小儿三五岁，可以诊视，第手腕短促，三部莫分，惟以一指候之，诚非易也。《内经》诊视小儿，以大小缓急
四脉为准。予不避僭越，体察其意，仍从浮沉迟数四脉，而以有力无力定其虚实缓急，更为明悉，比较尤为有根据。
《内经》脉要
黄帝曰∶乳子而病热，脉悬小者如何？
夫乳子病热，脉见悬小者，阳症见阴脉，本为大忌，但小而缓者，邪甚微，其愈易；小而急者，邪客深，为可
虑，故以为问。
岐伯曰∶手足温则生，寒则死。
夫小儿以稚阳为体，而如病，纹脉现暗淡，肢脉至虽小，手足温者，犹能生。以四肢为诸阳之本，阳犹在也。
若四肢寒冷者，则邪胜其正，元阳去矣，故曰死也。
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，缓者生，急者死。此言小儿之外
感也。风热中于阳分而喘鸣肩息者，脉当实大。但大而缓，则胃气好，邪渐退，故能生；实而急，则真脏见，病
日进，则死也。
此《内经》之旨，圣人立言简切，而总括无余。世人不悟，视为寻常，能于此处等处着眼，则诊视之要诀思
过半矣。予之临证诊视，无论凶吉，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。夫节庵亦一常人，而能以有力无力，辨其阴阳表里寒热虚实，虽
至显浅，至平易，亦至确当，岂真古今之人不相及耶。
四脉主病
浮脉主表（病在外），沉脉主里（病在内）。迟脉主脏（病为寒），数脉主腑（病为热）。四至五至为迟为
寒，为不足。七至八至为数为热，为太过。
浮迟外寒，沉迟内寒，有力实寒，无力虚寒。
浮数外热，沉数内热，有力实热，无力虚热。
主症∶浮而有力，风热；无力，阴虚。沉而有力，痰食；无力，气滞。迟而有力，为痛；无力，虚寒。数而
有力，实热；无力，疮疡。
总括脉要歌
太渊一指定安危，六至中和五至亏，七八热多三四冷，浮沉迟数贵详推，有力为阳为实热，虚寒无力里何疑，
若能留意于中取，何至望洋泣远岐。
浮而有力实兼风（风热皆阳，表之实也）。无力阴虚汗雨 （阴津妄泄，表之虚也）。有力而沉痰食害（痰
凝食滞，结于里也）。沉而无力气凝胸（气滞于中，不运化也）。迟而有力多为痛（浮迟外痛，沉迟内痛）。无力
虚寒气血亏（气弱血衰，至虚之候）。数脉热多终有力（数而有力，实热何疑）。疮痍无力热虚攻（阴虚受伤，虚热所致）。
脉证宜忌歌
脉浮身热汗之松（阳邪居表，热从汗解）。沉细身凉莫强攻（无论表里，不堪攻伐）。咳嗽正嫌浮带数
（浮缓为宜，浮数大忌）。细沉肿胀定知凶（脾胃虚寒，愈不运化）。
沉迟下痢方为吉（气血俱伤，最嫌洪数）。洪数偏宜痘疹逢（阴阳充足，毒不能留）。腹痛不堪浮有力（三
阴受病，浮则反常）。浮洪吐衄总无功（阳火太盛，阴血愈伤）。
陶节庵曰∶诊脉之要，无论浮沉迟数，但于有力无力中分别。有力者为阳，为实，为热；无力者为阴，为
虚，为寒。至哉斯言也，后贤无忽。
小儿到了三五岁，可以进行诊察，只是手腕短小，寸、关、尺三部脉位难以区分，只能用一根手指来候脉，这确实不容易。《黄帝内经》在诊察小儿时，以大、小、缓、急四种脉象作为标准。我不避讳僭越之嫌，体察其意，仍然遵循浮、沉、迟、数四种脉象，并以有力或无力来判断虚实和缓急，这样更加明确清晰，比较起来也更有依据。
《黄帝内经》脉法要义
黄帝问：婴儿患热病，脉搏悬细而小的，情况如何？
婴儿患热病，脉搏出现悬细而小的，这是阳证见到阴脉，本是大忌，但如果脉小而缓，说明邪气很轻微，容易痊愈；如果脉小而急，说明邪气深入，值得忧虑，所以提出这个问题。
岐伯回答：手足温暖就能存活，手足寒冷就会死亡。
小儿以稚嫩的阳气为体质基础，如果生病，指纹和脉象呈现暗淡，虽然四肢脉象至数虽小，但只要手足温暖，仍能存活。因为四肢是诸阳之本，说明阳气尚存。如果四肢寒冷，就是邪气胜过正气，元阳已去，所以说会死亡。
黄帝问：婴儿感受风热，出现气喘、喉间有声、耸肩呼吸的，脉象如何？岐伯回答：气喘、喉间有声、耸肩呼吸的，脉象应当实大。如果脉象大而缓，说明胃气良好，邪气逐渐消退，所以能存活；如果脉象实而急，说明真脏脉现，病情日益加重，就会死亡。这是论述小儿的外感病。风热侵袭阳分导致气喘、喉鸣、耸肩息者，脉象应当实大。但脉大而缓，则胃气好，邪气渐退，故能生；脉实而急，则真脏脉现，病势日进，故死。
