重实声 重实雄声体热为，三焦气壅在心脾，伤风咳嗽喉咽痛，结涩肠中粪
出迟。
悲焦声 声悲焦有燥，恐怖欲生风，重浊声沉静，疳攻必耳聋。
啼哭声 但哭无啼只是惊，多啼不哭痛分明，声轻颤嗄风痫病，速缓声频吐泻成。
HT 煎声 HT 煎烦躁病难安，燥促声音为感寒，语短气微尿主涩，长迟声细痢多般。
迟缓声 语短声迟缓，肠鸣泄泻频，嗄声多不响，风热肺家因。
候儿脉，当以大指按三部，一息六七至为平和，八九至为发热，五至为内寒。
脉弦为风痫，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
不匀为恶候、为鬼祟，浮大数为风、为热，伏结为物聚，单细为疳劳。凡腹痛，多
喘呕而脉洪者为有虫，沉而迟、潮热者胃寒也，温之则愈。诀曰∶小儿脉紧风痫候，
沉缓食伤多呕吐，弦急因知气不和，急促急惊神不守，冷则沉细风则浮，牢实大便
应秘久，腹痛之候紧而弦，脉乱不治安可救，变蒸之时脉必乱，不治自然无过缪，
单细疳劳洪有虫，大小不匀为恶候，脉沉而迟有潮热，此必胃寒来内冠，泻利脉大
不可医，仔细酌量宜审究。（云岐子云∶未及五岁、不可视听者，未可别脉，五岁以上，
方可以脉别浮沉迟数。按∶钱氏论，又不拘五岁上下也。）
脉应杂病∶
诸数脉 为热，属腑。
诸迟脉 为冷，属脏。
阳数脉 主吐逆，不吐必发热。
阴微脉 主泄泻，不泻必盗汗。
沉数脉 寒热，寒多热少，亦主骨蒸热。
紧数脉 寒热，热多寒少，又主骨热，急则惊痫。
沉紧脉 心腹痛，短数同，亦主咳嗽。
沉细脉 乳食不化，亦主腹痛下痢。
沉伏脉 为积聚，亦主霍乱。
微缓脉 乳不化，泄泻，沉缓亦同。
微涩脉 螈 筋挛。
微急脉 寒热唾血。
浮滑脉 宿食不消，亦主咳嗽。
浮紧脉 疳气耳聋。
浮弦脉 头疼身热。
紧滑脉 吐血恶。
心脉急数 惊痫。不惊者疳淋。
肝脉急甚 颠痫风痫，痰涎流液。
肺脉浮实 鼻塞，并大小便不通。
关脉紧滑 主蛔虫，尺脉沉，亦主蛔。
尺脉微细 溏泄冷痢，乳食不化。
尺脉微涩 便血，无血者必盗汗。
脉过寸口入鱼际 主遗尿。
审脉逆顺∶
惊搐脉 浮数顺，沉细逆，身温顺，肢冷逆。
夜啼脉 微小顺，洪大逆，身冷逆。
心腹痛 沉细顺，浮大逆，身温顺，肢冷逆。
伤寒脉 洪弦顺，沉细逆，浮大顺，微伏逆。
汗后脉 沉细顺，洪紧逆，困睡顺，狂躁逆。
温病脉 洪大顺，沉细逆，身热顺，腹痛逆。
咳嗽脉 滑浮顺，沉细逆，身温顺，肢冷逆。
霍乱脉 浮洪顺，迟微逆，身温顺，肢冷逆。
吐 脉 浮大顺，沉细逆，身温顺，肢冷逆。
泄泻脉 缓小顺，浮大逆，身温顺，肢冷逆。
诸痢脉 沉细顺，浮大逆，身温顺，肢冷逆。
诸渴脉 洪数顺，微细逆，身温顺，肢冷逆。
诸肿脉 浮大顺，沉细逆，脏实顺，肠泄逆。
腹胀脉 浮大顺，虚小逆，脏实顺，泄泻逆。
痰喘脉 滑大顺，沉细逆，身温顺，肢冷逆。
寒热脉 紧数顺，沉细逆，倦怠顺，强直逆。
疳劳脉 紧数顺，沉细逆，脏实顺，脾泄逆。
虫痛脉 紧滑顺，浮大逆，身温顺，唇青逆。
诸失血 沉细顺，浮数逆，身温顺，发热逆。
中恶腹胀 紧细顺，浮大逆，身热顺，身冷逆。
黄胆脉 浮大顺，沉细逆，腹宽顺，泄泻逆。
火瘅脉 浮洪顺，沉细逆，身热顺，身冷逆。
钱仲阳云∶小儿之脉，气不和则弦急，伤食则沉缓，虚惊则促急，风则浮，冷
则沉细，脉乱者不治。《水镜诀》云∶阴阳运合，男女成形，已分九窍四肢，乃生
五脏六腑，部分既别，逆顺难明，若凭寸口之浮沉，必乃横亡于孩子，须明虎口，
辨别三关，消详用药，始无差误。未至三岁，看虎口食指第一节名风关，脉初见易
治，第二节名气关，脉见病深难治，第三节名命关，脉见死不治。三关青是四足惊，
赤是水惊，黑是人惊，紫色泻利，黄色雷惊。三关通度，是极惊之症，必死。或青
或红、有纹如线一直者，是乳食伤脾，必发惊热。左右一样者，是惊与积齐发。有
三条、或散，是肺生风痰，或似 声。有赤，是伤寒及嗽。如红火，是泻。红黑
相兼，主下痢，青多白痢，红多赤痢，紫色相兼、加渴。虎口脉纹乱，主胃气不和。
青是惊与积。青黑发慢惊。脉入掌，乃内钓。指纹曲里、风盛，弯外、食积。此论
三岁以上之法。若三岁以下，更用一指按高骨，乃分三关，定其息数，呼吸八至为
平脉，九至不安，十至危困。浮主风。沉迟主虚冷。实主有热。紧主癫痫。洪主热
盛。沉缓主虚泻。微迟有积有虫。迟涩主胃脘不和。沉主乳食难化。沉细主乳食停
滞。紧弦主腹中热痛。牢实主大便秘。沉而数者，骨中有热。弦长是肝膈有风。紧
数乃惊风为患，四肢掣颤。浮洪乃胃口有热。沉紧主腹痛有寒。虚濡者有气，又主
慢惊。芤主大便利血。四岁以下用一指衮转寻三部，以关为准，七八岁移指少许，
九岁次第根据三关部位寻取，十一十二岁亦同，十四十五岁根据大方脉部位诊视。
凡看脉，先定浮沉迟数，阴阳冷热，沉迟为阴，浮数为阳。更兼看部位，青主惊风，
白主虚泻，赤主痰热，黑色病甚，黄主脾疳。以此相参，察病治疗，庶无误矣。《全
幼心鉴》云∶小儿半岁之际有病，当于额前、眉端、发际之间，以名中食三指曲
