Library

The diagnostic methods in pediatrics, although essentially no different from those for adults, present unique challenges due to the young age of infants who cannot speak, and older children who may fail to express their intentions clearly. Additionally, children often refuse strangers and cry during examinations, making it difficult to accurately ascertain the condition. Hence, there is a proverb: "It is easier to treat ten men than one woman; it is easier to treat one woman than one child." However, the seven emotions and six desires of children are ultimately different from those of adults. The diseases they suffer from are either deficiency (Xu) or excess (Shi), with clear evidence. As long as the examination is thorough and the root cause is understood, the complexity of pediatric diseases is generally less than that of adults. Therefore, treatment might even be easier than for adults. The difficulty lies primarily in the physician's intuitive understanding and acumen at the bedside. Below are described the specific diagnostic methods required for pediatrics that differ from adult medicine. Mastery and flexible application depend on the physician's judgment at the time; rigid adherence without adaptation (like marking the boat to find the sword) would be far off the mark.

1. Pulse Diagnosis
Children have short and small wrists, so physicians initially cannot palpate the Cun, Guan, and Chi positions separately as in adults. However, superficial (Fu), deep (Chen), slow (Chi), rapid (Shu), slippery (Hua), choppy (Se), deficient (Xu), and excess (Shi) pulse qualities must still be assessed here. The physician can use the thumb to press and discern the overall pulse quality. This is the first difference in pediatric pulse diagnosis compared to adults. Furthermore, the pulsation rate in children is faster than in adults, especially in younger ones. For infants in swaddling clothes, the pulse typically beats 7-8 times per breath cycle; for children over seven years old, 5 beats per breath cycle is considered normal; for children under seven, 6 beats per breath cycle is normal. This is the second difference. Additionally, when children are startled, crying, or wailing, their pulses may become irregular and indistinguishable due to sudden fluctuations. In such cases, it is advisable to wait until the child falls asleep and palpate quietly. Otherwise, deficiency may be mistaken for excess, or excess for deficiency, leading to serious consequences. This is the third difference. Moreover, since the pediatric pulse is rapid, the respiration is also shorter. Adults typically breathe 19 times per minute, whereas infants under one year old breathe about 35 times per minute, and children over one year old breathe approximately 26-27 times per minute or more. This is the fourth difference. Also, during crying or wailing, respiration becomes particularly hurried, which is not necessarily wheezing (Chuan). It is best to listen quietly after the child has calmed down for a while to hear the correct respiratory rate. This is the fifth difference.

2. Observation of Spirit and Expression
When consulting for pediatric illnesses, it is crucial to carefully observe the child's spirit and expression, noting both quiet and active states, and the nuances between movement and stillness, through which many pathological mechanisms can be intuitively understood. For instance, if a child is awake but remains still, there is likely no significant pain in the body. If the child alternates between stillness and activity, frequently touching the abdomen, it indicates intermittent abdominal pain. If the child appears drowsy yet remains still with rapid breathing, it suggests dyspnea, chest oppression, and weak spirit with reluctance to move. If the child alternates between stillness and activity, frequently touching the chest, it indicates chest irritability. If the child is quiet but responds vaguely to calls and has a fever, it suggests heat penetrating inward causing mental confusion. If the child is still, reluctant to speak, has clear and long respiration, and no fever, it indicates a chronic deficiency syndrome. If the child is restless, almost manic, thirsty for cold water, and has high fever, it suggests excessive internal pathogenic heat trying to vent outward. Similarly, a child with headache often protects the head; one with toothache protects the cheek; one with heart/chest pain bends over to protect the chest; one in severe pain crawls on the bed and scratches the mat; one whose pain is aggravated by pressure firmly refuses touch; one scratching the skin with fingernails suffers from itching; one who wants to eat but cries upon swallowing has oral or throat pathology. By intuitively grasping these signs, one can infer other conditions by analogy, leaving no disease hidden. Combined with observation of complexion and pulse, the treatment plan will surely be accurate.

3. Examination of the Three Passages (Finger Veins)
For children under three years old, where pulse diagnosis is unreliable, it is customary to examine the finger veins on the index finger at the Three Passages (San Guan), observing the left hand for boys and the right for girls. Starting from the web of the thumb, the end of the first phalanx is the Wind Passage (Feng Guan), the end of the second phalanx is the Qi Passage (Qi Guan), and the end of the third phalanx is the Life Passage (Ming Guan). When a child is ill, the vein pattern appears across the three passages. If the vein is hidden and not visible, the illness is mild; if the color is exposed, the illness is severe. Purple veins indicate Heat; red veins often indicate Cold Damage (Shang Han); green/blue veins often indicate Convulsions (Jing Feng); white veins often indicate Malnutrition (Gan Ji); yellow or pale red veins often indicate minor ailments; black veins indicate a critical condition. Furthermore, veins appearing only in the lower Wind Passage indicate mild illness; those in the middle Qi Passage indicate severity; those in the upper Life Passage are even more severe; veins penetrating all three passages indicate a critical prognosis. (Note: Various theories linking specific vein patterns to specific diseases are considered inaccurate and are omitted.)

4. Supplementary Methods
Regarding the sound of a child, a clear, bright, and peaceful voice is auspicious. A cry resembling a crow's croak, straight and without resonance, indicates a critical condition regardless of whether it is deficiency or excess. Crying with tears is called "Ku" (cry), while crying without tears is called "Hao" (wail). Crying with tears implies fluids are not depleted; wailing without tears implies fluid depletion. Continuous, straight crying indicates either fright or pain. Intermittent crying that stops periodically suggests pain that comes and goes. Checking the nasal cavity: sneezing immediately upon stimulation with a finger indicates open and unobstructed orifices; inability to sneeze even with medication indicates blocked orifices. Generally, open orifices in various diseases suggest mildness, while blocked orifices suggest severity. These allow inference of the condition from a single sign. Regarding abdominal palpation: distension that is firm and hard suggests food retention (Shi Ji) or parasitic accumulation (Chong Ji); bright/distended areas suggest water-dampness; tense and vacuously distended areas suggest Qi deficiency; eating much but remaining thin suggests parasitic disease or Stomach Fire. These can also be deduced intuitively.