儿科自古最为难，毫厘之差千里愆，气血未充难据脉，神识未发不知言。惟凭面色识因病，再向
三关诊热寒，听声审病兼切脉，表里虚实随证参。
【注】儿科一道，自古为难，盖以小儿形质柔脆，易虚易实，调治少乖，则毫厘之失，
遂致千里之谬。气血未充者，气血尚未充盈也。难据脉者，脉无定准，不可只以脉为主
也。神识未发者，茫然无知识也。不知言者，不能言其疾苦也。诊小儿之病，惟凭察面部
形色，识其因何而生也。三关者，手虎口处风、气、命三关也，当视脉纹形色，以诊其
属热属寒也。听声者，听其五声所主之病也。审病者，审其安、烦、苦、欲、饮食、二便
也。切脉者，切脉之浮、沉、迟、数、滑、涩、大、小、有力、无力也。医者诚能以四诊参
合表里、虚实、寒热之病，则可保万全也。
欲识小儿百病原，先从面部色详观，五部五色应五脏，诚中形外理昭然。额心颏肾鼻脾位，右腮属肺
左属肝，青肝赤心黄脾色，白为肺色黑肾颜。青主惊风赤火热，黄伤脾食白虚寒，黑色主痛多恶候，明
显浊晦轻重参。部色相生为病顺，部色相克病多难，相生实者邪助病，相克虚者正难堪。天庭青暗惊风
至，红主内热黑难痊，太阳青惊入耳恶，印堂青色惊泻缠。风气青惊紫吐逆，两眉青吉红热烦，鼻
赤脾热黑则死，唇赤脾热白脾寒。左腮赤色肝经热，右腮发赤肺热痰，承浆青惊黄呕吐，黑主抽搐
病缠绵。此是察色之大要，还将脉证一同参。
\r面部图\p03-b9a.bmp\r
\r面部五脏部位图\p03-b9b.bmp\r
【注】小儿之病，先从面部气色观之。详察五部之色，则五脏之病，自昭然可见矣。五
部者∶额属心，颏属肾，鼻属脾，左腮属肝，右腮属肺也。五色者
青为肝色，赤为心色，
黄为脾色，白为肺色，黑为肾色也。如面青主是惊风之证，面赤主火热，面黄主伤脾伤
食，面白主虚寒，面黑主痛，多是恶候。总之，五色明显为新病，其证轻；浊晦为久病，
其证重。部色相生为顺者，如脾病色黄，此正色也。若见红色，乃火能生土，故为顺也。
若见青色，乃木来克土，故为逆也。余病仿此。若气血充实，又遇部色相生，纵有外邪
助病，亦易为治疗。若久病气血虚弱，又遇部色相克，则正气不支，每难治疗。如天庭
青暗主惊风，红主内热，黑则不治。太阳青，主惊风，青色入耳者死。印堂青，主惊泻。风
池在眉下，气池在眼下，二处青主惊风，紫多吐逆。两眉青主吉，红色主多烦热。鼻赤
主脾热，鼻黑则死。唇赤主脾热，白主脾寒。左腮发赤主肝经有热，右腮发赤主肺热痰盛。
承浆青主惊，黄主吐，黑主抽搐。此皆察色之大要，再以脉证参之，庶治得其要矣。
儿科自古以来就最为困难，毫厘之间的差错会导致千里般的谬误。小儿气血尚未充盈，难以单纯依靠脉诊；神识尚未发育成熟，无法用语言描述病痛。只能凭借面色来识别病因，再结合“三关”（虎口处的风、气、命三关）来诊断寒热，同时听取声音以审察病情并切按脉搏，根据表里、虚实的证候进行综合参详。
【注】儿科这一领域，自古便被视为难点，因为小儿形体质地柔嫩脆弱，容易由虚转实或由实转虚，如果调治稍有偏差，就会造成毫厘之差、千里之谬的严重后果。“气血未充”，是指气血尚未充盈。“难据脉”，是指脉象没有固定的标准，不能仅仅以脉诊为主。“神识未发”，是指茫然无知，缺乏认知能力。“不知言”，是指不能言语表达其疾苦。诊治小儿疾病，主要依靠观察面部的形色，来识别病因所在。“三关”，是指手虎口处的风、气、命三个关卡，应当观察脉纹的形色，以诊断属于热证还是寒证。“听声”，是听取五音所主应的病证。“审病”，是审察患儿的安静或烦躁、痛苦或舒适、饮食情况及大小便情况。“切脉”，是切按脉搏的浮、沉、迟、数、滑、涩、大、小、有力、无力等特征。医生如果能将四诊合参，辨别表里、虚实、寒热的病机，就可以保证治疗万无一失。
想要了解小儿百种疾病的根源，先从详细观察面部气色开始。面部五个部位与五种颜色对应五脏，内在脏腑的状态反映于外在形色，道理十分明显。额头对应心，下巴对应肾，鼻子对应脾，右腮对应肺，左腮对应肝。青色属肝，赤色属心，黄色属脾，白色属肺，黑色属肾。青色主惊风，赤色主火热，黄色主脾伤食积，白色主虚寒，黑色主疼痛且多为恶候，需根据颜色的明暗浊晦来判断轻重。部位与颜色相生为病势顺，部位与颜色相克则病情多难治。若实证遇到相生之色，邪气虽助病但尚可应对；若虚证遇到相克之色，正气难以承受。天庭（前额中央）出现青暗色预示惊风将至，红色主内热，黑色则难治愈。太阳穴处青色主惊风入耳属恶候，印堂处青色主惊泻纠缠。风气池（眉下）和气池（眼下）处青色主惊风，紫色主呕吐逆乱。两眉间青色主吉，红色主烦热。鼻头赤色主脾热，鼻头黑色主死症。嘴唇赤色主脾热，白色主脾寒。左腮赤色主肝经有热，右腮发红主肺热痰盛。承浆穴（下巴沟中）处青色主惊，黄色主呕吐，黑色主抽搐且病情缠绵。这是察色的主要要点，还需将脉象与证候一同参详。
【注】小儿的疾病，先从观察面部气色入手。详细察验五个部位的颜色，五脏的疾病自然清晰可见。所谓“五部”：额头属心，下巴属肾，鼻子属脾，左腮属肝，右腮属肺。所谓“五色”：青色为肝色，赤色为心色，黄色为脾色，白色为肺色，黑色为肾色。如面色青主惊风证，面色赤主火热，面色黄主伤脾伤食，面色白主虚寒，面色黑主痛，多是恶候。总之，五色鲜明为新病，证候较轻；浑浊晦暗为久病，证候较重。部位与颜色相生为顺，如脾病见黄色，这是本脏正色。若见到红色，乃火能生土，故为顺证。若见到青色，乃木来克土，故为逆证。其余病症仿照此类推。若气血充实，又遇到部位与颜色相生，即使有外邪助长病势，也易于治疗。若久病气血虚弱，又遇到部位与颜色相克，则正气不支，往往难以治疗。如天庭青暗主惊风，红色主内热，黑色则不治。太阳穴处青色主惊风，青色延伸至耳朵者死。印堂处青色主惊泻。风池在眉下，气池在眼下，这两处青色主惊风，紫色主呕吐逆乱。两眉间青色主吉，红色主烦热。鼻头赤色主脾热，鼻头黑色主死。嘴唇赤色主脾热，白色主脾寒。左腮发红主肝经有热，右腮发红主肺热痰盛。承浆处青色主惊，黄色主吐，黑色主抽搐。这些都是察色的主要要点，再结合脉证参详，治疗就能抓住要领了。