按之，儿头在左举右手，在右举左手，食指为上，中指为中，名指为下，三指俱热
主感风邪，鼻塞气粗，发热咳嗽。若三指俱冷，主外感风寒，内伤饮食，发热吐泻。
若食中二指热，主上热下冷。名中二指热，主夹惊之疾。食指热，主胸满食滞。又
当参辨脉形主之。流珠形，主饮食所伤，内热欲吐，或肠鸣自利，烦躁啼哭，用助
胃膏消饮食，分阴阳，若食消而病仍作，用香砂助胃膏以补脾胃。环珠形，主脾虚
停食，胸膈胀满，烦渴发热，用五味异功散加山楂、枳实健脾消食，后用六君子
汤调养中气。长珠形，主脾伤饮食积滞，肚腹作痛，寒热不食，先用大安丸消其积
滞，次以异功散健其脾气。来蛇形，主脾胃湿热，中脘不利，干呕不食，此疳邪内
作，先用四味肥儿丸治疳，后用四君子汤补脾。去蛇形，主脾虚食积，吐泻烦渴，
气短喘急，不食困睡，先用六君子汤加枳实健脾消积，次以七味白术散调补胃气。
弓反里形，主感冒寒邪，哽气出气，惊悸倦怠，四肢稍冷，小便赤色，咳嗽吐涎，
先用惺惺散助胃气，祛外邪，后以五味异功散加茯苓、当归养心血、助胃气，若外
邪既解，而惊悸指冷，脾气受伤也，宜用七味白术散补之，若闷乱气粗，喘促哽气
者难治，脾虚甚故也。弓反外形，主痰热心神恍惚，夹惊夹食，风痫痰盛，先以天
麻防风丸祛外邪，又用五味异功散调中气。枪形，主风热生痰发搐，先用抱龙丸，
如未应，用牛黄清心丸，若传于脾肺，或过用风痰之药而见一切诸症者，专调补脾
胃。鱼骨形，主惊痰发热，先用抱龙丸治之，如未应，属肝火实热，少用抑青丸以
清肝，随用六味丸以补肝，或发热少食，或痰盛发搐，乃肝木克脾土，用六君子汤
加柴胡补脾土以制肝木。水字形，主惊风食积，胸膈烦躁，顿闷少食，或夜啼痰
盛，口噤搐搦，此脾胃虚弱，饮食积滞而木克土也，先用大安丸消导饮食，次以六
君、钓藤钩、补中清肝，若已服消食化痰等剂而病不愈者，用四君、升麻、柴胡、
钓藤钩升补脾气、平制肝木。针形，主心肝热极生风，惊悸顿闷，困倦不食，痰盛
搐搦，先用抱龙丸祛风化痰，次用六君子加钓藤钩平肝实脾。透关射指形，主惊风
痰热，聚于胸膈，乃脾肺亏损，痰邪乘聚，先用牛黄清心丸清脾肺、化痰涎，次用
六君子汤加桔梗、山药补脾土、益肺金。透关射甲形，主惊风肝木克制脾土之败
症，急用六君、木香、钓藤钩、官桂温补脾土，未应，即加附子以回阳气，多得
生者。尝闻古人云∶小儿为芽儿，如草之芽，水之沤，盖因脏腑脆嫩，口不能言，
最难投剂，当首察面色而知其所属，次验虎口以辨其所因，实为治法之简要也。
\r虎口三关脉纹\p03-b44a1.bmp\r
\r十三指形\p03-b44a2.bmp\r
流珠只一点红色。环珠差大。长珠圆长。以上非谓圈子，总皆红脉贯气之如此。
来蛇即是长珠，散一头大，一头尖。去蛇亦如此，分上下朝，故曰来去。角弓反张，
向里为顺，向外为逆。枪形，直上。鱼骨，分开。水字，即三脉并行。针形，即过
关一二粒米许。射甲，命脉向外。透指，命脉曲里。虽然，余常治之亦有不专执其
形脉而投剂者，盖但有是症，即服是药，而亦多验。
【听声】
重实声：声音沉重、坚实且雄壮，伴有身体发热，这是三焦气机壅滞在心脾的表现。若因伤风导致咳嗽、咽喉疼痛，且大便干结难出，也属此类。
悲焦声：声音悲哀且焦躁，提示体内有燥热，易生恐惧并可能引发肝风；若声音重浊而沉静，则多为疳积攻冲所致，必然伴随耳聋。
啼哭声：只哭不啼（无泪或声短促）多为受惊；多啼而不哭（声长而响）多为疼痛明显；声音轻细、颤抖且嘶哑，是风痫病的表现；哭声急促且频繁呕吐腹泻，则是吐泻症形成的征兆。
煎声：烦躁不安，病势难以安宁，声音干燥急促为感受寒邪所致；言语短促、气息微弱且小便涩痛，多见于痢疾等多种病症。
迟缓声：言语短少，声音迟缓，伴有肠鸣和频繁泄泻；声音嘶哑且不响亮，多由风热侵袭肺脏引起。
【脉法】
诊察小儿脉搏时，应用大拇指按压寸、关、尺三部。一呼一吸间脉搏跳动六七次为平和之脉；跳动八九次为发热；跳动五次为内寒。
脉象弦紧主风痫；沉缓主伤食；促急主虚惊；弦急主气机不和；沉细主冷证；浮脉主风证；脉象大小不均匀为恶候，或由鬼祟（指不明原因的怪病）引起；浮大数脉主风热；伏结脉主有形之物积聚；单细脉主疳劳。凡是腹痛，若伴有气喘、呕吐且脉象洪大，说明体内有虫；若脉象沉迟且伴有潮热，则是胃寒，温补即可痊愈。歌诀说：小儿脉紧为风痫候，沉缓多为伤食呕吐，弦急可知气机不和，急促为急惊神志不守，冷证则脉沉细，风证则脉浮，牢实脉大便应秘结日久，腹痛之候脉紧而弦，脉象紊乱不安者难救，变蒸期间脉象必乱，不治亦自然无过错，单细脉主疳劳，洪大脉主有虫，大小不匀为恶候，脉沉迟伴潮热必为胃寒内侵，泻利见大脉不可医，仔细斟酌审究。（云岐子说：五岁以下，无法通过视听准确判断的，不可单独凭脉诊断；五岁以上，方可凭脉辨别浮沉迟数。按：钱乙的论述，又不拘泥于五岁上下。）
脉象与杂病对应：
诸数脉：主热，属腑病。
诸迟脉：主冷，属脏病。
阳数脉：主呕吐逆气，若不吐必发热。
阴微脉：主泄泻，若不泻必盗汗。
沉数脉：主寒热往来，寒多热少，也主骨蒸热。
紧数脉：主寒热往来，热多寒少，又主骨热，急则发惊痫。
