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Children aged six and above require pulse diagnosis. Using one finger to press the three positions (Cun, Guan, Chi) determines the pulse rate (breaths). A slow pulse indicates cold, and a rapid pulse indicates heat; this has been passed down from ancient times. A floating pulse indicates wind pathogenic factors, and a deep pulse indicates accumulation; these should be identified first. The left Renying position (referring to the left pulse generally) governs external pathogens, while the right Qikou position (referring to the right pulse generally) governs internal diseases.

External pathogens include invasion by wind, cold, summer-heat, and dampness. Internal conditions involve observing milk retention, phlegm, and food accumulation. A floating and tight pulse without sweating indicates Cold Damage (Shanghan). A floating and relaxed pulse with sweating indicates Wind Injury (Shangfeng). A floating and surging pulse indicates severe wind-heat. A deep and fine-slippery pulse indicates milk and food accumulation.

A deep and tight pulse indicates unceasing abdominal pain. A deep and wiry pulse indicates wheezing and urgency in the throat. When the pulse is tight and hurried, it may signal the emergence of rashes or smallpox. When the pulse is tight and rapid, it may indicate convulsive disorders (Jingfeng). A deficient, soft, slow pulse indicates slow convulsions with spasms. A tight and vigorous pulse indicates wind epilepsy with twitching and jerking.

A soft and fine pulse indicates worm-related malnutrition (Ganchong). A firm and solid pulse indicates constipation. A slippery pulse indicates phlegm obstruction and dietary injury. A knotted pulse (Kou, hollow like a scallion stalk) definitely indicates blood loss. Deficiency combined with qi disorder leads to fright. A wiry and urgent pulse indicates Ke Wu (sudden fright or alien qi influence), which physicians must recognize.

An irregular pulse size is an ominous sign. Three beats per breath indicates collapse; two beats per breath indicates sudden death. Five beats per breath indicates deficiency; four beats per breath indicates damage. Six beats per breath is a harmonious pulse, indicating no disease. Seven to eight beats per breath indicates mild illness. Nine to ten beats per breath indicates extreme severity. Eleven to twelve beats per breath confirms death. This rule is infallible.

For children over three years old, one finger is used to simultaneously press the Cun, Guan, and Chi positions. Typically, six to seven beats per breath is the normal pulse. An increase in beats indicates heat; a decrease indicates cold. A surging and floating pulse indicates prevailing wind. A rapid pulse indicates frequent fright. A deep and stagnant pulse indicates deficiency; a deep and solid pulse indicates accumulation.

The heart governs sound, but sound emanates from the lungs. When lung qi fails, crying is silent. Excessive crying is due to liver and gallbladder being affected by external wind and fright. Slow breathing, spirit fatigue, and severe convulsions indicate qi deficiency. Hoarseness is caused by evil heat insulting the lungs. Clear voice indicates no invasion by toxic fire. Crow-like hoarse voice accompanied by spasms is an inauspicious omen; mutual overcoming leads to death (returning to the underworld).

A straight, repetitive sound without tears indicates pain. Continuous sound with much tearing indicates fright. Restless sounds like swallows are difficult to cure. Irregular and sparse sounds indicate cold invasion.

The five tones correspond to the five zang organs. Metal tone is crisp, earth tone is turbid, wood tone is long, water tone is clear, and fire tone is dry. Liver disease manifests as sad sounds; lung disease as hurried sounds; heart disease as majestic sounds; spleen disease as slow sounds; kidney disease as deep sounds. Large intestine disease manifests as long sounds; small intestine disease as short sounds; stomach disease as fast sounds; spleen disease as clear sounds (note: original text repeats spleen); bladder disease as faint sounds. Light voice indicates weak qi. Heavy and turbent voice indicates pain and wind. Loud voice indicates heat欲狂 (desire for mania). Choked voice indicates qi stagnation. Panting indicates rapid breathing. Urgent voice indicates fright. Blocked voice indicates phlegm. Trembling voice indicates cold. Turbid and quiet voice indicates Ganchong (malnutrition/accumulation). Sneezing indicates wind-cold injury. Yawning indicates spirit fatigue. Deep and dull voice indicates critical condition. If a newborn does not cry loudly but makes a squeaking sound, it indicates premature death. By recognizing their voices and frequently observing their complexion, one can know the root of the disease.

Being a physician is difficult, especially treating infants. Therefore, when examining children, if the complexion and pulse are diagnosed precisely, life and death can be judged. If one hesitates due to fear of offending the patient's family and does not speak the truth, any mistake will lead to resentment. It is better to warn beforehand than to suffer resentment afterwards. Even if there is danger, what is there to resent? In the past, Bian Que told Duke Huan of Cai: "The disease is in the skin and muscles; if untreated, it will deepen." The Duke did not believe him. Upon seeing him again, Bian Que said: "The disease is in the bone marrow; even the God of Life cannot help." Later, he indeed died. Students should apply this logic and study diligently to understand the profound principles of Bian Que.

[Image: Yang Palm Diagram]
The Ten Kings acupoints are located on the fingernails of the five fingers.