Pediatrics has been the most difficult field since ancient times; a discrepancy of a hair's breadth can lead to an error of a thousand miles. Because Qi and Blood (vital energy and blood) are not yet full, pulse diagnosis alone is unreliable; because Shen Zhi (spiritual consciousness) has not yet developed, children cannot verbalize their suffering. One must rely on observing facial complexion to identify the cause, examine the Three Passages (Feng, Qi, Ming gates at the tiger's mouth for pulse pattern analysis) to diagnose heat or cold, listen to vocal sounds to assess pathology, and palpate the pulse, synthesizing exterior-interior and deficiency-excess patterns.
[Note] The practice of pediatrics has always been considered difficult because children have delicate and fragile constitutions, tending easily towards either deficiency or excess. A slight deviation in treatment can result in catastrophic errors. "Qi and Blood not yet full" means that vital energy and blood are not yet abundant. "Difficult to rely on pulse" means that pulse qualities lack fixed standards and should not be relied upon exclusively. "Shen Zhi not yet developed" refers to a state of ignorance or lack of cognitive awareness. "Unable to speak" means the child cannot articulate their distress. In diagnosing pediatric diseases, one primarily relies on observing facial form and color to identify etiology. "Three Passages" refer to the Feng (Wind), Qi (Energy), and Ming (Life) gates located at the tiger's mouth (the web between thumb and index finger); one should observe the color and shape of the subungual veins to determine if the condition is heat or cold. "Listening to sound" involves assessing diseases indicated by the five vocal tones. "Examining illness" involves assessing whether the child is calm or restless, comfortable or distressed, along with dietary intake and bowel/bladder movements. "Palpating pulse" involves feeling the floating, deep, slow, rapid, slippery, choppy, large, small, forceful, or forceless qualities of the pulse. If a physician can integrate the Four Diagnostic Methods (inspection, auscultation-olfaction, inquiry, palpation) to differentiate exterior-interior, deficiency-excess, and cold-heat patterns, they can ensure a safe and effective treatment.