沉紧脉：主心腹痛，短数脉同理，也主咳嗽。
沉细脉：主乳食不化，也主腹痛下痢。
沉伏脉：主积聚，也主霍乱。
微缓脉：主乳食不化、泄泻，沉缓脉同理。
微涩脉：主抽搐、筋挛。
微急脉：主寒热、唾血。
浮滑脉：主宿食不消，也主咳嗽。
浮紧脉：主疳气、耳聋。
浮弦脉：主头疼、身热。
紧滑脉：主吐血、恶露。
心脉急数：主惊痫。不惊者主疳淋。
肝脉急甚：主颠痫、风痫，痰涎流溢。
肺脉浮实：主鼻塞，以及大小便不通。
关脉紧滑：主蛔虫，尺脉沉也主蛔虫。
尺脉微细：主溏泄、冷痢，乳食不化。
尺脉微涩：主便血，无血者必盗汗。
脉过寸口入鱼际：主遗尿。
审察脉象的顺逆：
惊搐脉：浮数为顺，沉细为逆；身温为顺，肢冷为逆。
夜啼脉：微小为顺，洪大为逆；身冷为逆。
心腹痛：沉细为顺，浮大为逆；身温为顺，肢冷为逆。
伤寒脉：洪弦为顺，沉细为逆；浮大为顺，微伏为逆。
汗后脉：沉细为顺，洪紧为逆；困睡为顺，狂躁为逆。
温病脉：洪大为顺，沉细为逆；身热为顺，腹痛为逆。
咳嗽脉：滑浮为顺，沉细为逆；身温为顺，肢冷为逆。
霍乱脉：浮洪为顺，迟微为逆；身温为顺，肢冷为逆。
呕吐脉：浮大为顺，沉细为逆；身温为顺，肢冷为逆。
泄泻脉：缓小为顺，浮大为逆；身温为顺，肢冷为逆。
诸痢脉：沉细为顺，浮大为逆；身温为顺，肢冷为逆。
诸渴脉：洪数为顺，微细为逆；身温为顺，肢冷为逆。
诸肿脉：浮大为顺，沉细为逆；脏实为顺，肠泄为逆。
腹胀脉：浮大为顺，虚小为逆；脏实为顺，泄泻为逆。
痰喘脉：滑大为顺，沉细为逆；身温为顺，肢冷为逆。
寒热脉：紧数为顺，沉细为逆；倦怠为顺，强直为逆。
疳劳脉：紧数为顺，沉细为逆；脏实为顺，脾泄为逆。
虫痛脉：紧滑为顺，浮大为逆；身温为顺，唇青为逆。
诸失血：沉细为顺，浮数为逆；身温为顺，发热为逆。
中恶腹胀：紧细为顺，浮大为逆；身热为顺，身冷为逆。
黄胆脉：浮大为顺，沉细为逆；腹宽为顺，泄泻为逆。
火瘅脉：浮洪为顺，沉细为逆；身热为顺，身冷为逆。
钱仲阳说：小儿脉象，气不和则弦急，伤食则沉缓，虚惊则促急，风则浮，冷则沉细，脉乱者不治。《水镜诀》说：阴阳运合，男女成形，已分九窍四肢，乃生五脏六腑，部分既别，逆顺难明，若仅凭寸口之浮沉，必致横亡于孩子，须明虎口，辨别三关，详查用药，始无差误。未满三岁，看虎口食指第一节名风关，脉初见易治；第二节名气关，脉见病深难治；第三节名命关，脉见死不治。三关青色是四足惊，赤色是水惊，黑色是人惊，紫色主泻利，黄色主雷惊。三关通度，是极惊之症，必死。或青或红、有纹如线一直者，是乳食伤脾，必发惊热。左右一样者，是惊与积齐发。有三条、或散，是肺生风痰，或似呻吟声。有赤色，是伤寒及嗽。如红火，是泻。红黑相兼，主下痢，青多白痢，红多赤痢，紫色相兼加渴。虎口脉纹乱，主胃气不和。青色是惊与积。青黑发慢惊。脉入掌，乃内钓。指纹曲里、风盛，弯外、食积。此论三岁以上之法。若三岁以下，更用一指按高骨，乃分三关，定其息数，呼吸八至为平脉，九至不安，十至危困。浮主风。沉迟主虚冷。实主有热。紧主癫痫。洪主热盛。沉缓主虚泻。微迟有积有虫。迟涩主胃脘不和。沉主乳食难化。沉细主乳食停滞。紧弦主腹中热痛。牢实主大便秘。沉而数者，骨中有热。弦长是肝膈有风。紧数乃惊风为患，四肢掣颤。浮洪乃胃口有热。沉紧主腹痛有寒。虚濡者有气，又主慢惊。芤主大便利血。四岁以下用一指衮转寻三部，以关为准，七八岁移指少许，九岁次第根据三关部位寻取，十一十二岁亦同，十四十五岁根据大方脉部位诊视。凡看脉，先定浮沉迟数，阴阳冷热，沉迟为阴，浮数为阳。更兼看部位，青主惊风，白主虚泻，赤主痰热，黑色病甚，黄主脾疳。以此相参，察病治疗，庶无误矣。《全幼心鉴》说：小儿半岁之际有病，当于额前、眉端、发际之间，以名中食三指曲按之，儿头在左举右手，在右举左手，食指为上，中指为中，名指为下，三指俱热主感风邪，鼻塞气粗，发热咳嗽。若三指俱冷，主外感风寒，内伤饮食，发热吐泻。若食中二指热，主上热下冷。名中二指热，主夹惊之疾。食指热，主胸满食滞。又当参辨脉形主之。流珠形，主饮食所伤，内热欲吐，或肠鸣自利，烦躁啼哭，用助胃膏消饮食，分阴阳，若食消而病仍作，用香砂助胃膏以补脾胃。环珠形，主脾虚停食，胸膈胀满，烦渴发热，用五味异功散加山楂、枳实健脾消食，后用六君子汤调养中气。长珠形，主脾伤饮食积滞，肚腹作痛，寒热不食，先用大安丸消其积滞，次以异功散健其脾气。来蛇形，主脾胃湿热，中脘不利，干呕不食，此疳邪内作，先用四味肥儿丸治疳，后用四君子汤补脾。去蛇形，主脾虚食积，吐泻烦渴，气短喘急，不食困睡，先用六君子汤加枳实健脾消积，次以七味白术散调补胃气。弓反里形，主感冒寒邪，哽气出气，惊悸倦怠，四肢稍冷，小便赤色，咳嗽吐涎，先用惺惺散助胃气，祛外邪，后以五味异功散加茯苓、当归养心血、助胃气，若外邪既解，而惊悸指冷，脾气受伤也，宜用七味白术散补之，若闷乱气粗，喘促哽气者难治，脾虚甚故也。弓反外形，主痰热心神恍惚，夹惊夹食，风痫痰盛，先以天麻防风丸祛外邪，又用五味异功散调中气。