夏禹铸曰；望闻问切，固医家之不可少一者也。在大方脉则
然，而小儿科则惟以望为主，问则继，闻则次，而切则无矣。经云∶切而知之之谓巧。夫小儿六脉未全，切无可切，
而巧亦无所用其巧矣。问而知之之谓工。小儿于未言语时，问之无可问；即于能言者问之，多不以真对，是问之不
必问，而工亦无所用其工。闻而知之之谓圣。小儿初病之时，声音或不失其常，至病久而气丧，气丧而声失，闻之
无可闻，而圣又何所见其圣。况书又曰∶哭声不响赴阴君，而亦有不赴阴君者何？无非泥其声而不得肺之绝与不绝
故也。吾故曰以望为主。曰∶五脏之体隐而理微，望从何处？曰体固隐矣，然发见于苗窍颜色之间者，用无不周；
理固微矣，乃昭着于四大五官之外者，无一不显。中庸所谓费而隐，显之微者，不可引之相发明哉。故小儿病于内，
必形于外，外者内之着也。望形审窍，自知其病，按病推拿用药，见效之速，未有不如响之应声者。内有脏，曰心，
曰肝，曰脾，曰肺，曰肾。五脏不可望，惟望五脏之苗与窍。舌乃心之苗，红
紫，心热也；肿黑，心火极也；淡白，虚也。鼻准与牙床乃脾之窍，鼻红燥，脾热也；惨黄，脾败也，牙床红肿，
脾热也；破烂，胃火也。唇乃脾胃之窍，红紫热也；淡白，虚也；如黑漆者，脾胃绝也，口左扯，肝风也；右
扯，脾之痰也。鼻孔肺之窍，干燥，热也；流清涕，寒也。耳与齿乃肾之窍，耳鸣，气不和也；耳流脓，肾热也；
齿如黄豆，肾气绝也。目乃肝之窍，勇视而转睛者，风也，直视而睛不转者，肝之将绝也。以目分言之，又属五脏之
窍。黑珠属肝，纯是黄色，凶症也。白珠属肺，色青，肝气伤也；淡黄色，腑有积滞也，老黄色，乃肺受湿热也。
瞳人属肾，无光彩，又兼发黄，肾气虚也。大眼角属大肠，破烂，肺有风也。小眼角属小肠，破烂，心有热也。上皮属
脾，肿，脾伤也。下皮属胃，青色，胃有寒也。上下皮睡合不紧，露线缝者，脾胃极虚也。面有五位，五脏各有所属，
额属心，离火也；左腮属肝，震木也，右腮属肺，兑金也；唇之下属肾，坎水也。五脏里也，六腑表也。小肠心之表，
小便短黄涩痛，心热也；清长而利虚也。胃乃脾之表，唇红而吐，胃热也；唇惨白而吐，胃虚也；唇色平常而吐，作伤
胃论。大肠肺之表，大便闭结，肺有火也；肺无热而便闭，必血枯，不可通下；脱肛，肺虚也。胆乃肝之表，口苦，肝
旺也；闻声着吓，肝虚也。膀胱肾之表，居脐下气海之右，有名无形，筋肿筋痛，肾水之寒气入膀胱也。面有五色∶一
曰红，红病在心，面红者热；一曰青，青病在肝，面青者痛；一曰黄；黄病在脾，面黄脾伤；一曰白，白病在肺，面白
者寒；一曰黑；黑病在肾，面黑而无润泽，肾气败也。望其色，若异于平日，而苗窍之色与面色相符，则
脏腑虚实，无有不验者矣。
涂蔚生曰∶夏禹铸先生此篇望形证论，固于小儿之大体病状，略形完备，似具一种特别慧思心得者。然其所谓不
可切，必问，不可闻，是则未免过于拘泥，偏于非其常事者也。盖有病之儿，未必尽系六脉未全，不可用切；未必尽
系不会言语，不必以问；未必尽系好谎，问之多不以实对；未必尽系病久失音，闻无可闻者也。纵其六脉未全，言语
未能，平素好谎，病久失音，不可根据切与闻问，而其每日怀抱之父母，未常稍离左右，岂有不可问其饮食起居为何
若者乎？吾故曰∶禹铸此论，未免过于拘泥。然则设遇如此之儿，吾人将何以处此。曰∶舍去切闻，持望与问。因诊
断平常之医师，全恃问症，以为疗治者也。至其所谓耳鸣气不和，固属小儿诚有之事，然耳鸣究系肾虚者多。因儿有
禀受先天浓薄，与脏腑传克之异，不可谓小儿无情欲之私，便无肾虚等事也。若夫所谓瞳人无光，兼发黄为肾虚之黄
字，则不如易作焦字为妥。因发黄之儿颇多，发黄者，未必肾虚；肾虚者，未必发黄。然肾水干涸，不能上滋毛发，
究见何状？曰外形焦燥，稀落作穗。若以发黄为肾虚，恐人于发黄之儿患病，尽认为肾虚；而发焦作穗之儿，反无以
名之也。其所谓上眼皮属脾，下眼皮属胃，虽无大差，亦不如以上胃下脾为妥。因阳上阴下，此天地化生之定义也。
其所谓小便清利而长为小肠虚，必须兼有别症，方可断为虚症，因小便宜于清利也。其所谓五脏里也，六腑表也，根
