮冬沉。四季缓。各推其王相表里以察病。假令春得弦而浮者。病在表在府。
为阳为顺。病则易治。若得弦而沉者。病在里在藏。为阴为逆。病则难治。余时仿之。
王氏脉歌 小儿乳后辄吐逆。更兼脉乱无忧虑。弦急之时被寒缠。脉缓即是不消乳。紧急细快亦少苦。虚
濡邪气惊风助。痢下宣肠急痛时。浮大之脉归泉路。
脉经曰。小儿之脉快疾。一息七八至曰平。不及曰损。太过曰至。
通真子歌 小儿三岁至五岁。呼吸须将八至看。九至不安十至困。短长大小有邪干。
又曰 小儿脉紧是风痫。沉脉须知乳化难。腹痛紧弦牢实秘。沉数有热在骨间。
死证脉 脉来三动而止不见者死。脉来速如弓弦硬直者死。脉来瞥然不见者死。
〔歌曰〕三动而止不来凶。速硬如弦劲在弓。瞥然至而反不见。皆为死脉定由宗。
诸般病脉 脉弦者为风寒。弦数者为疟。脉急者为气不和。或
为客忤。脉紧者为痛。紧数者惊痫。脉浮者为风。浮紧者惊风。浮大者伤寒。浮虚者盗汗。浮数者风热。脉伏
者为气滞。脉缓脉细者皆为冷。为乳不化。脉虚脉濡者。为虚弱。为惊。虚濡者慢惊风。虚紧者伏
热，脉沉重者为有积。沉数者骨间冷。（一云骨间热）沉迟者虚冷。沉缓者伤食。脉牢紧者癖聚。牢实者肠秘。
心脉满大。肝脉小急者惊痫。心脉数小者疳淋。数急者热。寸口脉直上直下者为惊。寸口脉大小脉不匀。乱者
变蒸。左手寸口无脉。心痛中热。呕逆口疮。或咳嗽。喉中哽声。头汗出而热。此乳母食冷以乳儿所作也。又脉
乱者吐逆。右手寸口无脉。胸满短气。吐逆噫哕。喉中响。此乳母抱儿冲冒风寒所作也。凡脉如雀啄而紧者
风痫。
凡脉大小不根据部次者恶候。
凡小儿脉快。呼吸八至曰平。九至曰病。十至曰困。
凡小儿脉虚者病亦虚。轻手得也。脉实者病亦实。重手得也。故急惊脉促急。慢惊脉虚微。
凡是小儿的先天禀赋，其脏腑、气血、营卫和形体，虽然出生时都具备完整的基础，但在尚未学会说话之前，处于“变蒸”（婴幼儿生长发育过程中的生理现象）阶段时，血气尚未充盈，皮肤腠理尚未坚固，筋骨尚未强健，脉象形态尚未形成。此时若有疾病，很难进行切脉诊断，也难以通过询问病史来了解病情。因此，古代圣贤说婴儿和小儿的疾病难治，是因为缺乏确切的诊断依据。所以确立了观察小儿神色和形体的诊法。
小儿从出生起，经过五百七十六天，大小“变蒸”周期全部结束后，气血才会旺盛，精神面貌会有变化，筋骨变得强壮，脉理结构完备。然后才可以进行切脉诊断，并且能够言语回答问话。
有人声称小儿的阴气与成年人不同，这是不懂医学大体原则的说法。凡是通过脉象判断长短迟速，应根据小儿的体型特征来辨别，不必拘泥于具体的至数（脉搏跳动次数）。医经中说小儿脉象多如雀啄或斗柄状，但关键在于把握寸、关、尺三部脉象。脉象细小而快速属于平脉（正常脉象）。各家说法很多，现在选取恰当的内容列举如下。
孙思邈真人说：小儿的脉象固然难以分辨表里，现在概括其主要要点，不出几条。总纲歌诀说：“小儿有病须凭脉，一指三关定其息。”（因为小儿手臂短小，难以用三根手指分别按在寸、关、尺三部，所以用一根手指诊察。）
浮脉主风邪，秋季出现称为平脉；其他季节出现，主伤风寒，症状包括头痛高热，或者夜间发热白天凉爽，咳嗽打喷嚏，鼻塞流清涕，呕吐逆气不能进食。
〔歌诀〕浮脉主风邪，秋季见为平；其余季节见，中风寒致头目痛；壮热夜间极甚，鼻流清涕，频繁打喷嚏、咳嗽、呕吐食物。
洪脉主热证，夏季出现称为平脉；其他季节出现，主风热壅盛，症状包括身体温热壮热，疮疡出血泄泻。