枪形，主风热生痰发搐，先用抱龙丸，如未应，用牛黄清心丸，若传于脾肺，或过用风痰之药而见一切诸症者，专调补脾胃。鱼骨形，主惊痰发热，先用抱龙丸治之，如未应，属肝火实热，少用抑青丸以清肝，随用六味丸以补肝，或发热少食，或痰盛发搐，乃肝木克脾土，用六君子汤加柴胡补脾土以制肝木。水字形，主惊风食积，胸膈烦躁，顿闷少食，或夜啼痰盛，口噤搐搦，此脾胃虚弱，饮食积滞而木克土也，先用大安丸消导饮食，次以六君、钓藤钩、补中清肝，若已服消食化痰等剂而病不愈者，用四君、升麻、柴胡、钓藤钩升补脾气、平制肝木。针形，主心肝热极生风，惊悸顿闷，困倦不食，痰盛搐搦，先用抱龙丸祛风化痰，次用六君子加钓藤钩平肝实脾。透关射指形，主惊风痰热，聚于胸膈，乃脾肺亏损，痰邪乘聚，先用牛黄清心丸清脾肺、化痰涎，次用六君子汤加桔梗、山药补脾土、益肺金。透关射甲形，主惊风肝木克制脾土之败症，急用六君、木香、钓藤钩、官桂温补脾土，未应，即加附子以回阳气，多得生者。尝闻古人云：小儿为芽儿，如草之芽，水之沤，盖因脏腑脆嫩，口不能言，最难投剂，当首察面色而知其所属，次验虎口以辨其所因，实为治法之简要也。
虎口三关脉纹图
十三指形图
流珠形只有一点红色。环珠形稍大。长珠形圆长。以上并非指圆圈，总皆红脉贯气呈现如此形态。来蛇形即是长珠形，散开一头大一头尖。去蛇形也是如此，分上下朝向，故曰来去。角弓反张，向里为顺，向外为逆。枪形，直上。鱼骨形，分开。水字形，即三脉并行。针形，即过关一二粒米许。射甲，命脉向外。透指，命脉曲里。虽然，我常治疗也有不专执其形脉而投药的，盖只要有是症，即服是药，也多有效验。
[Listening to Voice]
Heavy and Solid Voice: A voice that is heavy, solid, and robust, accompanied by body heat, indicates Qi stagnation in the San Jiao (Triple Burner) affecting the Heart and Spleen. If caused by Wind-Cold injury leading to cough and sore throat, with dry and difficult stool, it also belongs to this category.
Sad and Scorching Voice: A voice that is sad and scorching suggests internal dryness-heat, fearfulness, and a tendency to generate Liver Wind. If the voice is heavy, turbid, and quiet, it is likely due to Guan Syndrome (malnutrition syndrome) attacking, inevitably accompanied by deafness.
Crying and Wailing Voice: Crying without wailing (short sound or no tears) indicates fright. Frequent wailing without crying (long and loud sound) indicates clear pain. A light, trembling, and hoarse voice is a sign of Wind Epilepsy. A rapid voice frequency with frequent vomiting and diarrhea indicates the formation of Vomiting and Diarrhea syndromes.
Boiling/Restless Voice: Restlessness and inability to find peace indicate severe illness. A dry and rapid voice suggests Cold pathogen invasion. Short speech, faint Qi, and astringent urination are common in various types of Dysentery.
Slow and Delayed Voice: Short speech and slow voice, accompanied by borborygmus and frequent diarrhea, along with hoarseness and lack of resonance, are often caused by Wind-Heat invading the Lung.