据旧书习惯说法，似乎未可浓非。然阴阳互相对待，六腑各配一脏，除手厥阴心包络，配匹手少阳三焦人多不知外，人
每呼为五脏六腑。我辈既确知三焦实有其物，亦有配匹，即可力改前非。其所谓膀胱为肾之表，有名无形，则确属有误。
盖古人只有谓三焦有名无形者，实则不知三焦为何物，即内而上中下三焦脏腑相连系之油膜，外而肥瘦肉间相隔之
白膜也。若夫膀胱，则更有名有形，其为肾行水之府也，则火蒸水化，上升而为津
液，外达而为卫气。其受肾邪热之传也，则溺道涩滞不通，而为癃闭，半通而为淋浊；其当肾火之败也，则非少
腹寒结胀满疼痛，即溺多而或不禁。前人见牲畜已死，膀胱收缩莫辨，遂谓其有上口无下口，是不知其上口已在
下焦油膜连网之中也。若谓其有名无形，则其块然一物，果何以置之？至其所谓筋肿筋痛一层，义更难会，不知
其是指外肾阴茎？抑是指周身之筋？盖肝主筋，而膀胱不主筋也。
夏禹铸说：望、闻、问、切，本来是医生不可缺少的四种诊法。对于成人内科病（大方脉）来说确实如此，但对于儿科而言，则以望诊为主，问诊次之，闻诊再次，而切诊则几乎不用。经典医籍说：“通过切脉来诊断疾病叫做‘巧’。”然而小儿的六部脉象尚未完全形成，没有脉可切，所谓的“巧”也就无从施展了。“通过问诊来诊断疾病叫做‘工’。”小儿在还不会说话的时候，无可询问；即使到了能说话的时候去询问，他们往往也不说真话，所以问诊并非必须，所谓的“工”也无从施展。“通过闻声嗅味来诊断疾病叫做‘圣’。”小儿刚生病时，声音可能还没有失去常态，但病情久了元气耗散，元气耗散则声音改变，此时闻诊也无可闻，所谓的“圣”又从何体现呢？况且书上又说：“哭声不响亮是阴气将绝的表现”，但也有哭声不响亮的情况是怎么回事呢？这无非是因为拘泥于声音表象，而无法判断肺气是否衰竭的缘故。所以我主张以望诊为主。有人问：“五脏的形体隐蔽且道理精微，望诊从哪里入手？”回答说：形体虽然隐蔽，但表现在苗窍和面色上的征象，运用起来无不周全；道理虽然精微，但显露在四肢五官之外的现象，无一不显著。《中庸》所说的“显明中蕴含隐微”，这种显明中的精微之处，难道不可以互相阐发说明吗？所以小儿体内有病，必然反映在体表外部，外部是内部的外在表现。观察形体审查苗窍，自然就知道是什么病，根据病情进行推拿用药，见效之快，没有不像回声应声那样迅速的。体内有五脏，即心、肝、脾、肺、肾。五脏本身无法直接观察，只能观察五脏的苗窍。舌是心的苗窍，舌色红紫，是心热；肿胀发黑，是心火极盛；淡白色，是虚证。鼻头和牙龈床是脾的窍，鼻头红燥，是脾热；惨黄色，是脾败；牙龈红肿，是脾热；破烂，是胃火。嘴唇是脾胃的窍，红紫色是热证；淡白色是虚证；像黑漆一样，是脾胃之气将绝；口角向左歪斜，是肝风；向右歪斜，是脾痰。鼻孔是肺的窍，干燥是热证；流清鼻涕是寒证。耳朵和牙齿是肾的窍，耳鸣是气机不和；耳流脓是肾热；牙齿像黄豆大小（指乳牙未长或发育不良），是肾气将绝。眼睛是肝的窍，目光勇猛且眼球转动的是风证；直视且眼球不转动的，是肝气将绝。细分眼睛各部分，又属于五脏的窍。黑珠属肝，如果纯黄，是凶险病症；白珠属肺，色青是肝气受伤；淡黄色，是腑中有积滞；老黄色，是肺受湿热。瞳孔属肾，无光彩且兼发黄，是肾气虚。大眼角属大肠，破烂是肺有风。小眼角属小肠，破烂是有心热。上眼皮属脾，肿是脾伤。下眼皮属胃，青色是胃寒。上下眼皮闭合不紧，露出线缝的，是脾胃极度虚弱。面部有五个部位，五脏各有归属：额头属心，对应离火；左腮属肝，对应震木；右腮属肺，对应兑金；嘴唇下方属肾，对应坎水。五脏在内为里，六腑在外为表。小肠是心的表里关系，小便短少黄赤涩痛，是心热；小便清长通畅，是虚证。胃是脾的表里关系，唇红且呕吐，是胃热；唇惨白且呕吐，是胃虚；唇色正常却呕吐，按伤食论治胃。大肠是肺的表里关系，大便闭结，是肺有火；肺无热而大便闭结，必定是血枯，不可使用通下法；脱肛，是肺虚。胆是肝的表里关系，口苦，是肝旺；听到声音就惊吓，是肝虚。膀胱是肾的表里关系，位于脐下气海的右侧，有名无形，筋肿筋痛，是肾水的寒气侵入膀胱所致。面部有五色：一是红，红色病在心，面红者属热；二是青，青色病在肝，面青者主痛；三是黄，黄色病在脾，面黄者脾伤；四是白，白色病在肺，面白者属寒；五是黑，黑色病在肾，面黑而无润泽，是肾气败坏。观察面色，如果与平日不同，且苗窍的颜色与面色相符，那么脏腑的虚实，就没有不准确的了。
