小儿六岁须凭脉。一指三关定数息。迟冷数热古今传。浮风沉积当先识。左手人迎主外邪。右手气口主内疾。
外邪风寒暑湿侵。内候乳食痰兼积。浮紧无汗是伤寒。浮缓伤风有汗液。浮而洪大风热盛。沉而细滑乳食积。
沉紧腹中痛不休。沉弦喉间作喘急。紧促之时疹痘生。紧数之际惊风疾。虚软慢惊作螈 。紧盛风痫发搐掣。
软而细者为疳虫。牢而实者必便结。滑主痰壅食所伤。芤脉必主于失血。虚而有气为之惊。弦急客忤君须识。
大小不匀为恶候。三至为脱二至卒。五至为虚四至损。六至平和曰无疾。七至八至病犹轻。九至十至病势极。
十一二至死无疑。此诀万中无一失。
凡小儿三岁以上。乃用一指按寸关尺三部。常以六七至为平脉。添则为热。减则为寒。洪浮风盛。数则多惊。
沉滞为虚。沉实为积。
心主声从肺出。肺绝啼哭无声。多啼肝胆客风惊。气缓神疲搐盛。音哑邪热侮肺。声清毒火无侵。鸦声螈 候
非祯。相克必归泉冥。
直声往来而无泪者是痛。连声不绝而多泪者是惊。兹燕烦躁者难愈。疏促声音者感寒。
五音以应五脏。金声响。土声浊。木声长。水声清。火声燥。肝病声悲。肺病声促。心病声雄。脾病声慢。肾病声
沉。大肠病声长。小肠病声短。胃病声速。脾病声清。膀胱病声微。声轻者气弱也。重浊者痛与风也。高声者热欲狂也。
声噎者气不顺也。喘者气促也。声急者惊也。声塞者痰也。声战者寒也。声浊沉静者疳积也。喷嚏者伤风也。呵
欠者神倦也。声沉不响者。病势危也。如生来不大啼哭。声啾唧者夭也。既能识其声音。又常辨其气色。即知其
病之根源矣。
为医固难。及幼尤难。故医者诊视小儿之证。倘色脉精切。则死生可判。若因恐触病家之讳。犹豫其说。不吐
真情。稍有差池。必遭其怨。与其受怨于后。孰若告之于先。纵有危难。夫复何怨。昔扁鹊见桓侯曰。疾在腠理。
不治将深。桓侯不信。复见曰。疾在骨髓。虽司命无如之何。后果弗起。学人于此触类究心。斯有得于扁鹊之
妙旨。
\r阳掌图\p03-b26a53.bmp\r
五指甲伦为十王穴
小儿六岁以后，诊脉必须依靠切脉。用食指一指按在寸、关、尺三关部位，以测定脉搏的至数（息）。脉迟主寒证，脉数主热证，这是古今相传的经验。脉浮主风邪，脉沉主积滞，应当首先识别。左手人迎穴（此处指左寸或整体左脉象）主要判断外邪侵袭，右手气口穴（此处指右寸或整体右脉象）主要判断内伤疾病。
外邪包括风寒暑湿的侵袭。内伤主要候察乳食停滞、痰饮和积滞。脉浮紧且无汗，是伤寒的表现；脉浮缓且有汗，是伤风的表现。脉浮而洪大，是大风热盛的表现；脉沉而细滑，是乳食积滞的表现。
脉沉紧，是腹中疼痛不止的表现；脉沉弦，是喉间作喘急的表现。脉紧促之时，可能是疹痘发出的征兆；脉紧数之际，可能是惊风疾病的发作。脉虚软缓慢，是慢惊风导致抽搐痉挛的表现；脉紧盛有力，是风痫病导致抽搐掣动的表现。
脉软而细，多是疳虫病的表现；脉牢而实，必定是大便干结的表现。脉滑主痰壅和饮食所伤；脉芤（中空如葱管）必定主失血。脉虚而有气乱，会导致惊悸；脉弦急，是客忤（突受惊吓或异气刺激），医生必须识别。
脉律大小不匀，是恶候（预后不良）的表现。一息三至为脱证，二至为卒死之兆。五至为虚证，四至为损证。六至为平和脉，称为无疾。七至八至，病势尚轻。九至十至，病势极重。十一二至，死亡无疑。这个诀法万无一失。
凡是小儿三岁以后，才使用一指同时按压寸、关、尺三部。通常以每呼吸周期六七次搏动为平脉（正常脉象）。脉搏次数增多则为热证，减少则为寒证。脉洪大浮越，主风邪盛；脉数，主多惊。脉沉滞，主虚证；脉沉实，主积滞。
心主宰声音，但声音从肺发出。肺气绝时，啼哭无声。多啼叫是肝胆受客风惊扰所致。气缓神疲且抽搐严重，是正气不足的表现。音哑是邪热侮犯肺脏所致。声音清亮，说明毒火未侵。声音像乌鸦一样嘶哑伴抽搐，是凶险的征候，五行相克，必归黄泉（死亡）。
直声往来且不流泪的是疼痛。连声不绝且多流泪的是惊骇。像燕子一样烦躁不安的声音，病情难愈。声音疏密不均的是感受寒邪。