[Pulse Diagnosis]
When examining a child's pulse, use the thumb to press the Cun, Guan, and Chi positions on both wrists. Six to seven beats per respiratory cycle indicate a harmonious pulse; eight to nine beats indicate fever; five beats indicate internal Cold.
A wiry pulse indicates Wind Epilepsy; a deep and slow pulse indicates food injury; a hurried pulse indicates deficiency fright; a wiry and rapid pulse indicates disharmony of Qi; a deep and fine pulse indicates Cold; a floating pulse indicates Wind; an irregular pulse of varying sizes indicates a malignant prognosis or "ghostly affliction" (unexplained strange diseases); a floating, large, and rapid pulse indicates Wind-Heat; a hidden and knotted pulse indicates accumulation of masses; a single fine pulse indicates Guan Labor (chronic malnutrition). For abdominal pain, if accompanied by panting, vomiting, and a洪 (Surging) pulse, it indicates intestinal parasites. If the pulse is deep and slow with tidal fever, it is Stomach Cold, which heals with warming treatment. The rhyme states: A tight pulse in children indicates Wind Epilepsy; deep and slow indicates food injury with vomiting; wiry and rapid indicates Qi disharmony; hurried indicates acute fright with loss of spirit; Cold presents as deep and fine; Wind presents as floating; firm and solid indicates long-term constipation; abdominal pain presents as tight and wiry; a chaotic pulse is incurable; during the "Bian Zheng" (physiological growth period), the pulse must be chaotic, and non-treatment is not an error; single fine indicates Guan Labor; Surging indicates parasites; irregular sizes indicate malignant prognosis; deep and slow with tidal fever indicates internal Stomach Cold; large pulse in diarrhea is incurable; careful deliberation is required. (Yun Qizi said: For children under five, who cannot be accurately assessed by hearing and sight, pulse diagnosis alone is insufficient; for those over five, one can distinguish floating, sinking, slow, and rapid pulses. Note: Qian Yi's discussion does not strictly adhere to the age of five.)
