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According to the *Luxin Jing* (Cranial Fontanelle Classic) regarding pediatric diseases: 1. Eyes appearing blue and rubbing/itching indicate Liver Gan (Liver malnutrition syndrome). 2. Scorched teeth in children indicate Bone Gan. 3. Pale flesh color and dry nostrils indicate Lung Gan. 4. Dry skin and cracked muscles indicate Sinew Gan. 5. Scorched yellow hair indicates Blood Gan. 6. Sores on the tongue indicate Heart Gan. 7. Children craving to eat dirt indicate Spleen Gan.

If a child has solid muscle and bone, white skin, yet experiences unprovoked irritability and thirst, this is due to damage to the Lung Zang caused by forceful breastfeeding since infancy. According to the following formula, internally administer Gancao Renshen He Yinzi (Licorice and Ginseng Combined Decoction). If there is rapid breathing, protruding bones, bluish discoloration of the nose and lower eyelids, and groaning sounds, this is a sign of certain death; do not administer medicine. If a child's dysentery resembles rice water sediment, it is difficult to be effective; if the dysentery resembles goose or duck blood, the Spleen has already rotted and been damaged, and medicine should not be administered. For any disease causing distress in children, if the eyelids droop and pull, death is certain. Pediatric malaria is generally difficult to cure. If attacks occur without fixed timing, accompanied by locked jaws, grinding teeth, and vocalization, this is also a sign of certain death. This is called Li Ji Gan Malaria (Dripping Emaciation Gan Malaria), also known as Suo Chang Gan (Locking Intestine Gan).

If a child desires breast milk and food, cries at night with sound, this indicates abdominal pain. Unprovoked head shaking in children indicates Brain Top Wind. If a child vomits all ingested milk and food, this indicates Cold Spleen. Unprovoked abdominal distension with a thin neck, emaciated limbs, and protruding sinews, vessels, and joints indicates that insufficient breastfeeding from childhood and early introduction of solid foods have led to early onset of Bone Heat Gan Lao (Bone Heat Consumption Syndrome). Initially, administer Bao Tong Wan (Protect Child Pill), followed by Chaihu Biejia Yinzi (Bupleurum and Turtle Shell Decoction). (The formula for Bao Tong Wan is found in the Section on All Gan Syndromes; the formula for Chaihu Yinzi is found in the Section on Delayed Walking.)

If a child has thick flesh on the head, face, chest, and back, but thin arms and head, and walks slowly, this is due to improper holding during infancy. Clear nasal discharge or redness and itching under the nose indicate severe Nasal and Brain Gan. Use the following formula. Blow Qingdai San (Indigo Naturalis Powder) into the nose and apply to the red, ulcerated area below. (The formula is found in the Section on Gan Diseases, Nose Blowing Section.)

The above are methods for diagnosing and observing pediatric conditions. Children's Qi and pulse are unregulated, their Zang-Fu organs and membranes are thin, and their Couli (pores/skin texture) are open and sparse. Pulse diagnosis must consider seasonal timing, and medication should be prescribed according to formulas.

*Huatuo Jiu Hou Lun* (Huatuo's Nine Observations Treatise) describes four types of Yin Slow Diseases:
Man Pi Feng (Slow Spleen Wind), Man Jing Feng (Slow Convulsion Wind), Pi Kun (Spleen Distress), Xu Ji (Deficiency Accumulation).

Discussing these four syndromes, the constitution is generally emaciated and weak, lacking spirit or emotion, eyes close slowly, and the pulse is faint, sinking, and fine. It is crucial to carefully examine pediatric symptoms to avoid error.

**Man Pi Feng (Slow Spleen Wind) Syndrome:** Caused by vomiting and diarrhea leading to Spleen-Stomach deficiency. Symptoms include bluish complexion, yellow lips, foam at the mouth corners, excessive sleepiness, occasional limb twitching, cold limbs, and a sinking-weak pulse. The song states:
*The pulse of Slow Spleen is faint, drowsy sleep makes it hard to distinguish. Or if there is head shaking and jaw locking, one in ten thousand can be cured.*

**Man Jing Feng (Slow Convulsion Wind) Syndrome:** Caused by phlegm-fluid invading the Heart due to fright. Symptoms include red lips, straight eyes, slight hand movements resembling convulsions, mild body heat with muteness, and a faint-sinking-fine pulse. The song states:
*For Slow Convulsion Wind, look for red lips; careful deduction yields quick results. If the fontanelle is swollen, know there is no miraculous drug; even taking spiritual pills is in vain.*