〔歌诀〕洪脉顺应夏时之和；其余季节多见发热壮温；风热壅盛引发惊风或疮肿，有时伴有大量便血。
数脉主惊风，春季出现称为平脉；其他季节出现，主惊风抽搐。脉数而细小的，多表现为嗜睡易惊跳，直视恐惧，非正常时间盗汗，磨牙吐舌，轻微喘息；脉数而大的，一两天内必然发生抽搐。
〔歌诀〕数脉主惊候，春日长见为平；其余季节小数则睡眠中易惊扬；喘息直视、频繁吐舌；大数之脉则潮热抽搐，发为沉疴。
沉迟脉主虚冷，冬季出现称为平脉；其他季节出现，主脾胃虚弱，症状包括泄泻滑肠脱肛，呕吐痢疾不止，日渐消瘦，形成脾困，或者发展为疳积劳损。
〔歌诀〕沉迟之脉冬日安适；其余季节提示脾胃弱虚；泄泻滑肠肛门脱出，呕吐痢疾导致羸瘦变为疳积。
实脉主积滞，四季出现，皆主饮食损伤积聚，症状包括面色黄、腹胀、毛发焦枯、烦躁口渴，呕吐腹痛。
〔歌诀〕实脉包含伤食积滞之意；壮热腹胀、毛发干枯；呕吐痢疾肚疼或形成癖块，四季诊察无异一般看待。
综合鉴别四时脉象，所谓弦脉见于春，洪脉见于夏，浮脉见于秋，沉脉见于冬，缓脉见于四季末月。各推求其旺相表里关系以察病机。例如春季见到弦而浮的脉象，病在表、在腑，属阳、属顺，病则容易治疗；若见到弦而沉的脉象，病在里、在脏，属阴、属逆，病则难治。其他季节仿照此理推断。
王氏脉歌：小儿吃奶后随即呕吐逆气，兼见脉象紊乱，无需过度忧虑。若是弦急之时被寒邪缠绕，脉缓则是乳食不消化。紧急细快也是少苦，虚濡则是邪气助长惊风。痢下宣肠急痛时，若见浮大之脉，则预后不良（归泉路指死亡）。
《脉经》说：小儿脉象快疾，一呼一吸间跳动七八次为平脉。少于这个次数叫“损”，多于这个次数叫“至”。
通真子歌：小儿三岁到五岁，呼吸间需看八至。九至表示不安，十至表示困顿，长短大小异常都有邪气干扰。
又说：小儿脉紧是风痫，沉脉须知是乳化困难（乳汁难化）。腹痛紧弦牢实且便秘，沉数表示骨间有热。
死证脉：脉来三次跳动后停止且不再出现的，主死。脉来迅速如弓弦般硬直的，主死。脉来忽然消失不见的，主死。
〔歌诀〕三动而止不来凶险，迅速坚硬如弦劲在弓，忽然出现反而不见，皆为死脉确定无疑。
诸般病脉：脉弦者为风寒，弦数为疟疾，脉急者为气不和，或者为客忤（外邪侵袭）。脉紧者为痛，紧数为惊痫，脉浮者为风，浮紧者为惊风，浮大为伤寒，浮虚者为盗汗，浮数为风热。脉伏者为气滞，脉缓脉细者皆为冷，为乳食不化。脉虚脉濡者为虚弱，为惊。虚濡者为慢惊风，虚紧者为伏热，脉沉重者为有积，沉数者为骨间冷（一说骨间热），沉迟者为虚冷，沉缓者为伤食，脉牢紧者为癖聚，牢实者为肠秘。
心脉满大，肝脉小急者为惊痫。心脉数小者为疳淋，数急者为热。寸口脉直上直下者为惊。寸口脉大小不均，紊乱者为变蒸。左手寸口无脉，主心痛中热，呕吐逆气口疮，或者咳嗽，喉中有哽塞声，头汗出而热，这是乳母食用生冷食物哺乳所致。又脉乱者主吐逆。右手寸口无脉，主胸满短气，吐逆噫哕，喉中有响声，这是乳母抱着孩子冲冒风寒所致。凡脉象如雀啄且紧的，为风痫。
凡小儿脉象大小不符合部位次序的，为恶候。
凡小儿脉快，呼吸间八至为平脉，九至为病脉，十至为困脉。
Translation of the original text into modern vernacular Chinese, then into academic English based on WHO standards.