涂蔚生说：夏禹铸先生的这篇望形辨证论，对于小儿的大体病状，大致完备，似乎具备一种特别的慧思心得。然而他说小儿不可切脉、不必问诊、不可闻诊，未免过于拘泥，偏离了常规情况。大概生病的孩子，未必都是六脉未全而不能切脉；未必都不会说话而不必问诊；未必都是爱说谎而问之不实；也未必都是病久失音而无可闻。纵然他们六脉未全、言语不能、平素爱说谎、病久失音，不能仅凭切脉和闻诊来判断，但是每天怀抱孩子的父母，从未离开左右，难道不可以询问他们的饮食起居情况吗？所以我说道：禹铸的这个论点，未免过于拘泥。那么如果遇到这样的孩子，我们将如何处理呢？回答说：舍弃切诊和闻诊，坚持望诊和问诊。因为一般的医师，全靠问诊来作为治疗的依据。至于他说耳鸣气机不和，固然是小儿确实存在的情况，但耳鸣终究多是肾虚引起的。因为儿童有先天禀赋厚薄的差异，以及脏腑传克的不同，不能说小儿没有情欲私念，就没有肾虚等情况。至于他说瞳孔无光且兼发黄是肾虚的黄，不如改为“焦”字更妥当。因为发黄的小儿很多，发黄的未必就是肾虚；肾虚的未必就会发黄。然而肾水干涸，不能上滋毛发，究竟呈现什么状态呢？回答说：外形焦躁干枯，头发稀疏结成穗状。如果把发黄当作肾虚，恐怕人们遇到发黄患病的小儿，都认为是肾虚；而头发焦枯成穗的小儿，反而无法命名其病。他说上眼皮属脾，下眼皮属胃，虽然差别不大，但不如以上胃下脾更妥当。因为阳在上阴在下，这是天地化生的定义。他说小便清利而长为小肠虚，必须兼有其他症状，才能断定为虚证，因为小便本来就应该清利通畅。他说五脏为里，六腑为表，根据旧书的习惯说法，似乎不可过分非议。然而阴阳互相对待，六腑各配一脏，除了手厥阴心包络配手少阳三焦大多数人不知道外，人们常称为五脏六腑。我们既然确知三焦实有其物，也有配对，就可以努力改正以前的错误。他说膀胱是肾的表里关系，有名无形，这确实有误。大概古人只有说三焦有名无形的，实际上是因为不知道三焦是什么东西，其实内而上中下三焦是脏腑相连系的油膜，外而肥瘦肉之间相隔的白膜。至于膀胱，则是更有名有形，它是肾行使水液功能的府库。如果是火蒸水化，上升成为津液，外达成为卫气。如果受到肾邪热的传变，则尿道涩滞不通，成为癃闭，半通则为淋浊；如果是肾火败坏，则不是小腹寒结胀满疼痛，就是尿多而失禁。前人看到牲畜死后，膀胱收缩难以分辨，就说它有上口无下口，这是不知道它的上口已经在下焦油膜连网之中了。如果说它有名无形，那么这一块独立存在的物体，究竟放在哪里呢？至于他说筋肿筋痛一层，意义更难理解，不知道他是指外肾阴茎，还是指全身的筋？因为肝主筋，而膀胱不主筋。
Xia Yuzhu stated: Observation, Auscultation and Olfaction, Inquiry, and Palpation are indeed indispensable to physicians. This holds true for adult internal medicine (Da Fang Mai), but in pediatrics, observation is primary, inquiry follows, auscultation and olfaction are secondary, and palpation is virtually non-existent. The classics state: "Diagnosing through palpation is called 'Qiao' (skill)." However, since the six pulse positions in children are not fully developed, there