产后因得热病临。脉细四肢暖者生。脉大忽然肢逆冷。须知其死莫留停。
伤寒论阴病得阳脉者生。阳病得阴脉者死。此大法也。惟产后则不同。
血虚脉亦虚。故诊得细脉。不得谓之阳病见阴脉。但四肢欲暖暖者。阳
病易已也。若诊脉大。大为血虚。血虚为无阴。无阴则偏阳隆盛。身虽热
而四肢逆冷。此乃空得阳脉。而阳气已绝。不得谓之阴病见阳脉也。须知死而已矣。
小儿乳后辄呕逆。更兼脉乱无忧虑。
巢氏病源曰。小儿变蒸者。以长血气也。变者上气。蒸者体热。变蒸有轻
重。其轻者体热而微惊。耳冷髋亦冷。上唇头白泡起如死鱼目珠子。微
汗出。近者五日而歇。远者八九日乃歇。其重者体壮热而脉乱。或汗或
不汗。不欲食。食辄吐。 无所苦也。变蒸之时。目白睛微赤。黑睛微白赤。
无所苦。蒸毕自明了矣。先变五日。后蒸五日。为十日之中。热乃除。变蒸
之时。不欲惊动。勿令傍边多人。变蒸或早或晚。根据时如法者少也。初变
之时。或热甚者。违日数不歇。审计日数。必是变蒸。服黑散。发汗热不止
者。服紫双丸。小瘥便已。勿复服之。其变蒸之时。遇寒加之。则寒热交争。
腹痛夭矫啼不止者。熨之则愈。变蒸与温壮伤寒相似。若非变蒸。身热
耳热，髋亦热。此乃为他病。可为余治。审是变蒸。不得为余治。其变日数。
从初生至三十二日一变。六十四日再变。变且蒸。九十六日三变。变者
丹孔出而泄也。至一百二十八日四变。变且蒸。一百六十日五变。一百
九十二日六变。变且蒸。二百二十四日七变。二百五十六日八变。变且
蒸。二百八十八日九变。三百二十日十变。变且蒸。积三百三十日小蒸
毕。后六十四日大蒸。后百二十八日复蒸。积五百七十六日大小蒸毕也。
弦急之时被风缠。
小儿脉见弦而急。当是风气所缠。何也。弦。肝木也。肝主风。弦而且急。则为风寒之气所缠矣。一本作被风气缠。
钱仲阳云。小儿之脉气不和。则弦急。幼科当以钱氏为的。
脉缓即是不消乳。
小儿脉一息六七至为平。何也。盖以人身之脉。不论大小。一日一夜。皆
五十周于身。得一万三千五百息。脉行八百一十丈。此其常也。但大人
身量长大。故以一息四至为平。小儿身量短小。亦必尽五十荣之数。所
以息则犹是。而脉之丈尺促紧。故以六七至为平也。今脉见缓。缓则小
驶于迟矣。缓为脾土之脉。必脾胃虚。不能消化乳食。所以脉见迟也。准
绳脉法。沉缓。食伤多呕吐。又曰微缓脉。乳不化。泄泻沉缓亦同。
紧数细快亦少若。
云岐子曰。数而细快。乃小儿平脉。加之以紧。亦有些须表邪。
虚濡邪气惊风助。
小儿元阳之气充足。故脉五六至以上而有力为平。今脉虚而濡。则脾胃之气衰。而虚风乘之。乃成惊风之候。然惊
有二种。曰急曰慢。急者属阳。阳动而躁疾。慢者属阴。阴静而迟缓。皆因脏腑虚而得之。虚能发热。热则生风。是以
风生于肝。痰生于脾。惊出于心。热出于肝。而心亦热。以惊风痰热。合为四证。搐搦掣颤。反引窜视为八候。又急惊
属阳。用药以寒。慢惊属阴。用药以温。今脉见虚濡。当是慢惊之候。治者审之。
痢下宣肠急痛时。
下痢之证。里急而腹痛。其本在脾肾。其现证在手阳明大肠。大肠属庚金。今脉见浮大。浮大属丙火来克庚金。故
痢下无巳时也。
产后因感受热病而发病。若脉象细弱且四肢温暖，说明预后良好；若脉象洪大却突然四肢厥冷，则预示死亡，不可迟疑。
《伤寒论》中认为阴证见到阳脉者生，阳证见到阴脉者死，这是一般法则。但产后情况则不同。
产后血虚，脉象也自然虚弱，所以诊得细脉时，不能称之为“阳病见阴脉”。只要四肢尚暖，说明阳气未绝，病情容易痊愈。如果诊得脉象洪大，这是因为血虚导致阴虚，阴虚则阳气偏盛（无阴则孤阳独亢）。虽然身体发热，但四肢逆冷，这是空有阳脉之象，实际上阳气已经衰竭，不能称之为“阴病见阳脉”，这种情况只能判断为死亡。
巢元方在《诸病源候论》中说：小儿的“变蒸”过程是为了生长气血。“变”是指气息变化，“蒸”是指身体发热。变蒸有轻重之分。轻度的表现为身体微热且轻微惊悸，耳朵和髋部发凉，上唇出现白色小泡如死鱼眼珠状，微微出汗。短的经过五天停止，长的经过八九天才停止。重度的表现为身体壮热且脉象紊乱，或有汗或无汗，不想吃东西，吃了就吐，但并没有痛苦。变蒸期间，眼白部分微红，黑眼球微带白红色，也没有痛苦。变蒸结束后自然恢复正常。先变五天，后蒸五天，十天之内热势自退。变蒸期间，不要惊动小儿，不要让旁边人多聚集。变蒸的时间早晚不一，完全符合常规时间的很少。初变之时，如果热势严重，超过天数不退，仔细计算日数，必定是变蒸。服用黑散以发汗，如果热仍不止，服用紫双丸，稍有好转即可停药，不要再服。如果在变蒸期间又受寒邪侵袭，导致寒热交争，腹痛剧烈啼哭不止，用熨法治疗即可痊愈。变蒸与温壮伤寒相似，如果不是变蒸，而是身体热、耳朵热、髋部也热，这就是其他疾病，可以按其他病症治疗。如果是变蒸，就不能按其他病症治疗。变蒸的日数，从出生到三十二天为一变，六十四天再变（变且蒸），九十六天三变，一百二十八天四变（变且蒸），一百六十天五变，一百九十二天六变（变且蒸），二百二十四天七变，二百五十六天八变（变且蒸），二百八十八天九变，三百二十天十变（变且蒸）。累计三百三十天小蒸结束。之后六十四天大蒸，再之后一百二十八天复蒸。累计五百七十六天大小蒸全部结束。
小儿在脉象弦急的时候被风邪缠绕。
小儿脉象呈现弦而急的特征，应当是风气缠绕所致。为什么呢？弦脉属肝木，肝主风。脉象既弦且急，就是被风寒之气缠绕了。另一版本作“被风气缠”。