Pulse Correspondence with Miscellaneous Diseases:
All Rapid Pulses: Indicate Heat, belonging to Fu organs.
All Slow Pulses: Indicate Cold, belonging to Zang organs.
Yang Rapid Pulse: Indicates vomiting and regurgitation; if not vomiting, there will be fever.
Yin Micro Pulse: Indicates diarrhea; if not diarrhea, there will be night sweats.
Deep-Rapid Pulse: Indicates alternating cold and heat, more cold than heat, also indicates bone-steaming heat.
Tight-Rapid Pulse: Indicates alternating cold and heat, more heat than cold, also indicates bone heat; if urgent, it leads to fright epilepsy.
Deep-Tight Pulse: Indicates heart and abdominal pain; short-rapid pulse is similar, also indicates cough.
Deep-Fine Pulse: Indicates indigestion of milk and food, also indicates abdominal pain and dysentery.
Deep-Hidden Pulse: Indicates accumulations and masses, also indicates cholera-like disorder.
Micro-Slow Pulse: Indicates indigestion of milk and diarrhea; deep-slow pulse is similar.
Micro-Choppy Pulse: Indicates convulsions and tendon spasms.
Micro-Urgent Pulse: Indicates cold and heat, spitting blood.
Floating-Slippery Pulse: Indicates retained food not digesting, also indicates cough.
Floating-Tight Pulse: Indicates Guan Qi and deafness.
Floating-Wiry Pulse: Indicates headache and body heat.
Tight-Slippery Pulse: Indicates hematemesis and恶露 (lochia/discharge).
Heart Pulse Urgent and Rapid: Indicates fright epilepsy. If not frightened, it indicates Guan strangury.
Liver Pulse Very Urgent: Indicates Dian-Xian (epilepsy) and Wind Epilepsy, with flowing phlegm-saliva.
Lung Pulse Floating and Solid: Indicates nasal congestion and obstruction of urination and defecation.
Guan Pulse Tight and Slippery: Indicates roundworms; Chi pulse deep also indicates roundworms.
Chi Pulse Micro and Fine: Indicates loose stools and cold dysentery, indigestion of milk and food.
Chi Pulse Micro and Choppy: Indicates blood in stool; if no blood, there will be night sweats.
Pulse Extending Past Cun into Yuji: Indicates enuresis.
Examining Pulse Compliance and Non-compliance:
Fright Convulsion Pulse: Floating and rapid is compliant; deep and fine is non-compliant; warm body is compliant; cold limbs are non-compliant.
Night Crying Pulse: Micro and small is compliant; Surging and large is non-compliant; cold body is non-compliant.
Heart and Abdominal Pain: Deep and fine is compliant; floating and large is non-compliant; warm body is compliant; cold limbs are non-compliant.
Shang Han Pulse: Surging and wiry is compliant; deep and fine is non-compliant; floating and large is compliant; micro and hidden is non-compliant.
Post-Sweating Pulse: Deep and fine is compliant; Surging and tight is non-compliant; drowsiness is compliant; mania/restlessness is non-compliant.
Wen Bing Pulse: Surging and large is compliant; deep and fine is non-compliant; body heat is compliant; abdominal pain is non-compliant.
Cough Pulse: Slippery and floating is compliant; deep and fine is non-compliant; warm body is compliant; cold limbs are non-compliant.
Huo Luan Pulse: Floating and Surging is compliant; slow and micro is non-compliant; warm body is compliant; cold limbs are non-compliant.
Vomiting Pulse: Floating and large is compliant; deep and fine is non-compliant; warm body is compliant; cold limbs are non-compliant.
Diarrhea Pulse: Slow and small is compliant; floating and large is non-compliant; warm body is compliant; cold limbs are non-compliant.
All Dysentery Pulses: Deep and fine is compliant; floating and large is non-compliant; warm body is compliant; cold limbs are non-compliant.
All Thirst Pulses: Surging and rapid is compliant; micro and fine is non-compliant; warm body is compliant; cold limbs are non-compliant.
All Edema Pulses: Floating and large is compliant; deep and fine is non-compliant; Zang excess is compliant; intestinal diarrhea is non-compliant.
Abdominal Distension Pulse: Floating and large is compliant; deficient and small is non-compliant; Zang excess is compliant; diarrhea is non-compliant.
Phlegm Asthma Pulse: Slippery and large is compliant; deep and fine is non-compliant; warm body is compliant; cold limbs are non-compliant.
Cold and Heat Pulse: Tight and rapid is compliant; deep and fine is non-compliant; fatigue is compliant; rigidity is non-compliant.
Guan Labor Pulse: Tight and rapid is compliant; deep and fine is non-compliant; Zang excess is compliant; Spleen diarrhea is non-compliant.
Parasite Pain Pulse: Tight and slippery is compliant; floating and large is non-compliant; warm body is compliant; blue lips are non-compliant.
All Blood Loss: Deep and fine is compliant; floating and rapid is non-compliant; warm body is compliant; fever is non-compliant.
Zhong E Abdominal Distension: Tight and fine is compliant; floating and large is non-compliant; body heat is compliant; body cold is non-compliant.
Jaundice Pulse: Floating and large is compliant; deep and fine is non-compliant; wide abdomen is compliant; diarrhea is non-compliant.