is no pulse to feel, and thus "Qiao" has no application. "Diagnosing through inquiry is called 'Gong' (competence)." For infants who cannot yet speak, there is nothing to ask; even when they can speak, they often do not answer truthfully. Thus, inquiry is not always necessary, and "Gong" finds no use. "Diagnosing through auscultation and olfaction is called 'Sheng' (sagehood)." When a child first falls ill, their voice may remain normal, but after prolonged illness, vital energy dissipates, leading to changes in voice. In such cases, there is little to hear, and "Sheng" cannot be demonstrated. Furthermore, texts mention that a weak cry indicates the exhaustion of Yin, yet some cries are weak without indicating Yin exhaustion. This is merely due to being stuck on the superficial sound without determining whether Lung Qi is exhausted or not. Therefore, I assert that observation should be primary. One might ask: "The organs are hidden and their principles subtle; where does observation begin?" I reply: Although the organs are hidden, their manifestations in the sensory orifices and facial colors are comprehensive; although the principles are subtle, their signs displayed on the limbs and five senses are evident. As stated in the *Zhong Yong* (Doctrine of the Mean), "What is manifest contains the hidden." Can these manifest subtleties not illuminate each other? Thus, internal diseases in children must manifest externally; the external is the manifestation of the internal. By observing the form and examining the orifices, one naturally knows the disease. Applying tuina and medication accordingly yields results as swift as an echo responding to a sound.