钱仲阳说：小儿脉气不和，就会呈现弦急。儿科医生应以钱乙的理论为准。
脉象缓滞表示乳食不消化。
小儿脉搏一息跳动六七次为平脉。为什么呢？因为人身脉气，不论大小，一天一夜都在全身运行五十周，共一万三千五百息，脉行八百一十丈，这是常态。但大人身体高大，所以一息四至为平脉；小儿身体矮小，也必须完成五十周的营气运行次数，所以呼吸频率相同，但脉搏运行的距离短促紧迫，因此一息六七至为平脉。现在脉象见缓，缓比迟稍微快一点。缓脉是脾土的脉象，必定是脾胃虚弱，不能消化乳食，所以脉象显得迟缓。《医学准绳》脉法说：沉缓脉，多是饮食损伤导致的呕吐。又说微缓脉，乳汁不化，泄泻见沉缓脉也是同理。
紧数细快脉象也较少见。
云岐子说：数而细快的脉象，是小儿的平脉。加上紧象，也有些许表邪。
小儿元气充足，所以脉象五六至以上且有力为平脉。现在脉象虚而濡，说明脾胃之气衰弱，虚风乘虚而入，形成了惊风的证候。然而惊风有两种，叫急惊和慢惊。急惊属于阳，阳气主动而躁疾；慢惊属于阴，阴气主静而迟缓。都是因为脏腑虚弱而得的。虚能发热，热则生风。所以风生于肝，痰生于脾，惊出于心，热出于肝，而心也热。惊、风、痰、热合为四证，搐搦、掣颤、反引、窜视称为八候。另外急惊属阳，用药宜寒凉；慢惊属阴，用药宜温补。现在脉象见虚濡，应当是慢惊的证候。治疗者需仔细审察。
痢疾发作时肠道急迫疼痛。
下痢的证候，里急后重且腹痛，其根本在脾肾，表现症状在手阳明大肠经。大肠属庚金。现在脉象见浮大，浮大属丙火来克制庚金，所以痢疾会持续不止。
After childbirth, if a heat disease is contracted, the prognosis depends on the pulse and limb temperature. If the pulse is fine (Xi) and the limbs are warm, life is preserved. If the pulse is large (Da) but suddenly the limbs become cold (Ni), death is certain; do not delay.
In the *Shanghan Lun* (Treatise on Cold Damage Diseases), it is stated that Yin syndromes presenting with Yang pulses indicate survival, while Yang syndromes presenting with Yin pulses indicate death. This is a general principle. However, postpartum conditions differ.
Postpartum blood deficiency leads to a deficient pulse. Therefore, when a fine (Xi) pulse is diagnosed, it cannot be called "Yang syndrome seeing Yin pulse." As long as the limbs remain warm, indicating that Yang qi is not yet exhausted, the condition is easy to resolve. If a large (Da) pulse is felt, this indicates blood deficiency leading to Yin deficiency. Yin deficiency results in the hyperactivity of Yang qi (solitary Yang flourishing). Although the body may be hot, the limbs are cold (Ni). This is an empty Yang pulse, signifying that Yang qi has already perished. It cannot be interpreted as "Yin syndrome seeing Yang pulse." One must recognize this as a fatal condition.
Infants often vomit or have hiccups after breastfeeding, accompanied by a chaotic pulse; there is no need for worry.