这是《黄帝内经》的宗旨，圣人立言简洁切要，总括无遗。世人不能领悟，视为平常，能在此处等处着眼，那么诊察的要诀就掌握了一半了。我临证诊察，无论吉凶，大多符合此理，也只是心意所至，口难尽宣。仔细推敲经文所说的“大小缓急”，也是含蓄不露的意思。大概“大”即属于浮洪类，“小”即属于沉细类，“急”即数脉，“缓”即迟脉，何不直接改用浮、沉、迟、数更为得当呢？再结合节庵（陶华）的“有力、无力”，辨别表里虚实，确实是诊察小儿天然不易的妙诀。节庵也是一常人，却能以有力无力辨别阴阳表里寒热虚实，虽然至显浅、至平易，但也至确当，难道真是古今之人不相及吗？
四脉主病
浮脉主表（病在外），沉脉主里（病在内）。迟脉主脏（病为寒），数脉主腑（病为热）。一息四至五至为迟，为寒，为不足。一息七至八至为数，为热，为太过。
浮迟为外寒，沉迟为内寒，有力为实寒，无力为虚寒。
浮数为外热，沉数为内热，有力为实热，无力为虚热。
主要症状：浮而有力，属风热；无力，属阴虚。沉而有力，属痰食；无力，属气滞。迟而有力，属痛；无力，属虚寒。数而有力，属实热；无力，属疮疡。
总括脉要歌
太渊穴一指定安危，六至脉象中和，五至脉象亏虚，七八至脉象热多，三四至脉象冷多，浮沉迟数贵在详细推究，有力为阳、为实、为热，无力为虚、为寒，若能在中取脉时留意，何至于面对岐黄之术望洋兴叹哭泣呢？
浮而有力兼有风邪（风热皆属阳，为表实证）。无力则为阴虚汗出如雨（阴津妄泄，为表虚证）。有力而沉为痰食为害（痰凝食滞，结于里）。沉而无力为气凝于胸（气滞于中，不运化）。迟而有力多为疼痛（浮迟为外痛，沉迟为内痛）。无力则为虚寒气血亏（气弱血衰，至极虚之候）。数脉热多终归有力（数而有力，实热何疑）。疮痍无力为热虚攻（阴虚受伤，虚热所致）。
脉证宜忌歌
脉浮身热，发汗则松解（阳邪居表，热从汗解）。沉细身凉，不要强行攻伐（无论表里，不堪攻伐）。咳嗽正嫌脉浮带数（浮缓为宜，浮数大忌）。细沉肿胀定知凶险（脾胃虚寒，愈不运化）。
沉迟下痢方为吉利（气血俱伤，最嫌洪数）。洪数偏宜痘疹逢（阴阳充足，毒不能留）。腹痛不堪脉浮有力（三阴受病，浮则反常）。浮洪吐衄总无功（阳火太盛，阴血愈伤）。
陶节庵说：诊脉的要领，无论浮沉迟数，只要在有力无力中分别。有力者为阳，为实，为热；无力者为阴，为虚，为寒。这话真是精辟啊，后辈贤人不可忽视。
When children reach three or five years of age, pulse diagnosis can be performed. However, their wrists are short and narrow, making it difficult to distinguish the Cun (Inch), Guan (Bar), and Chi (Cubit) positions; thus, only one finger is used to palpate the pulse, which is indeed not easy. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) uses the four pulse qualities of Large (Da), Small (Xiao), Slow/Relaxed (Huan), and Urgent/Rapid (Ji) as standards for pediatric pulse diagnosis. Not daring to overstep my bounds, I have studied its intent and still adhere to the four pulses of Floating (Fu), Deep (Chen), Slow (Chi), and Rapid (Shu), determining deficiency and excess, slackness and urgency, by whether the pulse is Forceful (Youli) or Feeble (Wuli). This approach is clearer and more well-founded.
