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The appearance of red vessels on the upper eyelids extending downward through the pupil, swelling and protrusion of the fontanelle (anterior fontanelle) even sinking into a pit, dryness and blackening of the nose, hepatomegaly with exposed cyanotic veins, frequent staring with fixed eyeballs, blackening of the fingernails, sudden emission of crow-like sounds, protrusion of the tongue with deficient breath, grinding of teeth accompanied by biting, fish-mouth breathing with急促 respiration, crying without sound, insects crawling out of the nostrils—all these are signs of inevitable death. Even with urgent medicinal intervention, fewer than one in ten will survive.

For children aged three to five years, the pulse rate is assessed based on six beats per respiratory cycle; seven beats indicate instability, while ten beats indicate critical danger. Abnormalities in pulse length and magnitude suggest pathogenic interference.

A large pulse in children mostly indicates Wind-Heat; a deep and fine pulse results from milk and food retention; a string-taut and long pulse often indicates Liver Wind in the diaphragm; a tight and rapid pulse indicates Convulsive Disease (Jing Feng) with twitching of the four limbs; a floating and surging pulse indicates Stomach Fire; a deep and tight pulse indicates unceasing abdominal pain; a deficient and soggy pulse, accompanied by shortness of breath and fright, suggests deficiency with fright; a knotted pulse indicates dysentery with blood or hemorrhage; a pulse that is large anteriorly and small posteriorly is favorable for children; a pulse that is small anteriorly and large posteriorly indicates food retention; a pulse at four beats per cycle that is surging indicates vexation and fullness; a deep and fine pulse with cutting pain indicates severe abdominal pain; a slippery pulse indicates injury by cold mist and dew; a string-taut and long pulse clearly indicates external shock (Ke Wu); a pulse at five beats per cycle worsening at night but floating and large during the day, and a pulse at six beats per cycle being thin at night but distinct and floating during the day—these are distinctions. A peaceful respiration of five to six beats per cycle is the secret method passed down by sages.

Floating, Deep, Slow, and Rapid pulses are the four basic types, serving as criteria for the Five Zang and Six Fu organs. Floating indicates Wind pathogen and exterior disease; Deep indicates interior disease involving sinews and bones; Slow indicates Cold and Deficiency; Rapid indicates excess Heat. This principle applies by analogy.

The Liver corresponds to Wind in Heaven, Wood in Earth, the Liver organ in Humanity, and Spring in Seasons. Kidney Water is its Mother, Heart Fire is its Child. It governs the sinews and stores the Hun (Ethereal Soul). Its voice is shouting, its fluid is tears, its taste is sour. It connects upward to the eyes and outward to the nails. Its color is Green; it should resemble the luster of green jade, not the dullness of blue dye. The Liver governs Wind, and Wind easily injures the Liver, with diseases primarily manifesting as Convulsive Disease. Sudden anger causing Qi rebellion injures Liver Qi. In smallpox, it manifests as vesicles. Excess Dryness causes disease. A white complexion is adverse (Metal overacts on Wood).
Liver Disease: Cyan complexion, tense sinews, irritability, eye pain, closing eyes unwilling to see people, pulsation to the left of the umbilicus.
Liver Excess: Red eyes, irritability, dizziness, pain radiating from the hypochondrium to the lower abdomen.
Liver Deficiency: Blurred vision, chest pain, tendon contraction and spasms, fear as if being pursued.
Liver Exhaustion: Everted lips, cyan cheeks, excessive sweating of the four limbs, frequent weeping, curled tongue, and retracted scrotum.
In Spring, the Liver pulse should be String-Taut, Moderate, and Long, which is auspicious; it prospers for 72 days in Spring.
Thief Pulse (Pulse of the Overacting Element) is Floating, Choppy, and Short (Metal overacts on Wood). Critical Pulse is String-Taut like a bowstring; death occurs without Stomach Qi.

The Heart corresponds to Heat in Heaven, Fire in Earth, the Heart organ in Humanity, and Summer in Seasons. Liver Wood is its Mother, Spleen Earth is its Child, and Heart Fire overacts on Lung Metal. It governs Blood and stores the Shen (Spirit). Its voice is speaking, its fluid is sweat, its taste is bitter. It connects upward to the tongue and outward to the palms. Its color is Red; it should resemble silk wrapping cinnabar, not the dullness of hematite. The Heart governs Heat, and Heat easily injures the Heart, with diseases primarily manifesting as Fright-Heat. Worry and overthinking injure the Heart. In smallpox, it manifests as macules. Severe Cold causes disease. A black complexion is adverse (Water overacts on Fire).
Heart Disease: Red complexion, excessive laughter, mental restlessness, hot palms, thirst, open eyes, delirious speech, pulsation above the umbilicus.
Heart Excess: Dry mouth, excessive laughter, body heat with sweating, fullness and pain in the hypochondrium radiating to the back.
Heart Deficiency: Mental confusion and frequent fright, melancholy and irritability with poor complexion, cough with stiff tongue, soreness and pain in the waist and back.
Heart Exhaustion: Shaking head with staring eyes, complexion like soot.
In Late Summer, the Heart pulse should be Surging, Moderate, Floating, Large, and Scattered, coming rapidly and departing slowly, which is auspicious.
Thief Pulse is Deep and Soggy (Water overacts on Fire). It prospers for 72 days in Summer.
Critical Pulse is Surging and Large without Stomach Qi leads to death.