Fire Jaundice Pulse: Floating and Surging is compliant; deep and fine is non-compliant; body heat is compliant; body cold is non-compliant.
Qian Zhongyang said: In children, Qi disharmony presents as wiry and urgent; food injury presents as deep and slow; deficiency fright presents as hurried; Wind presents as floating; Cold presents as deep and fine; chaotic pulse is incurable. *Shui Jing Jue* says: Yin and Yang combine, male and female form, nine orifices and four limbs are divided, then five Zang and six Fu organs are born. Once parts are distinct, compliance and non-compliance are hard to discern. Relying solely on the floating and sinking of the Cun-Kou pulse will surely lead to premature death of the child. One must understand the Tiger Mouth and distinguish the Three Passages, carefully analyzing before prescribing medication to avoid errors. Under three years old, observe the Tiger Mouth: the first segment of the index finger is the Wind Passage, where the appearance of the pulse is easy to treat; the second segment is the Qi Passage, where the appearance indicates deep disease and difficulty to treat; the third segment is the Life Passage, where the appearance indicates death and incurability. Blue color in the three passages indicates fright from four-legged animals; red indicates water fright; black indicates human fright; purple indicates diarrhea; yellow indicates thunder fright. All three passages filled indicates extreme fright, which is fatal. Blue or red with a line-like streak indicates Spleen injury from milk/food, leading to fright-heat. Symmetrical on both sides indicates simultaneous fright and accumulation. Three lines or scattered indicates Lung-generated Wind-Phlegm, or moaning sounds. Red indicates Shang Han and cough. Like bright fire indicates diarrhea. Red and black mixed indicates dysentery; more blue indicates white dysentery; more red indicates red dysentery; purple mixed with thirst. Chaotic Tiger Mouth pulse texture indicates Stomach Qi disharmony. Blue indicates fright and accumulation. Blue-black indicates slow fright. Pulse entering the palm indicates internal hooking. Texture curving inward indicates excessive Wind; curving outward indicates food accumulation. This method applies to children over three. For under three, use one finger to press the high bone to divide the three passages, determining breath count: eight beats per breath is normal; nine beats indicates unrest; ten beats indicates critical condition. Floating indicates Wind. Deep and slow indicates deficiency-cold. Solid indicates Heat. Tight indicates epilepsy. Surging indicates excessive Heat. Deep and slow indicates deficiency diarrhea. Micro and slow indicates accumulation and parasites. Slow and choppy indicates Stomach disharmony. Deep indicates difficult digestion of milk/food. Deep and fine indicates milk/food stagnation. Tight and wiry indicates abdominal heat-pain. Firm and solid indicates constipation. Deep and rapid indicates heat in the bones. Wiry and long indicates Wind in Liver/Gallbladder. Tight and rapid indicates fright-wind pathology, with limb twitching. Floating and Surging indicates heat in the stomach opening. Deep and tight indicates abdominal pain with Cold. Deficient and soft indicates Qi issue, also slow fright. Hollow pulse indicates profuse bloody stool. For under four, use one finger to roll and search the three positions, using Guan as standard; for seven-eight years, shift fingers slightly; for nine years, follow the three passages sequentially; eleven-twelve years same; fourteen-fifteen years follow adult pulse diagnosis sites. Generally, determine floating/sinking, slow/rapid, Yin/Cold, Yang/Heat first; deep/slow is Yin, floating/rapid is Yang. Also observe locations: Blue indicates fright-wind; White indicates deficiency diarrhea; Red indicates Phlegm-Heat; Black indicates severe disease; Yellow indicates Spleen Guan. Cross-reference these to examine and treat diseases to avoid errors. *Quan You Xin Jian* says: For children around half a year old with illness, press the forehead, between eyebrows, and hairline with the curved middle, index, and ring fingers. If the child's head is left, raise right hand; if right, raise left hand. Index is upper, Middle is middle, Ring is lower. Heat in all three fingers indicates Wind-Evil invasion, nasal congestion, rough breathing, fever, and cough. Cold in all three indicates external Wind-Cold and internal food injury, with fever, vomiting, and diarrhea. Heat in Index and Middle indicates upper heat and lower cold. Heat in Middle and Ring indicates夹杂惊 (mixed with fright). Heat in Index indicates chest fullness and food retention. Further analyze pulse shapes. Bead shape (Liu Zhu): Indicates food injury, internal heat with desire to vomit, or borborygmus and spontaneous diarrhea, restlessness and crying. Use Zhu Wei Gao to digest food and separate Yin/Yang. If food digests but illness persists, use Xiang Sha Zhu Wei Gao to tonify Spleen/Stomach. Ring bead shape (Huan Zhu): Indicates Spleen deficiency with retained food, chest/diaphragm distension, irritability, thirst, and fever. Use Wu Wei Yi Gong San plus Shan Zha and Zhi