Essentials of Pulse Diagnosis in the *Neijing*
The Yellow Emperor asked: When an infant suffers from fever, what does a suspended and small pulse indicate?
When an infant has fever and presents a suspended and small pulse, this represents a Yang syndrome manifesting Yin pulses, which is fundamentally a major taboo. However, if the pulse is small yet relaxed (Huan), the pathogenic factor is minimal, and recovery is likely; if the pulse is small yet urgent (Ji), the pathogen has penetrated deeply, which is concerning. Hence, this question was raised.
Qibo replied: Survival is indicated if the hands and feet are warm; death ensues if they are cold.
Children possess tender Yang Qi as their constitutional basis. When ill, the fingerprint and pulse may appear dim and faint. Although the pulse at the limbs may be small, if the hands and feet remain warm, survival is possible because the four limbs are the root of all Yang meridians, indicating that Yang Qi is still present. If the limbs are cold, it signifies that pathogenic factors have overcome healthy Qi, and the Primordial Yang has departed; hence, death is predicted.
The Yellow Emperor asked: When an infant contracts wind-heat, presenting with wheezing, rhonchi, and shoulder breathing, what is the pulse like? Qibo replied: In cases of wheezing, rhonchi, and shoulder breathing, the pulse should be Excessively Large (Shi Da). If the pulse is large yet relaxed (Huan), stomach Qi is robust, pathogens are receding, and survival is possible. If the pulse is excessive and urgent (Ji), the Zang-Fu organs' true nature is exposed, the disease progresses daily, and death results. This discusses external contraction in children. Wind-heat attacking the Yang aspect causes wheezing, rhonchi, and shoulder breathing, where the pulse should be Shi Da. A large yet Huan pulse indicates good Stomach Qi and receding pathogens, leading to survival; a Shi and Ji pulse indicates the appearance of the True Zang pulse and progressive disease, leading to death.
This is the purport of the *Neijing*. The sages spoke concisely and comprehensively. People today fail to comprehend this, treating it as ordinary. If one focuses on these points, half of the essential secrets of pulse diagnosis will be understood. In my clinical practice, regardless of prognosis, most cases align with this principle. It is a matter of intuitive understanding, hard to express fully. Carefully examining the scripture’s mention of "Large, Small, Huan, Ji," it implies implicit meanings. Generally, "Large" belongs to the category of Floating and Surging (Hong); "Small" belongs to Deep and Fine (Xi); "Urgent" refers to Rapid (Shu); "Relaxed" refers to Slow (Chi). Is it not better to directly use Floating, Deep, Slow, and Rapid? Furthermore, combining Jie'an’s (Tao Hua) method of distinguishing Forceful vs. Feeble to identify Exterior/Interior, Deficiency/Excess constitutes a natural and indispensable secret for pediatric pulse diagnosis. Jie'an was but an ordinary person, yet he could distinguish Yin/Yang, Exterior/Interior, Cold/Heat, and Deficiency/Excess through Forcefulness and Feebleness. Though seemingly simple and plain, it is extremely accurate. Does this truly mean ancient and modern people are incomparable?
