脉诀启蒙曰凡诊小儿脉当大指按三部一息六七至为平八九至为内寒弦脉为风痫沉缓为伤
食促
急为虚惊弦急为气不和沉细为冷浮为风大小不均为鬼祟浮大数为风热伏结为物张单细为疳劳
风肠痛多喘呕脉洪为有虫浮而迟潮热者为胃寒也
脉经曰小儿四岁呼吸八至细数者吉又云呼吸八至者平九至者伤十至者困诊小儿脉法多雀
斗要
以三部脉为主若急为风痫沉者乳不消弦急为客忤气小儿是其日数应变蒸之时身热而脉乱无汗
不欲食乳辄吐 者脉乱无苦也脉沉而数者骨间有热欲以腹按清冷也宝鉴云小儿三岁以上五
岁
以下五百七十六日变蒸毕乃成人血脉骨肉皆坚牢方可诊候也盖小儿纯阳故脉息数促如大人为
不同也故病多见七表脉为属阳脉然也是以八里脉多不经见为属阴脉耳当知此理
按半 以上方可看虎口周 以上看虎口兼以一指脉若五百七十六日变蒸满足只与看一指
脉以
食指衮转分取三部凡言三部者非寸关尺系小儿三部面看气色为一部虎口脉纹为二部寸口一指
脉为三部也
小儿有病须凭脉一指三关定有息浮洪风盛热多惊虚冷沉迟实有积小儿三岁至五岁呼吸须
得八至看九至为迟十至困长短大小有邪干
小儿脉大多风热沉细元因乳食结弦长多是肝膈风紧数惊风四肢掣浮洪胃口如火烧沉紧腹
中痛
不歇虚濡有气又兼惊脉芤大小便中血四至洪来若烦满沉细腹中痛切切滑中露湿冷所伤弦急客
忤明分说
小儿乳后辄呕逆更兼脉乱无忧虑弦急之时被气缠脉缓即是不消乳紧数细数亦少苦虚濡邪
风惊风助痢下宣肠急痛时浮大之脉归泉路
伤寒脉大最相宜肿满浮洪病可医微细心痛终是顺沉迟吐泻必须危虫攻紧滑皆知吉渴饮微
沉势已衰惊搐浮洪多易治喘粗涎盛滑为奇
《脉诀启蒙》说:凡是诊察小儿的脉象,应当用大拇指按压寸、关、尺三部。一呼一吸之间脉搏跳动六七次为平脉;八九次为内寒证;出现弦脉多为风痫证;脉象沉缓为伤食证;脉象促急为虚惊证;脉象弦急为气机不和;脉象沉细为冷证;脉象浮为风邪;脉象大小不均匀为鬼祟作怪(指不明原因的怪异病症);脉象浮大数多为风热证;脉象伏结为体内有积滞物;脉象单细为疳劳证。若见风邪、肠痛、多喘、呕吐,脉象洪大则提示有虫积;脉象浮而迟且伴有潮热的,是胃寒证。
《脉经》说:四岁小儿呼吸八至,脉象细数是吉兆。又说:呼吸八至为平脉;九至为病态(伤);十至为危重(困)。诊察小儿脉法,大多以雀啄、屋漏等“斗要”脉象为主,但更应以寸、关、尺三部脉象为核心。若脉象急,多为风痫;脉象沉,多为乳食不消化;脉象弦急,多为客忤气(外邪侵袭导致的气机逆乱),多见于小儿。如果小儿处于日数应验“变蒸”之时,身体发热而脉象紊乱,无汗,不想吃奶,吃了就吐,这是脉乱,并无大碍。脉象沉而数的,说明骨间有热,可以用腹部触按来辨别是否清冷。《幼科发挥·宝鉴》说:小儿三岁以上、五岁以下,经过五百七十六日的变蒸过程结束后,才成为成人,此时血脉骨肉都坚实牢固,才可以进行全面的诊候。大概因为小儿属纯阳之体,所以脉息急促快速,与大人不同。因此疾病多见七表脉,属于阳脉;然而八里脉多不常见,属于阴脉罢了。应当明白这个道理。
诊脉时,一岁半以上可以看虎口指纹;一岁半以下看虎口指纹,并配合一指脉法。如果五百七十六日变蒸已满,只看一指脉即可。用食指滚动旋转,分别取寸、关、尺三部。所谓“三部”,并非指成人的寸、关、尺,而是指:看面色气色为一部,看虎口脉纹为二部,看寸口一指脉为三部。
小儿有病必须凭脉诊,通过一指在三关的定位来确定病情。脉浮洪,主风盛、热多、惊悸、虚冷;脉沉迟,主实证、有积滞。小儿三岁至五岁,呼吸次数须得八至;看九至为迟缓(病态),十至为困顿(危重)。脉象长短大小不一,是有邪气干扰。
小儿脉大多因风热所致;脉沉细多因乳食凝结;脉弦长多是肝膈受风;脉紧数多为惊风,伴有四肢抽搐;脉浮洪,胃口如火烧;脉沉紧,腹中疼痛不止;脉虚濡,既有气滞又兼惊悸;脉芤,大小便中有血;脉象四至洪大,若伴烦闷胀满;脉沉细,腹中疼痛;脉切切滑利,多露湿冷所伤;脉弦急,多为客忤,可以分明解说。
小儿喂奶后随即呕吐,如果兼见脉乱,无需忧虑。若是脉象弦急,是被邪气缠绕;脉缓即是不消化乳汁;脉紧数、细数也较少痛苦。脉象虚濡,是邪风、惊风辅助所致;痢疾下泄,宣通肠道,急痛时脉象浮大,预后不良(归泉路指死亡)。
伤寒病脉象大最为适宜;肿满病脉象浮洪,病可医治;脉微细、心痛,终究是顺证(易治);脉沉迟,吐泻,必须警惕危险;虫积攻注,脉紧滑,皆知为吉;口渴饮水,脉微沉,病势已衰;惊搐,脉浮洪,多易治疗;气喘粗重、涎液旺盛,脉滑为奇特(好现象)。
*Juefa Qimeng* (Enlightenment on Pulse Diagnosis) states: When diagnosing the pulse of children, one should use the thumb to press the Cun, Guan, and Chi positions. Six to seven beats per respiration indicate a normal pulse; eight to nine beats indicate internal cold; a Wiry pulse (Xian Mai) suggests Wind Epilepsy (Feng Xian); a Deep and Slow pulse indicates Food Retention (Shang Shi); a Choppy and Rapid pulse indicates Deficiency Palpitations (Xu Jing); a Wiry and Rapid pulse indicates Disharmony of Qi; a Deep and Fine pulse indicates Cold; a Floating pulse indicates Wind; an irregular pulse in size suggests Gui Sui (demonic influence or unexplained pathological conditions); a Floating, Large, and Rapid pulse indicates Wind-Heat; a Hidden and Knotted pulse indicates accumulation of pathogenic substances; a Single and Fine pulse indicates Gan Lao (chronic malnutrition syndrome). If Wind pathogens, intestinal pain, frequent wheezing, or vomiting are present, a洪 (Hong/Full) pulse suggests the presence of parasites; a Floating and Slow pulse accompanied by tidal fever indicates Stomach Cold.