To understand the origins of hundreds of pediatric diseases, one must first carefully observe the facial complexion. The five facial regions correspond to the five colors and the five Zang organs; internal organ states manifest externally, making the principles clear. The forehead corresponds to the Heart, the chin to the Kidney, the nose to the Spleen, the right cheek to the Lung, and the left cheek to the Liver. Green corresponds to the Liver, red to the Heart, yellow to the Spleen, white to the Lung, and black to the Kidney. Green indicates Convulsive Wind (Jing Feng), red indicates Fire-Heat, yellow indicates Spleen injury from food stagnation, white indicates Deficiency-Cold, and black indicates pain and often ominous prognoses; severity is judged by the brightness or turbidity of the color. When the region and color generate each other (Sheng cycle), the disease course is favorable; when they overcome each other (Ke cycle), the disease is difficult. In Excess conditions, a generating color may aid the pathogen but remains manageable; in Deficiency conditions, an overcoming color overwhelms the healthy Qi. A dark green tint on the Tian Ting (upper forehead) indicates impending Convulsive Wind; red indicates internal Heat; black indicates untreatable conditions. Green at the Tai Yang area (temples) indicates Wind entering the ear, an ominous sign; green at the Yin Tang (between eyebrows) indicates convulsive diarrhea. Green at Feng Chi (below eyebrows) and Qi Chi (below eyes) indicates Convulsive Wind; purple indicates vomiting and rebellion. Green between the eyebrows is auspicious; red indicates irritability and heat. Redness of the nose tip indicates Spleen Heat; blackness indicates death. Red lips indicate Spleen Heat; white lips indicate Spleen Cold. Redness of the left cheek indicates Liver channel Heat; redness of the right cheek indicates Lung Heat with phlegm. Green at Cheng Jiang (chin groove) indicates fright; yellow indicates vomiting; black indicates convulsions and lingering disease. These are the essentials of complexion observation, which must be synthesized with pulse and symptom assessment.
[Facial Diagram]
[Five Regions of Face Diagram]
[Note] Pediatric diseases are first assessed by observing facial Qi and color. Detailed examination of the five facial regions reveals the status of the five Zang organs clearly. The "Five Regions" are: Forehead belongs to Heart, Chin belongs to Kidney, Nose belongs to Spleen, Left Cheek belongs to Liver, Right Cheek belongs to Lung. The "Five Colors" are: Green is Liver color, Red is Heart color, Yellow is Spleen color, White is Lung color, Black is Kidney color. For instance, a green face indicates Convulsive Wind syndrome; a red face indicates Fire-Heat; a yellow face indicates Spleen injury from food stagnation; a white face indicates Deficiency-Cold; a black face indicates pain, often an ominous sign. Generally, bright and distinct colors indicate new diseases with mild symptoms; turbid and dull colors indicate chronic diseases with severe symptoms. Region-color generation is favorable; e.g., in Spleen disease, yellow is the proper color. If red appears, it represents Fire generating Earth, thus favorable. If green appears, it represents Wood overcoming Earth, thus unfavorable. Other cases follow this logic. If Qi and Blood are robust and the region-color relationship is generative, even with external pathogens aiding the disease, treatment is easy. If Qi and Blood are depleted due to chronic illness and the region-color relationship is overcoming, healthy Qi cannot withstand the pathogen, making treatment difficult. For example, dark green on the Tian Ting indicates Convulsive Wind; red indicates internal Heat; black indicates untreatable conditions. Green at Tai Yang indicates Convulsive Wind; green extending to the ears indicates death. Green at Yin Tang indicates convulsive diarrhea. Feng Chi is below the eyebrows, Qi Chi is below the eyes; green in these areas indicates Convulsive Wind, purple indicates vomiting/rebellion. Green between eyebrows is auspicious; red indicates irritability/heat. Red nose tip indicates Spleen Heat; black nose tip indicates death. Red lips indicate Spleen Heat; white lips indicate Spleen Cold. Red left cheek indicates Liver Heat; red right cheek indicates Lung Heat with abundant phlegm. Green at Cheng Jiang indicates fright; yellow indicates vomiting; black indicates convulsions. These are the essentials of complexion observation; combined with pulse and symptom analysis, treatment will hit the mark.