Shi to strengthen Spleen and digest food, followed by Liu Jun Zi Tang to regulate Middle Qi. Long bead shape (Chang Zhu): Indicates Spleen injury with food accumulation, abdominal pain, alternating cold/heat, and anorexia. First use Da An Wan to eliminate accumulation, then Yi Gong San to strengthen Spleen Qi. Coming Snake shape (Lai She): Indicates Spleen/Stomach Damp-Heat, epigastric discomfort, dry heaving, and anorexia, caused by Guan evil internally. First use Si Wei Fei Er Wan to treat Guan, then Si Jun Zi Tang to tonify Spleen. Going Snake shape (Qu She): Indicates Spleen deficiency with food accumulation, vomiting/diarrhea, irritability/thirst, shortness of breath, rapid breathing, anorexia, and drowsiness. First use Liu Jun Zi Tang plus Zhi Shi to strengthen Spleen and eliminate accumulation, then Qi Wei Bai Zhu San to regulate and tonify Stomach Qi. Bow Reverse Inner Shape (Gong Fan Li): Indicates Cold-Evil invasion, choking breath, fright palpitations, fatigue, slightly cold limbs, red urine, cough, and spitting saliva. First use Xing Xing San to assist Stomach Qi and dispel external Evil, then Wu Wei Yi Gong San plus Fu Ling and Dang Gui to nourish Heart Blood and assist Stomach Qi. If external Evil is resolved but fright/cold fingers persist, Spleen Qi is injured; use Qi Wei Bai Zhu San to tonify. If confused, rough breathing, and choking asthma occur, it is difficult to treat due to severe Spleen deficiency. Bow Reverse Outer Shape (Gong Fan Wai): Indicates Phlegm-Heat causing mental confusion, mixed fright and food, Wind Epilepsy with abundant Phlegm. First use Tian Ma Fang Feng Wan to dispel external Evil, then Wu Wei Yi Gong San to regulate Middle Qi. Spear Shape (Qiang): Indicates Wind-Heat generating Phlegm and convulsions. First use Bao Long Wan; if ineffective, use Niu Huang Qing Xin Wan. If transmitting to Spleen/Lung or due to overuse of Wind-Phlegm drugs showing various symptoms, focus on regulating and tonifying Spleen/Stomach. Fish Bone Shape (Yu Gu): Indicates Fright-Phlegm and fever. First use Bao Long Wan; if ineffective, it belongs to Liver Fire Excess-Heat, use minimal Yi Qing Wan to clear Liver, followed by Liu Wei Wan to tonify Liver. Or fever/anorexia, or abundant Phlegm/convulsions, indicating Liver Wood overcoming Spleen Earth; use Liu Jun Zi Tang plus Chai Hu to tonify Spleen Earth to control Liver Wood. Water Character Shape (Shui Zi): Indicates Fright-Wind and food accumulation, chest/diaphragm irritability, sudden stuffiness, reduced intake, or night crying with abundant Phlegm, locked jaw, and convulsions. This is Spleen/Stomach weakness with food accumulation and Wood overcoming Earth. First use Da An Wan to guide out food, then Liu Jun Zi, Gou Teng Gou, and Bu Zhong to clear Liver. If digestive/phlegm-resolving agents fail, use Si Jun Zi, Sheng Ma, Chai Hu, and Gou Teng Gou to ascend and tonify Spleen Qi and pacify/control Liver Wood. Needle Shape (Zhen): Indicates Extreme Heat in Heart/Liver generating Wind, fright palpitations, sudden stuffiness, fatigue, anorexia, abundant Phlegm, and convulsions. First use Bao Long Wan to dispel Wind and resolve Phlegm, then Liu Jun Zi plus Gou Teng Gou to pacify Liver and strengthen Spleen. Penetrating Passage Shooting Finger Shape (Tou Guan She Zhi): Indicates Fright-Wind Phlegm-Heat accumulating in chest/diaphragm, due to Spleen/Lung deficiency and Phlegm Evil accumulation. First use Niu Huang Qing Xin Wan to clear Spleen/Lung and resolve Phlegm, then Liu Jun Zi Tang plus Jie Geng and Shan Yao to tonify Spleen Earth and benefit Lung Metal. Penetrating Passage Shooting Nail Shape (Tou Guan She Jia): Indicates败症 (terminal stage) of Fright-Wind where Liver Wood overcomes Spleen Earth. Urgently use Liu Jun Zi, Mu Xiang, Gou Teng Gou, and Guan Gui to warm and tonify Spleen Earth. If ineffective, add Fu Zi to restore Yang Qi; many survive. I have heard ancients say: Children are like sprouts, like grass shoots or water foam, because their Zang-Fu are fragile and tender, unable to speak, making prescription difficult. One must first observe complexion to know the affiliation, then verify the Tiger Mouth to identify the cause, which is truly a concise treatment method.
[Images: Tiger Mouth Three Passages Pulse Texture; Thirteen Finger Shapes]
The Bead shape has only a dot of red. The Ring bead is slightly larger. The Long bead is round and long. These do not refer to circles, but generally describe red pulses penetrating Qi in such forms. The Coming Snake is essentially the Long bead, spreading with one end large and one end sharp. The Going Snake is similar, dividing upper and lower directions, hence called Coming and Going. Archaic Back Extension (Jiao Gong Fan Zhang), inward is compliant, outward is non-compliant. Spear shape, straight up. Fish bone shape, separated. Water character shape, three pulses running parallel. Needle shape, passing the passage by 1-2 rice grains. Shooting Nail, Life pulse outward. Penetrating Finger, Life pulse curving inward. Although, I often treat without strictly adhering to these pulse shapes when prescribing, for having the symptom means taking the medicine, which is also often effective.