The Spleen corresponds to Dampness in Heaven, Earth in Earth, the Spleen organ in Humanity, and the Four Seasons in Seasons. Heart Fire is its Mother, Lung Metal is its Child, and Spleen Earth overacts on Kidney Water. It governs muscles and stores Yi (Intellect/Intent). Its voice is singing, its fluid is saliva, its taste is sweet. It connects upward to the mouth and outward to the four limbs. Its color is Yellow; it should resemble yellow arsenic wrapped in gauze, not the dullness of soil. Irregular feeding (hunger or overeating) injures the Spleen. In smallpox, it manifests as pustules. Excess Wind overcoming Dampness causes disease. Green is adverse (Water overacts on Earth).
Spleen Disease: Yellow complexion, excessive thinking and lethargy, heavy body, testicular pain, flaccidity and weakness of the four limbs.
Spleen Excess: Heavy limbs unable to lift, abdominal distension, constipation despite feeling hungry.
Spleen Deficiency: Vomiting, regurgitation, diarrhea and dysentery, indigestion, bloating and borborygmus, weakness of the four limbs.
Spleen Exhaustion: Protruding umbilicus, everted lips, blackening around the mouth, soft sweat turning yellow.
The Spleen Earth pulse is Harmonious, Moderate, Warm, and Thick, circulating between the organs; peace without decline is observed. Each month of the Four Seasons sees it prosper for 18 days.
Thief Pulse is String-Taut, Long, and Tight (Wood overacts on Earth). Critical Pulse comes like a bird pecking or water dripping from a roof leads to death.

The Lung corresponds to Dryness in Heaven, Metal in Earth, the Lung organ in Humanity, and Autumn in Seasons. Spleen Earth is its Mother, Kidney Water is its Child, and Lung Metal overacts on Liver Wood. It governs Qi and stores the Po (Corporeal Soul). Its voice is crying, its fluid is nasal mucus, its taste is pungent. It connects upward to the nose and outward to the skin and hair. Its color is White; it should resemble the luster of white jade, not the dullness of chalk. The Lung governs Dryness, and Dryness injures the Lung, with diseases manifesting as cough. Exposure to cold and drinking cold fluids injures the Lung. In smallpox, it manifests as pustules. Sha disease belongs to the Lung Meridian; a red complexion is adverse (Fire overacts on Metal).
Lung Disease: Pale complexion, sadness and depression, aversion to cold and fever, wheezing and coughing, sneezing, vomiting blood or epistaxis, pulsation in the right hypochondrium.
Lung Excess: Wheezing and coughing, rebellious Qi with nasal congestion, pain in the shins, thighs, shoulders, and back with chest fullness.
Lung Deficiency: Shortness of breath, runny nose and dry throat, fatigue with cough and hemoptysis.
Lung Exhaustion: Sweat like pearls, hair loss, continuous exhalation without cessation.
In Autumn, the Lung pulse should be slightly Floating, Short, and Choppy, which is auspicious; it prospers for 72 days in Autumn.
Thief Pulse is Surging, Large, and Firm (Fire overacts on Metal). Critical Pulse like wind blowing feathers, without Stomach Qi leads to death.

The Kidney corresponds to Cold in Heaven, Water in Earth, the Kidney organ in Humanity, and Winter in Seasons. Lung Metal is its Mother, Liver Wood is its Child, and Kidney Water overacts on Heart Fire. It governs bones and stores Jing (Essence) and Zhi (Willpower). Its voice is groaning, its fluid is saliva, its taste is salty. It connects upward to the ears and downward to the waist and kidneys. Its color is Black; it should resemble the luster of lacquer, not the dullness of charcoal. The Kidney governs Cold, and Cold injures the Kidney. Its disease is hernia (scrotal swelling). Excessive desire injures the Kidney. In smallpox, it manifests as black sunken lesions. Excess Dampness causes disease; a very yellow complexion is adverse (Earth overacts on Water).
Kidney Disease: Black complexion, fear and yawning, cold and coldness of hands and feet, abdominal pain with diarrhea, tenesmus, pulsation below the umbilicus.
Kidney Excess: Abdominal distension and heaviness, shortness of breath and silence, bone pain with undigested stool in diarrhea, scanty urination.
Kidney Deficiency: Sensation of emptiness in the heart like hunger, chest pain radiating to the spine, coldness reversal, polyuria, tinnitus.
Kidney Exhaustion: Eyes rolling backward with staring, delirious speech and enuresis, broken waist and withered bones.
In Winter, the Kidney pulse should be Deep and Soggy; it prospers for 72 days in Winter.
Thief Pulse is Moderate and Large (Earth overacts on Water). Critical Pulse comes like unraveling a rope and departs like flicking stones, without Stomach Qi leads to death.