*Mai Jing* (Pulse Classic) states: For a four-year-old child, eight beats per respiration with a Fine and Rapid quality is auspicious. It further states that eight beats per respiration is normal; nine beats indicates pathology; ten beats indicates critical condition. In pediatric pulse diagnosis, although certain specific patterns like Que Zhuo (Sparrow Pecking) are noted, the primary focus should be on the three positions (Cun, Guan, Chi). A Rapid pulse suggests Wind Epilepsy; a Deep pulse suggests indigestion of milk; a Wiry and Rapid pulse suggests Ke Wu Qi (Qi disturbance caused by external shock or fright), common in children. If a child is undergoing "Bian Zheng" (physiological growth cycles), they may have fever, chaotic pulse, no sweat, refusal to nurse, and vomiting after feeding. This chaotic pulse is benign and not a cause for concern. A Deep and Rapid pulse indicates heat within the bones; abdominal palpation can help distinguish between cold and heat. *Baojian* (Treasure Mirror) states: Children aged three to five years undergo 576 days of Bian Zheng cycles. Only after this period, when blood vessels and bones become firm and solid like adults, can comprehensive diagnosis be performed. Generally, children possess Pure Yang constitution, so their pulses are rapid and hurried, differing from adults. Therefore, diseases often manifest as Seven Exterior Pulses (Yang pulses), while Eight Interior Pulses (Yin pulses) are rarely seen. This principle must be understood.
For diagnosis, if the child is over one and a half years old, observe the Tiger's Mouth (web between thumb and index finger) veins; if under one and a half years, observe the Tiger's Mouth veins combined with the One-Finger Pulse method. If the 576-day Bian Zheng cycle is complete, only the One-Finger Pulse is needed. Use the index finger to roll and rotate, assessing the three positions. The term "three positions" here does not refer to the adult Cun, Guan, Chi, but rather: Observation of facial complexion constitutes the first position; observation of Tiger's Mouth vein patterns constitutes the second position; observation of the One-Finger Pulse at Cun Kou constitutes the third position.
When children are ill, pulse diagnosis is essential. Positioning the finger across the three segments of the Tiger's Mouth vein determines the respiratory rate. Floating and Full pulses indicate excess Wind, Heat, Palpitations, or Deficiency-Cold; Deep and Slow pulses indicate Excess and Accumulation. For children aged three to five, the respiratory rate should be eight beats per respiration; nine beats indicates Slowness (pathology), and ten beats indicates Exhaustion (critical state). Variations in length and size indicate pathogenic interference.
Pediatric pulses are mostly due to Wind-Heat; Deep and Fine pulses are often due to milk food stagnation; Wiry and Long pulses suggest Liver/Gallbladder Wind; Tight and Rapid pulses suggest Wind Convulsions with limb twitching; Floating and Full pulses indicate burning stomach heat; Deep and Tight pulses indicate persistent abdominal pain; Weak and Soft pulses indicate Qi stagnation combined with fright; Hollow (Kou) pulses indicate blood in stool or urine; Four beats per respiration with Fullness suggests irritability and fullness; Deep and Fine pulses indicate abdominal pain; Slippery pulses suggest exposure to damp-cold; Wiry and Rapid pulses indicate Ke Wu (external shock), which can be clearly explained.
If a child vomits immediately after nursing and has a chaotic pulse, there is no need for worry. If the pulse is Wiry and Rapid, it is entangled by pathogens; a Slow pulse indicates undigested milk; Tight, Rapid, Fine, and Rapid pulses indicate less suffering. Weak and Soft pulses are aided by Evil Wind and Wind Convulsions; dysentery involves clearing the intestines; urgent pain with a Floating and Large pulse leads to death (returning to the spring road).
In Shang Han (Cold Damage), a Large pulse is most favorable; Edema and Fullness with a Floating and Full pulse are treatable; Micro and Fine pulses with heart pain are ultimately favorable; Deep and Slow pulses with vomiting and diarrhea are critical; Parasitic attack with Tight and Slippery pulses is auspicious; Thirst with drinking and a Micro-Deep pulse indicates declining disease intensity; Convulsions with Floating and Full pulses are easy to treat; Wheezing with profuse phlegm and a Slippery pulse is a positive sign.