Inside the body are the Five Zang Organs: Heart, Liver, Spleen, Lung, and Kidney. Since the Zang organs themselves cannot be observed directly, we observe their "biao" (external indicators) and orifices. The tongue is the biao of the Heart: redness or purpleness indicates Heart Heat; swelling with blackness indicates extreme Heart Fire; pale white indicates Deficiency. The nose tip and gum beds are the orifices of the Spleen: red and dry nose indicates Spleen Heat; sallow yellow indicates Spleen failure; red and swollen gums indicate Spleen Heat; ulceration indicates Stomach Fire. The lips are the orifices of the Spleen and Stomach: red/purple indicates Heat; pale white indicates Deficiency; black like lacquer indicates the exhaustion of Spleen/Stomach Qi; deviation of the mouth corner to the left indicates Liver Wind; to the right indicates Spleen Phlegm. The nostrils are the orifices of the Lung: dryness indicates Heat; clear runny nose indicates Cold. The ears and teeth are the orifices of the Kidney: tinnitus indicates Disharmony of Qi; pus in the ear indicates Kidney Heat; teeth resembling soybeans (indicating developmental issues) indicates exhaustion of Kidney Qi. The eyes are the orifices of the Liver: fierce gaze with moving eyeballs indicates Wind; fixed gaze with immobile eyeballs indicates impending exhaustion of Liver Qi. Subdividing the eye parts further relates them to the Five Zang Organs: The black pupil belongs to the Liver; pure yellowing is a ominous sign. The white sclera belongs to the Lung; bluish color indicates injury to Liver Qi; pale yellow indicates accumulation in the Fu organs; dark yellow indicates Damp-Heat in the Lung. The pupil belongs to the Kidney; lackluster appearance with yellowing indicates Kidney Qi Deficiency. The outer canthus belongs to the Large Intestine; ulceration indicates Wind in the Lung. The inner canthus belongs to the Small Intestine; ulceration indicates Heat in the Heart. The upper eyelid belongs to the Spleen; swelling indicates Spleen injury. The lower eyelid belongs to the Stomach; bluish color indicates Cold in the Stomach. Loose closure of both eyelids exposing a seam indicates extreme Deficiency of the Spleen and Stomach.
The face has five regions corresponding to the Five Zang Organs: The forehead belongs to the Heart (Li Fire); the left cheek belongs to the Liver (Zhen Wood); the right cheek belongs to the Lung (Dui Metal); the area below the lips belongs to the Kidney (Kan Water). The Zang organs are interior (Li), and the Fu organs are exterior (Biao). The Small Intestine is the Biao of the Heart: short, yellow, painful urination indicates Heart Heat; clear, long, free urination indicates Deficiency. The Stomach is the Biao of the Spleen: red lips with vomiting indicate Stomach Heat; sallow white lips with vomiting indicate Stomach Deficiency; normal lip color with vomiting suggests Food Injury affecting the Stomach. The Large Intestine is the Biao of the Lung: constipation indicates Fire in the Lung; if the Lung has no Heat but constipation persists, it must be Blood Dryness, and purgatives must not be used; rectal prolapse indicates Lung Deficiency. The Gallbladder is the Biao of the Liver: bitter taste indicates Liver Excess; fright upon hearing sounds indicates Liver Deficiency. The Bladder is the Biao of the Kidney, located to the right of the Qi Sea below the navel. It is described as having a name but no form. Tendon swelling and pain indicate Cold Qi from the Kidney entering the Bladder.