All children are endowed with complete foundations of Zang-Fu organs (internal organs), Qi and Blood, Ying-Wei (Nutritive and Defensive Qi), and physical form at birth. However, before they can speak, during the "Bian Zheng" (a physiological developmental phase in infants characterized by periodic fever and growth spurts), their Qi and Blood are not yet full, their skin and pores are not yet firm, their sinews and bones are not yet strong, and their pulse characteristics have not yet formed. If illness occurs at this stage, it is difficult to diagnose via palpation, and difficult to inquire about symptoms. Therefore, ancient sages stated that infantile diseases are difficult to treat because there is no solid basis for diagnosis. Thus, methods for observing the child's spirit, complexion, and physical form were established.
After birth, once a child has completed 576 days, encompassing all cycles of major and minor "Bian Zheng," their Qi and Blood will flourish, their spirit will change, their sinews and bones will strengthen, and their pulse structure will be complete. Only then can pulse palpation be performed, and can the child speak and answer questions.
Some claim that the Yin aspect of children differs from adults; this reflects a lack of understanding of general medical principles. When assessing pulse length, speed, slowness, or rapidity, one must distinguish based on the child's physical size, without rigidly adhering to specific beat counts per breath. The classics state that pediatric pulses often resemble the pecking of a sparrow or the handle of a dipper, but the key lies in focusing on the three positions (Cun, Guan, Chi). A small and slightly rapid pulse is considered normal (Ping). Various schools of thought offer many views; here, we select the appropriate ones.
Sun Simiao said: Pediatric pulses are indeed difficult to differentiate between exterior and interior. Summarizing the essentials, they fall into a few categories. The general rhyme states: "When a child is ill, rely on the pulse; use one finger across the three positions to determine the respiration." (Because children have short arms, it is difficult to place three fingers across the Cun, Guan, and Chi positions; thus, one finger is used.)
A Floating Pulse (Fu Mai) indicates Wind pathogen. It is normal in autumn; in other seasons, it indicates invasion of Wind-Cold, with symptoms such as headache and high fever, or night fever/day coolness, coughing, sneezing, nasal congestion with clear discharge, vomiting, and anorexia.
[Rhyme] Floating indicates wind, normal in autumn; otherwise, wind-cold causes head and eye pain. High fever peaks at night, clear nasal discharge, frequent sneezing, coughing, and vomiting.
A Surging Pulse (Hong Mai) indicates Heat. It is normal in summer; in other seasons, it indicates abundant Wind-Heat, with symptoms such as body warmth and high fever, sores/ulcers, bleeding, and diarrhea.
[Rhyme] Surging harmonizes with summer; otherwise, frequent fever and warmth occur. Wind stagnation may cause fright or swelling; sometimes blood flows profusely in stool.
A Rapid Pulse (Shu Mai) indicates Fright/Wind. It is normal in spring; in other seasons, it indicates Fright-Wind convulsions. A small and rapid pulse suggests excessive sleep with startles, staring eyes, fear, spontaneous sweating at night, grinding teeth, protruding tongue, and slight panting. A large and rapid pulse indicates convulsions will likely occur within one or two days.
[Rhyme] Rapid indicates fright, normal in long spring days; otherwise, small rapidity brings sleep and fright. Panting, staring eyes, frequent tongue protrusion; large rapidity leads to tidal convulsions and severe disaster.
A Deep and Slow Pulse (Chen Chi Mai) indicates Deficiency Cold. It is normal in winter; in other seasons, it indicates Spleen-Stomach deficiency, with symptoms such as diarrhea, intestinal sliding/prolapse, persistent vomiting and dysentery, gradual emaciation, leading to Spleen fatigue, or developing into Infantile Malnutrition (Gan Syndrome) and consumptive disease.
[Rhyme] Deep-slow pulse is peaceful in winter; otherwise, it speaks of weak Spleen-Stomach. Diarrhea, intestinal sliding, anal prolapse; vomiting, dysentery, emaciation turning into Gan syndrome.
A Full/Excess Pulse (Shi Mai) indicates Food Stagnation. Present in all four seasons, it indicates food injury and accumulation, with symptoms such as yellowish complexion, abdominal distension, dry/brittle hair, irritability, thirst, vomiting, and abdominal pain.
[Rhyme] Excess pulse implies food injury and stagnation. High fever, abdominal distension, dry hair. Vomiting, dysentery, belly pain, or forming masses; viewed generally regardless of season.