Diseases Governed by the Four Pulses
Floating (Fu) pulse governs Exterior patterns (disease outside); Deep (Chen) pulse governs Interior patterns (disease inside). Slow (Chi) pulse governs Zang organs (Cold disease); Rapid (Shu) pulse governs Fu organs (Heat disease). Four to five beats per respiration cycle constitute Slow (Chi), indicating Cold and Deficiency. Seven to eight beats per respiration cycle constitute Rapid (Shu), indicating Heat and Excess.
Floating and Slow indicate Exterior Cold; Deep and Slow indicate Interior Cold. Forceful indicates Excess Cold; Feeble indicates Deficiency Cold.
Floating and Rapid indicate Exterior Heat; Deep and Rapid indicate Interior Heat. Forceful indicates Excess Heat; Feeble indicates Deficiency Heat.
Main Symptoms: Floating and Forceful indicates Wind-Heat; Feeble indicates Yin Deficiency. Deep and Forceful indicates Phlegm-Food retention; Feeble indicates Qi Stagnation. Slow and Forceful indicates Pain; Feeble indicates Deficiency-Cold. Rapid and Forceful indicates Excess Heat; Feeble indicates Carbuncles and Sores.
Song Summarizing Pulse Essentials
At the Taoyuan point (Taiyuan, LU9), one finger determines safety or peril; six beats per cycle indicate harmony, five beats indicate deficiency. Seven to eight beats indicate much Heat; three to four beats indicate much Cold. Floating, Deep, Slow, and Rapid require detailed deduction. Forceful indicates Yang, Excess, and Heat; Feeble indicates Deficiency and Cold. If one pays attention to the Middle Extraction technique, why lament before the vastness of Qi-Bai (Huangdi and Qibo)?
Floating and Forceful combines Wind (Wind-Heat are Yang, representing Exterior Excess). Feeble indicates Yin Deficiency with profuse sweating (Yin fluids leaking excessively, representing Exterior Deficiency). Forceful and Deep indicates harm from Phlegm and Food stagnation (Phlegm congealing and food retaining, knotting in the Interior). Deep and Feeble indicates Qi stagnating in the chest (Qi stagnant in the middle, failing to transform). Slow and Forceful often indicates pain (Floating-Slow indicates exterior pain, Deep-Slow indicates interior pain). Feeble indicates Deficiency-Cold with Qi and Blood depletion (Weak Qi and declining Blood, a state of extreme deficiency). Rapid pulse usually involves Heat and ends with Forcefulness (Rapid and Forceful, how can Excess Heat be doubted?). Carbuncles without Forcefulness are attacked by Deficient Heat (Yin Deficiency causing injury, resulting from Deficient Heat).
Song on Pulse-Symptom Compatibility and Taboos
Floating pulse with body heat: Release via sweating (Yang pathogen resides in the Exterior, heat resolves through sweat). Deep and Fine pulse with cool body: Do not forcibly attack (Regardless of Exterior or Interior, not suitable for purgative/attacking methods). Cough is unfavorable with Floating and Rapid pulse (Floating-Slow is appropriate; Floating-Rapid is a major taboo). Fine and Deep pulse with swelling indicates ominous prognosis (Spleen-Stomach Deficiency-Cold, further failing to transform).
Deep and Slow pulse with dysentery is auspicious (Qi and Blood both injured, greatly disliking Surging and Rapid). Surging and Rapid pulse is suitable for encountering smallpox/rash (Yin and Yang sufficient, toxins cannot remain). Abdominal pain is incompatible with Floating and Forceful pulse (Diseases affecting the Three Yin, Floating is abnormal). Floating and Surging pulse with vomiting blood or nosebleeds yields no benefit (Yang Fire too excessive, Yin Blood further injured).
Tao Jie'an stated: The essence of pulse diagnosis lies in distinguishing Forceful from Feeble, regardless of Floating, Deep, Slow, or Rapid. Forceful indicates Yang, Excess, and Heat; Feeble indicates Yin, Deficiency, and Cold. Profound words! Later scholars must not neglect this.