Chao Yuanfang in the *Zhubing Yuanhou Lun* (Source Book of All Categories of Diseases) states: The "Bian Zheng" (growth and transformation) process in infants serves to grow blood and qi. "Bian" refers to changes in Qi, and "Zheng" refers to body heat. Bian Zheng varies in severity. Mild cases present with slight fever and minor fright, cold ears and hips, white blisters appearing on the upper lip resembling dead fish eyes, and slight sweating. These last five days for mild cases, or eight to nine days for severe ones. Severe cases present with high fever and a chaotic pulse, with or without sweating, loss of appetite, vomiting upon eating, but without suffering. During Bian Zheng, the whites of the eyes may appear slightly red, and the pupils slightly whitish-red, yet the infant suffers no distress. Once Bian Zheng concludes, clarity returns naturally. There is a five-day period of "Bian" followed by five days of "Zheng," with fever subsiding within ten days. During this time, avoid disturbing the infant and keep crowds away. The timing of Bian Zheng varies, and few follow the standard schedule exactly. If fever persists beyond the expected days during initial Bian, carefully calculate the days; it is certainly Bian Zheng. Administer Hei San (Black Powder) to induce sweating. If fever persists, administer Zi Shuang Wan (Purple Double Pill); stop once slight improvement occurs, do not continue. If cold pathogen invades during Bian Zheng, causing alternating cold and heat, abdominal pain, and incessant crying, moxibustion or warming therapy will cure it. Bian Zheng resembles Warm Heat Typhoid Fever. If it is not Bian Zheng, but rather heat in the body, ears, and hips, it is another disease and should be treated accordingly. If confirmed as Bian Zheng, do not treat it as another disease. The timeline for Bian Zheng is: one change at 32 days from birth, a second at 64 days (Bian and Zheng), third at 96 days, fourth at 128 days (Bian and Zheng), fifth at 160 days, sixth at 192 days (Bian and Zheng), seventh at 224 days, eighth at 256 days (Bian and Zheng), ninth at 288 days, and tenth at 320 days (Bian and Zheng). Small Zheng completes after accumulating 330 days. Then Great Zheng occurs after 64 days, followed by another Zheng after 128 days. Total accumulation of 576 days marks the completion of all small and great Zheng processes.
