小儿有病须凭脉,一指三关定其息,浮洪风盛数多惊,虚冷沉迟实有积。小儿一岁至三
岁,呼吸须将八至看,九至不安十至困,短长大小有邪干。小儿脉紧是风痫,沉脉须至气化
难,腹痛紧弦牢实秘,沉而数者骨中寒。小儿脉大多风热,沉重原因乳食结,弦长多是胆肝
风,紧数惊风四指掣。浮洪胃口似火烧,沉紧腹中痛不竭,虚濡有气更兼惊,脉乱多痢大便
血。前大后小童脉顺,前小后大必气咽,四至洪来若烦满,沉细腹中痛切切。滑主露湿冷所
伤,弦长客忤分明说,五至夜深浮大昼,六至夜细浮昼别,息数中和八九至,此是仙人留妙
要知虎口气纹脉,倒指看纹分五色,黄红安乐五脏和,红紫依稀有损益,紫青伤食气虚
烦,青色之时症候逆。忽然纯黑在其间,好手医人心胆寒,若也直上到风关,迟速短长分两
端,如枪衡射惊风至,分作枝叶有数般,弓反里顺外为逆,顺逆交连病已难,叉头长短尤可
救,如此医工仔细看。男儿两岁号为婴,三岁四岁幼为名,五六次第年少长,七龆八龄朝论
文,九岁为童十稚子,百病关格辨其因。十一痫疾方癫风,疳病还同劳病攻,痞癖定为沉积
候,退他潮热不相同,初看掌心中有热,便知身体热相从,肚热身冷伤食定,脚冷额热是感
风,额冷脚热惊所得,疮疹发时耳后红。小儿有积宜与塌,伤寒两种解为先,食泻之时宜有
积,冷泻须用与温脾,小儿宜与涩脏腑,先将带伤散与之。孩儿无事忽大叫,不是惊风是天
吊,大叫气促长声粗,误食热毒闷心窍,急后肚下却和脾,若将惊痫真堪笑。痢疾努气眉头
皱,不努不皱肠有风,冷热不调分赤白,脱肛因毒热相攻,十二种痢何为恶,禁口刮肠大不
同。孩儿不病不可下,冷热自汗兼自下,神因囟陷四肢冷,干呕气虚神却怕,吐虫面白毛焦
枯,疳气潮热食不化,鼻塞咳嗽及虚痰,脉细肠鸣烦躁讶,若还有疾宜速通。下了之时心上
脱。孩儿食热下无妨,面赤青红气壮强,脉弦红色肚正热, 腮喉痛尿如汤,屎硬腹胀胁肋
满,四肢浮肿夜啼长,遍身生疮肚隐痛,下之必愈是为良。
小儿患病必须依靠诊脉,医生用食指、中指、无名指三指按在寸、关、尺三个部位来测定脉搏的至数。脉象浮而洪大表示风邪盛,脉数多提示惊证;脉虚冷且沉迟表示体内有寒,脉实提示有积滞。
小儿一岁到三岁,呼吸次数以八次为正常标准(一呼一吸为一息,此处指每息脉动次数或每分钟呼吸频率,古法常以“至”计脉动,此处语境结合后文“九至不安”,通常指每息脉动次数,但现代理解常关联呼吸频率,依原文直译:每息脉动八次为度)。若达到九次则身体不安,达到十次则病情困重,无论脉象长短大小,都有邪气干扰。小儿脉紧是风痫病的表现,脉沉提示气化功能困难;腹痛且脉紧弦牢实并伴有大便秘结,脉沉而数则表示骨髓中有寒。小儿脉大多因风热所致,脉沉重原因是乳食积结;脉弦长多是胆肝风动,脉紧数则是惊风,表现为四肢抽搐。脉浮洪表示胃火炽盛如烧,脉沉紧表示腹中疼痛不止;脉虚濡表示气虚兼有惊证,脉乱多提示痢疾且大便带血。脉象前部大后部小符合小儿生理常态,前部小后部大则必见气逆喘息;脉象四至洪大若伴有烦闷胀满,脉沉细则腹中疼痛剧烈。脉滑主因露水湿气寒冷所伤,脉弦长明确提示客忤(外邪侵扰),脉象五至夜深时浮大昼间不同,六至夜细昼浮有别,呼吸脉数中和在八九至之间,这是仙人留下的妙法。
要知道虎口三关的气色和指纹脉象,需倒转手指观察指纹并分辨五色。黄红色泽表明五脏调和安乐,红紫色泽隐约提示有损益变化,紫青色泽提示伤食、气虚及烦躁,出现青色之时症候凶险。若忽然出现纯黑色夹杂其间,即使是高明的医生也会感到心惊胆战。若指纹直达风关,则需根据迟速长短分为两端判断;若指纹如枪杆笔直射向命关,则是惊风发作,其形态分作枝叶状有多种情况。指纹弯曲向内为顺,向外为逆,顺逆交错则病情难治;叉头形状长短尚可救治,如此细致的医工才能仔细辨认。
男孩两岁称为婴,三岁四岁称为幼,五六岁依次年少增长,七岁八岁进入童蒙阶段,九岁称为童,十岁称为稚子,百种疾病都要辨别其病因。十一岁易患癫痫风病,疳积病还如同劳损病攻伐,痞块癖积定为沉积之候,退除潮热与一般情况不同。初看手掌心中发热,便知身体其他部位也发热;肚子热脚冷确定为伤食,脚冷额头热是感受风邪,额头冷脚热是受惊所得,疮疹发出时耳后发红。小儿有积滞适宜使用消导法,伤寒两种类型应先解表,饮食泻利之时往往伴有积滞,冷泻必须使用温脾法。小儿宜固涩脏腑,先将带有损伤的散剂给予服用。孩子无病却突然大叫,不是惊风就是天吊(一种惊厥病症);大叫气促声音粗长,若是误食热毒导致心窍闭塞,急则调理下焦脾胃,若误认为是惊痫真是可笑。痢疾努责时眉头皱起,不努责不皱眉则肠道有风邪,冷热不调分清赤白痢,脱肛是因为毒热相互攻冲。十二种痢疾中何为恶候,禁口痢和刮肠痢大不相同。
孩子没有实证不可使用泻下法,若有冷热自汗兼腹泻,精神萎靡因囟门凹陷四肢冰冷,干呕气虚精神害怕,吐虫面白毛发焦枯,疳气潮热食物不消化,鼻塞咳嗽及虚痰,脉细肠鸣烦躁惊讶,如果还有积滞应当迅速通下。一旦使用了泻下法,心上就会脱失元气。孩子食用热性食物后泻下无妨,面色赤青红且气壮力强,脉弦红色肚子正热,腮喉痛小便如汤,屎硬腹胀胁肋满,四肢浮肿夜间啼哭长,遍身生疮肚隐痛,使用泻下法必定痊愈,这才是良策。