五音对应五脏。金声清脆，土声浑浊，木声悠长，水声清越，火声燥烈。肝病声音悲凉，肺病声音急促，心病声音雄壮，脾病声音缓慢，肾病声音低沉。大肠病声音长，小肠病声音短，胃病声音快速，脾病声音清亮（注：原文此处重复提及脾，前文为慢，此处理解为脾虚或特定状态下的清亮，依原文翻译），膀胱病声音微弱。声音轻者，是气弱；声音重浊者，是痛与风邪；声音高亢者，是热欲发狂；声音哽咽者，是气不顺；喘息者，是气促；声音急切者，是惊；声音堵塞者，是痰；声音颤抖者，是寒；声音浑浊沉静者，是疳积；打喷嚏者，是伤风；打呵欠者，是神倦；声音低沉不响亮者，是病势危重。如果生下来不大啼哭，声音细小啾唧的，是夭折之相。既然能识别其声音，又常辨别其气色，就能知道疾病的根源了。
做医生固然难，诊治幼童尤其难。所以医生诊视小儿病症，如果面色和脉象诊断精切，就能判断生死。如果因为害怕触犯病家的忌讳，犹豫不决，不吐露真情，稍有差错，必然遭到怨恨。与其事后遭受怨恨，不如事先告知。纵然有危难，又有什么可怨恨的呢？从前扁鹊见蔡桓侯说：“病在腠理，不治将会深入。”蔡桓侯不信。再次见面时说：“病在骨髓，虽然司命神也无能为力。”后来果然未能救活。学习中医的人在此应触类旁通，用心探究，才能领悟扁鹊的妙旨。
阳掌图（图片占位符）
五指甲伦为十王穴
Children aged six and above require pulse diagnosis. Using one finger to press the three positions (Cun, Guan, Chi) determines the pulse rate (breaths). A slow pulse indicates cold, and a rapid pulse indicates heat; this has been passed down from ancient times. A floating pulse indicates wind pathogenic factors, and a deep pulse indicates accumulation; these should be identified first. The left Renying position (referring to the left pulse generally) governs external pathogens, while the right Qikou position (referring to the right pulse generally) governs internal diseases.
External pathogens include invasion by wind, cold, summer-heat, and dampness. Internal conditions involve observing milk retention, phlegm, and food accumulation. A floating and tight pulse without sweating indicates Cold Damage (Shanghan). A floating and relaxed pulse with sweating indicates Wind Injury (Shangfeng). A floating and surging pulse indicates severe wind-heat. A deep and fine-slippery pulse indicates milk and food accumulation.