There are five facial colors: Red corresponds to the Heart; red face indicates Heat. Cyan corresponds to the Liver; cyan face indicates Pain. Yellow corresponds to the Spleen; yellow face indicates Spleen injury. White corresponds to the Lung; white face indicates Cold. Black corresponds to the Kidney; black face without luster indicates exhaustion of Kidney Qi. If the facial color differs from usual, and the colors of the orifices match the facial color, then the Deficiency or Excess of the Zang and Fu organs will be accurately diagnosed.
Tu Weisheng commented: Mr. Xia Yuzhu's treatise on observing forms to verify syndromes is largely complete regarding general pediatric conditions, showing unique insight. However, his assertion that palpation, inquiry, and auscultation are unnecessary for children is overly rigid and deviates from common practice. Not all sick children have undeveloped pulses making palpation impossible; not all cannot speak making inquiry useless; not all lie making inquiry unreliable; not all lose their voices making auscultation futile. Even if a child has undeveloped pulses, cannot speak, lies habitually, or has lost their voice due to chronic illness, relying solely on palpation and auscultation is insufficient. However, parents holding the child daily are always present. Is it not possible to inquire about their diet and lifestyle? Therefore, I say Xia Yuzhu's argument is too rigid. How should we handle such cases? We should rely on observation and inquiry while setting aside palpation and auscultation, as most physicians rely on inquiry for treatment.
Regarding tinnitus indicating Qi disharmony, this is true for children, but tinnitus is mostly due to Kidney Deficiency. Children vary in congenital endowment and organ interactions. One cannot claim that because children lack adult desires, they cannot suffer from Kidney Deficiency. Regarding the statement that a lusterless pupil with yellowing indicates Kidney Deficiency, it would be better to change "yellow" to "scorched/dry." Many children have yellow complexions, which do not necessarily indicate Kidney Deficiency; conversely, those with Kidney Deficiency do not necessarily have yellow complexions. When Kidney Water is exhausted and fails to nourish hair, what is the external sign? It appears as scorched, dry, sparse hair forming tufts. If yellowing is equated with Kidney Deficiency, people might misdiagnose all yellow-complexioned sick children as having Kidney Deficiency, while failing to identify those with scorched, tufted hair.
His view that the upper eyelid belongs to the Spleen and the lower to the Stomach is not entirely wrong, but assigning the upper to the Stomach and lower to the Spleen is more appropriate, based on the principle that Yang is above and Yin is below. His claim that clear, long urination indicates Small Intestine Deficiency requires accompanying symptoms to confirm Deficiency, as clear urination is generally normal. His statement that Zang are interior and Fu are exterior aligns with traditional conventions and should not be heavily criticized. Yin and Yang are complementary; each Fu pairs with a Zang. Except for the Pericardium (Hand Jueyin) pairing with the Sanjiao (Hand Shaoyang), which many do not know, people commonly refer to the Five Zang and Six Fu. Since we know the Sanjiao exists and has a pair, we should correct previous misconceptions.
His claim that the Bladder is the Biao of the Kidney and has a name but no form is erroneous. Ancient texts attributed "name but no form" to the Sanjiao because its nature was unknown; actually, internally, it refers to the fatty membranes connecting the upper, middle, and lower Jiao organs, and externally, the white membranes separating fat and muscle. The Bladder, however, has both name and form. It is the residence where the Kidney manages water. Through fire steaming water transformation, fluids rise to become Jin Ye (Body Fluids) and spread outward as Wei Qi (Defensive Qi). If transmitted by Kidney Pathogenic Heat, urinary flow becomes obstructed, leading to retention (Long Bi) or incomplete emptying with turbidity (Lin Zhuo). If Kidney Fire fails, symptoms include cold accumulation, distension, and pain in the lower abdomen, or excessive/incontinent urination. Ancients observed that animal bladders shrink after death and could not distinguish openings, leading to the misconception that it has an upper opening but no lower one. They failed to realize the upper opening connects within the lower Jiao membrane network. To say it has no form ignores its distinct physical existence. Finally, his mention of tendon swelling and pain is confusing. Does he refer to the external genitalia or the tendons of the body? The Liver governs tendons, whereas the Bladder does not.