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Lu Zhongyang stated: The principles of pediatric pulse diagnosis are as follows: A chaotic pulse indicates a difficult-to-treat condition. Disharmony of Qi presents with a wiry and rapid pulse. Food stagnation presents with a deep, slow, and deficient pulse. Shock or fright presents with an hurried and rapid pulse. Wind pathogen invasion presents with a floating pulse; Cold pathogen invasion presents with a deep and fine pulse.

The *Shuijing Jue* (Water Mirror Manual) states: Relying on Yin and Yang to govern destiny, male and female form their bodies, nine orifices and four limbs are divided, thereby generating the five zang organs and six fu organs. Pulse diagnosis sites are divided into three positions; determining favorable or unfavorable outcomes is difficult. If one relies solely on the floating or sinking nature of the cunkou (radial artery at the wrist) pulse, it will inevitably lead to the premature death of the child. One must clearly observe the tiger's mouth (the radial side of the infant's index finger) and distinguish the three gates (Feng Guan, Qi Guan, Ming Guan), carefully deliberating medication to avoid errors.

For children under three years old, examine the left hand for boys and the right hand for girls at the base of the second finger of the tiger's mouth. The first segment is named the Initial Gate, also known as the Wind Gate; if the vein pattern appears here, the illness is mild. The second segment is the Middle Gate, also known as the Qi Gate; if the vein pattern appears here, the illness is deep and severe. The third segment is the Terminal Gate, also known as the Life Gate; if the vein pattern appears here, the condition is critical and untreatable.

If all three gates appear green, it indicates convulsions caused by fright (Si Zu Jing); if red, it indicates water-related fright; if black, it indicates human-related fright; purple indicates diarrhea and dysentery; yellow indicates thunder fright (a severe type of convulsion). If the veins across the three gates are continuous, it signifies extreme fright syndrome, which is fatal; other diseases are treatable.

If the color is either green or red, with a single straight line like a thread, it indicates spleen damage from milk and food stagnation, along with the onset of fright-heat. If both hands show the same pattern, it indicates simultaneous occurrence of fright and accumulation. Three lines or scattered patterns indicate wind-phlegm generated in the lungs, or sounds resembling "xia sou" (coughing with phlegm). Redness indicates cold damage and cough; fire-red indicates diarrhea; black mixed with red indicates dysentery, where more red implies white dysentery and more black implies bloody dysentery. Purple mixed with other colors, accompanied by thirst but without deficiency, suggests specific internal imbalances. Chaotic tiger's mouth vein patterns indicate Qi disharmony; green indicates fright and accumulation; green-black indicates slow convulsions. Veins entering the palm indicate nei diao (a spasmodic disease). Curved veins bending inward indicate excess wind; bending outward indicates steaming upward from food accumulation.

This discusses pulse diagnosis for children over three years old. For infants aged one to two years, examine the tiger's mouth and additionally press the high bone (radial styloid process) with one finger, dividing the gate into three parts, to count breaths. Eight pulses per breath is a normal pulse; nine indicates unease; ten indicates critical danger.

Variations in length, size, and depth each indicate different pathogenic influences: Floating indicates wind generation; Rapid indicates fright; Deep and Slow indicates deficiency-cold; Excess indicates heat; Tight indicates epilepsy; Surging indicates excessive heat; Deep and Fine indicates abdominal pain; Deep and Slow indicates deficiency-diarrhea; Micro and Slow indicates accumulation and parasites; Delayed and Choppy indicates stomach epigastrium disharmony; Deep indicates difficulty in nursing; Deep and Fine indicates milk/food stagnation; Tight and Wiry indicates abdominal heat-pain; Firm and Solid indicates constipation; Deep and Rapid indicates heat within the bones; Wiry and Long indicates wind in the diaphragm and liver; Tight and Rapid indicates convulsions with limb twitching; Floating and Surging indicates heat in the stomach opening; Deep and Tight indicates unceasing abdominal pain; Deficient and Soggy indicates Qi issues combined with slow convulsions; Hollow indicates dysentery with blood in stool.

At four years old, use one finger to assess excess and deficiency; at five and six years old, roll one finger to locate the three positions correctly, using the Guan position as the standard; at seven and eight years old, shift the finger slightly to locate the three positions; at nine and ten years old, sequentially search according to the three-gate locations; eleven and twelve years old are examined similarly to ten years old; only at fourteen or fifteen years old should the adult pulse diagnosis sites be used.

In general pulse diagnosis, first determine floating, deep, slow, and rapid, as well as Yin, Yang, cold, and heat, following adult standards: Deep and Slow are Yin; Floating and Rapid are Yang. Additionally, observe the face: Green indicates convulsions; White indicates deficiency-diarrhea; Red indicates phlegm-heat; Black indicates a severe and difficult-to-handle disease state; Yellow indicates spleen-related gan accumulation (malnutrition syndrome). By correlating these signs, investigating the source of the disease, and planning treatment accordingly, no omissions or errors will occur.