A deep and tight pulse indicates unceasing abdominal pain. A deep and wiry pulse indicates wheezing and urgency in the throat. When the pulse is tight and hurried, it may signal the emergence of rashes or smallpox. When the pulse is tight and rapid, it may indicate convulsive disorders (Jingfeng). A deficient, soft, slow pulse indicates slow convulsions with spasms. A tight and vigorous pulse indicates wind epilepsy with twitching and jerking.
A soft and fine pulse indicates worm-related malnutrition (Ganchong). A firm and solid pulse indicates constipation. A slippery pulse indicates phlegm obstruction and dietary injury. A knotted pulse (Kou, hollow like a scallion stalk) definitely indicates blood loss. Deficiency combined with qi disorder leads to fright. A wiry and urgent pulse indicates Ke Wu (sudden fright or alien qi influence), which physicians must recognize.
An irregular pulse size is an ominous sign. Three beats per breath indicates collapse; two beats per breath indicates sudden death. Five beats per breath indicates deficiency; four beats per breath indicates damage. Six beats per breath is a harmonious pulse, indicating no disease. Seven to eight beats per breath indicates mild illness. Nine to ten beats per breath indicates extreme severity. Eleven to twelve beats per breath confirms death. This rule is infallible.
For children over three years old, one finger is used to simultaneously press the Cun, Guan, and Chi positions. Typically, six to seven beats per breath is the normal pulse. An increase in beats indicates heat; a decrease indicates cold. A surging and floating pulse indicates prevailing wind. A rapid pulse indicates frequent fright. A deep and stagnant pulse indicates deficiency; a deep and solid pulse indicates accumulation.
The heart governs sound, but sound emanates from the lungs. When lung qi fails, crying is silent. Excessive crying is due to liver and gallbladder being affected by external wind and fright. Slow breathing, spirit fatigue, and severe convulsions indicate qi deficiency. Hoarseness is caused by evil heat insulting the lungs. Clear voice indicates no invasion by toxic fire. Crow-like hoarse voice accompanied by spasms is an inauspicious omen; mutual overcoming leads to death (returning to the underworld).
A straight, repetitive sound without tears indicates pain. Continuous sound with much tearing indicates fright. Restless sounds like swallows are difficult to cure. Irregular and sparse sounds indicate cold invasion.
The five tones correspond to the five zang organs. Metal tone is crisp, earth tone is turbid, wood tone is long, water tone is clear, and fire tone is dry. Liver disease manifests as sad sounds; lung disease as hurried sounds; heart disease as majestic sounds; spleen disease as slow sounds; kidney disease as deep sounds. Large intestine disease manifests as long sounds; small intestine disease as short sounds; stomach disease as fast sounds; spleen disease as clear sounds (note: original text repeats spleen); bladder disease as faint sounds. Light voice indicates weak qi. Heavy and turbent voice indicates pain and wind. Loud voice indicates heat欲狂 (desire for mania). Choked voice indicates qi stagnation. Panting indicates rapid breathing. Urgent voice indicates fright. Blocked voice indicates phlegm. Trembling voice indicates cold. Turbid and quiet voice indicates Ganchong (malnutrition/accumulation). Sneezing indicates wind-cold injury. Yawning indicates spirit fatigue. Deep and dull voice indicates critical condition. If a newborn does not cry loudly but makes a squeaking sound, it indicates premature death. By recognizing their voices and frequently observing their complexion, one can know the root of the disease.
Being a physician is difficult, especially treating infants. Therefore, when examining children, if the complexion and pulse are diagnosed precisely, life and death can be judged. If one hesitates due to fear of offending the patient's family and does not speak the truth, any mistake will lead to resentment. It is better to warn beforehand than to suffer resentment afterwards. Even if there is danger, what is there to resent? In the past, Bian Que told Duke Huan of Cai: "The disease is in the skin and muscles; if untreated, it will deepen." The Duke did not believe him. Upon seeing him again, Bian Que said: "The disease is in the bone marrow; even the God of Life cannot help." Later, he indeed died. Students should apply this logic and study diligently to understand the profound principles of Bian Que.
[Image: Yang Palm Diagram]
The Ten Kings acupoints are located on the fingernails of the five fingers.