When the infant's pulse is wiry (Xuan) and rapid, it indicates entanglement by wind pathogen.
A wiry and rapid pulse in infants suggests entanglement by wind. Why? Wiry pulse corresponds to Liver Wood, and the Liver governs Wind. A pulse that is both wiry and rapid indicates entanglement by Wind-Cold pathogen. Another version reads "entangled by Wind Qi."
Qian Zhongyang stated: When infant Qi is disharmonious, the pulse becomes wiry and rapid. Pediatricians should take Qian Yi's theories as the standard.
A slow (Huan) pulse indicates indigestion of milk.
An infant's normal pulse beats six to seven times per respiration. Why? Because human pulse circulation, regardless of size, completes fifty cycles through the body in one day and night, totaling 13,500 respirations and traveling 810 zhang. This is the norm. Adults are larger, so four beats per respiration is normal. Infants are smaller but must complete the same fifty cycles of Ying Qi; thus, while the respiration rate is similar, the pulse travel distance is shorter and tighter, making six to seven beats per respiration normal. A slow (Huan) pulse here is slightly faster than a delayed (Chi) pulse. Huan is the pulse of Spleen Earth, indicating Spleen-Stomach deficiency and inability to digest milk/food, hence the seemingly slow presentation. The *Yixue Zhunsheng* Pulse Method states: Deep-Huan pulse indicates food injury with vomiting. Also, Micro-Huan pulse indicates undigested milk; sinking-Huan pulse also applies to diarrhea.
Tight (Jin), rapid (Shu), fine (Xi), and fast (Kuai) pulses are less common.
Yun Qingzi stated: Rapid and fine-fast pulses are normal for infants. If accompanied by a tight (Jin) quality, there is some exterior pathogen.
Deficient (Xu) and soft (Ru) pulses are assisted by evil Qi and convulsions.
Infants possess abundant primordial Yang Qi; thus, a pulse of five to seven beats per respiration with strength is normal. A deficient and soft (Ru) pulse now indicates Spleen-Stomach Qi decline, allowing Deficient Wind to invade, forming Convulsion patterns. Convulsions have two types: Acute (Ji) and Chronic (Man). Acute belongs to Yang, characterized by movement and agitation; Chronic belongs to Yin, characterized by stillness and slowness. Both arise from Zang-Fu deficiency. Deficiency generates heat, which generates wind. Thus, Wind arises from Liver, Phlegm from Spleen, Fright from Heart, and Heat from Liver (and consequently Heart). Fright, Wind, Phlegm, and Heat combine into four syndromes; twitching, pulling, trembling, and staring constitute eight signs. Acute Convulsion is Yang, treated with cold herbs; Chronic Convulsion is Yin, treated with warm herbs. A deficient and soft pulse indicates Chronic Convulsion. Practitioners must examine carefully.
Dysentery presents with urgent intestinal pain.
Dysentery involves urgency and abdominal pain. The root lies in Spleen and Kidney, manifesting in the Hand-Yangming Large Intestine channel. Large Intestine belongs to Geng Metal. A floating (Fu) and large (Da) pulse indicates Bing Fire overcoming Geng Metal, causing dysentery to persist indefinitely.