When a child is ill, one must rely on pulse diagnosis. The physician uses three fingers (index, middle, ring) to press the Cun, Guan, and Chi positions to determine the pulse rate. A floating and surging pulse indicates an excess of wind; a rapid pulse often suggests fright. A deficient and cold pulse, or a deep and slow pulse, indicates internal accumulation.
For children aged one to three years, eight beats per respiration are considered normal. Nine beats indicate unrest, and ten beats indicate exhaustion. Abnormalities in the length and size of the pulse suggest pathogenic interference. A tight pulse in children indicates wind epilepsy; a deep pulse with difficulty in Qi transformation suggests impaired physiological function. Abdominal pain with a tight, wiry, firm, and solid pulse indicates constipation; a deep and rapid pulse indicates cold in the bones. A large pulse in children is mostly due to wind-heat; a heavy pulse is caused by milk and food stagnation. A wiry and long pulse often indicates liver and gallbladder wind; a tight and rapid pulse indicates wind-fright accompanied by limb convulsions. A floating and surging pulse suggests stomach heat ("stomach like fire burning"); a deep and tight pulse indicates unceasing abdominal pain; a deficient and soggy pulse indicates Qi stagnation combined with fright; a chaotic pulse often indicates dysentery with bloody stools. A pulse that is large at the front (Cun) and small at the back (Chi) is a favorable pattern for children; if it is small at the front and large at the back, it indicates Qi rebellion in the throat. A pulse with four beats that is surging, accompanied by irritability and fullness, suggests discomfort; a deep and fine pulse indicates severe abdominal pain. A slippery pulse indicates injury from dew, dampness, or cold; a wiry and long pulse clearly indicates external invasion (Ke Wu). A pulse rate of five beats appearing floating and large at night but fine during the day, or six beats appearing fine at night but floating during the day, reflects circadian variations. A harmonious pulse rate of eight to nine beats per respiration is the profound method left by immortals.