To differentiate pulses across the four seasons: String-like (Xian) in Spring, Surging (Hong) in Summer, Floating (Fu) in Autumn, Deep (Chen) in Winter, and Moderate/Slack (Huan) in the transition months of each season. One must deduce the Wang-Xiang (prosperous and ministerial) relationships and interior-exterior dynamics to examine the disease. For example, if a String-like and Floating pulse is found in Spring, the disease is in the Exterior and Fu organs, is Yang and favorable, and is easy to treat. If a String-like and Deep pulse is found, the disease is in the Interior and Zang organs, is Yin and unfavorable, and is difficult to treat. Other seasons follow this logic.
Wang Shi's Pulse Rhyme: If a child vomits immediately after breastfeeding and the pulse is chaotic, do not worry excessively. If the pulse is wiry and tight due to cold entanglement, or slow indicating undigested milk, these are manageable. Urgent, fine, and fast pulses indicate little suffering; Deficient and Soft (Ru) pulses indicate evil qi aiding Fright-Wind. In cases of bloody diarrhea with urgent abdominal pain, a Floating and Large pulse indicates death (returning to the spring/tomb).
The *Mai Jing* (Pulse Classic) states: Pediatric pulses are rapid. Seven to eight beats per respiration is normal. Fewer beats indicate "Sun" (damage); more beats indicate "Zhi" (excess).
Tong Zhen Zi's Rhyme: For children aged three to five, count eight beats per respiration as normal. Nine beats indicate unrest; ten beats indicate distress. Abnormalities in length, size, etc., indicate pathogenic interference.
It also states: A Tight (Jin) pulse in children indicates Wind-Epilepsy. A Deep pulse indicates difficulty in digesting milk. Abdominal pain with Tight, Wiry, Firm, and Excess pulse accompanied by constipation indicates heat in the bone interspace.
Death Pulses: A pulse that stops after three beats and does not return indicates death. A pulse that is rapid and hard/straight like a bowstring indicates death. A pulse that suddenly disappears indicates death.
[Rhyme] Three beats then stopping is ominous; rapid and hard like a bowstring tension; suddenly appearing then vanishing; all are definitive death pulses.
Various Disease Pulses: String-like indicates Wind-Cold; String-like and Rapid indicates Malaria. Urgent indicates Disharmony of Qi or External Intrusion (Ke Wu). Tight indicates Pain; Tight and Rapid indicates Fright-Epilepsy. Floating indicates Wind; Floating and Tight indicates Fright-Wind; Floating and Large indicates Cold Damage (Shang Han); Floating and Deficient indicates Night Sweats; Floating and Rapid indicates Wind-Heat. Hidden (Fu) indicates Qi Stagnation. Slow and Fine indicate Cold and undigested milk. Deficient and Soft (Ru) indicate Weakness and Fright; specifically, Deficient-Soft indicates Slow Fright-Wind. Deficient-Tight indicates Latent Heat. Heavy indicates Accumulation. Deep and Rapid indicates Cold (or Heat, according to some) in the bone interspace. Deep and Slow indicates Deficiency Cold. Deep and Moderate indicates Food Injury. Firm and Tight indicates Masses (Pi). Firm and Excess indicates Intestinal Constipation.
Full and Large Heart Pulse, Small and Urgent Liver Pulse indicate Fright-Epilepsy. Small and Rapid Heart Pulse indicates Gan Syndrome with Dysuria; Urgent and Rapid indicates Heat. Straight up-and-down Cun Kou pulse indicates Fright. Unequal size and chaotic Cun Kou pulse indicates Bian Zheng (developmental fever). Absence of pulse at Left Cun Kou indicates Heart Pain with Internal Heat, vomiting, mouth ulcers, cough, hoarseness, head sweating with fever; this is caused by the nursing mother consuming cold foods. Chaotic pulse indicates vomiting. Absence of pulse at Right Cun Kou indicates Chest Fullness, Shortness of Breath, vomiting, belching/hiccupping, throat noise; this is caused by the mother exposing the child to Wind-Cold. Any pulse resembling a pecking sparrow and being tight indicates Wind-Epilepsy.
Any pediatric pulse where size does not correspond to the correct position is an ominous sign.
Generally, a rapid pulse with eight beats per respiration is normal; nine beats is diseased; ten beats is distressed.
If the pediatric pulse is Deficient, the disease is Deficient, detectable with light pressure. If the pulse is Excess, the disease is Excess, detectable with heavy pressure. Thus, Acute Fright-Wind presents with Urgent and Rapid pulses, while Chronic Fright-Wind presents with Deficient and Minute pulses.