One must know the Qi color and fingerprint patterns at the Tiger's Mouth (Web between thumb and index finger). Observing the fingerprint against the light reveals five colors: yellow-red indicates peace and harmony of the five Zang organs; red-purple implies slight damage or benefit; purple-green indicates food injury, Qi deficiency, and irritability; the appearance of green indicates a adverse prognosis. If pure black suddenly appears among them, even skilled physicians may feel fear. If the fingerprint extends straight to the Wind Gate (first phalanx), its speed and length divide into two categories: resembling a spear shaft indicates impending wind-fright; branching like leaves shows various manifestations. An arc curving inward is favorable (Shun), outward is adverse (Ni); when Shun and Ni intersect, the disease is difficult to treat. Forked tips of varying lengths can still be saved; such detailed observation requires a skilled practitioner.
Boys aged two are called "Ying" (infant), three to four are "You" (young), five to six grow older, seven to eight are "Tiao" (changing teeth), nine are "Tong" (child), and ten are "Zhi" (youngster). One must identify the cause of hundreds of diseases. At eleven or twelve, epilepsy and mania-wind are common; Gan syndrome (malnutrition) attacks like consumption; Pi and Pi masses are definite signs of sedimentation; remitting fever differs from other fevers. Initially checking for heat in the palm center indicates accompanying body heat. A hot belly with cold hands and feet confirms food injury; cold feet with a hot forehead indicate wind sensation; a cold forehead with hot feet indicate fright; redness behind the ears appears when rashes erupt. For children with accumulation, resolving methods are suitable; for the two types of Shanghan (Cold Damage), releasing the exterior is prioritized. Food diarrhea usually involves accumulation; cold diarrhea requires warming the Spleen. Children should have their Zang-Fu secured with astringents, first administering formulas to disperse injuries. If a healthy child suddenly screams loudly, it is not wind-fright but Tian Diao (a sudden convulsive disorder). Loud screaming with shortness of breath and coarse voice suggests ingestion of hot toxins blocking the heart orifices. Urgent purgation after this soothes the spleen; mistaking this for wind-fright is laughable. Dysentery with straining causes furrowed brows; no straining indicates wind in the intestines. Cold-heat imbalance distinguishes red and white dysentery; rectal prolapse is caused by toxic heat attacking internally. Among twelve types of dysentery, which are malignant? Forbidden-mouth dysentery and bowel-scraping dysentery are significantly different.
Children without excess syndromes should not undergo purgation. If there is spontaneous sweating from cold-heat imbalance and spontaneous diarrhea, sunken fontanelles, cold limbs, dry retching, Qi deficiency, fearful spirit, vomiting worms, pale face, dry and brittle hair, Gan Qi with remitting fever, undigested food, nasal congestion, cough, deficiency-phlegm, fine pulse, borborygmus, and irritability—if there is still pathology, rapid unblocking (purgation) is appropriate. Improper purgation leads to collapse of the Heart Spirit. However, if a child eats hot foods and has diarrhea without harm, with a red-blue-red complexion and strong Qi, wiry-red pulse, hot abdomen, sore cheeks and throat, urine like boiling water, hard stool, abdominal distension, full hypochondrium, limb edema, prolonged night crying, widespread skin sores, and hidden abdominal pain, purgation will surely cure them and is considered excellent therapy.