**Pi Kun (Spleen Distress) Syndrome:** Caused by prolonged vomiting and diarrhea. Symptoms include excessive sleep with eyes closed, restlessness despite movement, warm body, cold limbs, and a faint-sinking-fine pulse. The song states:
*Spleen Distress originates from chronic diarrhea deficiency, continuously sleeping without comfort. Even if fed milk, worms will grow in the mouth, leading to inevitable death.*

**Xu Ji (Deficiency Accumulation) Syndrome:** Caused by long-standing accumulation that is frequently purged but not fully cleared. (Alternatively: Injury due to deficiency, leading to accumulation in the Zang-Fu.) Symptoms include abdominal heat, white diarrhea, frequent drinking of water/milk with indigestion, cold limbs, and a faint-sinking pulse. Another description notes internal abdominal heat and a warm body. The song states:
*How does the affliction of Deficiency Accumulation manifest? Drinking water frequently without satiety. If the umbilicus protrudes and eyes swell, even Dan Ling may not cure him.*
Another song states:
*Either diarrhea or dysentery occurs constantly, the anus remains open and the child fails to gain weight. Seeing them drink water frequently, fools still treat it as Gan-Thirst.*

*Huatuo Jiu Hou Lun* describes four types of Yang Urgent Diseases:
Ji Jing Feng (Urgent Convulsion Wind), Shang Han (Cold Damage), Tian Diao (Heavenly Hook), Ban Zhen (Macules and Papules/Rash).

Discussing these four syndromes, the constitutions are generally similar. Whether due to toxic pathogens or phlegm-fluid, this condition requires urgent medical attention. Do not neglect or delay; injury spreads rapidly, and life or death hangs in the balance. Apply medication with focus, examining the subtleties.

**Ji Jing Feng (Urgent Convulsion Wind) Syndrome:** Caused by phlegm-fluid flooding the Liver and Heart due to fright. Symptoms include upward-gazing eyes (Diao Yan), fist-clenched convulsions of hands and feet, rattling phlegm in the throat, whole-body jerking, body heat, and a surging-large pulse. The song states:
*The syndrome of Urgent Convulsion originates from phlegm, accumulated heat transmits to both Liver and Heart. Red eyes, blue lips, and bilateral hand convulsions; removing phlegm and dispelling wind is the essence.*

**Shang Han (Cold Damage) Syndrome:** Caused by cold wind injuring the Couli (skin pores). Symptoms include weak Stomach Qi, internal accumulation of cold wind, yellow face with red cheeks, clear nasal discharge, frequent crying, high fever, and a surging-large pulse. Do not frequently administer exterior-releasing medicines. The song states:
*Cold Damage is most bitter, requiring careful examination. If one speaks of frequent sweating to release the exterior, by the seventh day, contradictions appear. Only use cooling medicines to resolve; if resolution is late, jaundice will arise. Mouth sores are hard to save, all because it is purely Yang.*

**Tian Diao (Heavenly Hook) Syndrome:** Not caused by spirits, but by intense heat from fright. Initially, there is frequent yawning, sudden tears in the eyes that do not fall, high fever, occasional slight limb convulsions, and a floating-surge-solid-large pulse. The song states:
*Ordinary Heavenly Hook disease, do not say the child is delicate. Accumulated heat lingers, eyes roll and phlegm surges. Backward arching often results from treatment, accompanied by scorched lips and mouth. Foolish doctors still use moxibustion/cautery, death will come within three days.*

**Ban Zhen (Rash) Syndrome:** Caused by Cold Damage toxins transmitting to the Stomach. Symptoms include macules, measles, and smallpox, which are essentially one entity. Frequent crying/shouting, large hand pulse, intense whole-body heat, cold ear tips, cold nasal tip, frequent vomiting after drinking water. It is appropriate to induce the eruption of sores. Large lesions indicate Yin, small lesions indicate Yang. The song states:
*Stomach heat creates macules and rashes, know the origin of this disease. Excessive crying indicates extreme Heart congestion, black tongue is worrisome. Swelling and double edema, red phlegm flows from the anus. Once it transforms into such a syndrome, seeing it means life must end.*

*Huatuo Jiu Hou Lun*: Song of Pediatric Miscellaneous Disease Syndromes:
Know all miscellaneous diseases well, regardless of infant gender. Excessive sleep stems from the Liver; Heart retention of accumulated heat causes night frights and crying. Crying with cold sweat is due to worm pain; chills and fever accumulate in the Spleen. Red cheeks and mouth sores indicate Lung-Heart congestion; deficient wind causes convulsions and drooping limbs. Cold slipperiness injures the Spleen, causing diarrhea/dysentery with pus or blood at times. Excess accumulation leads to large abdomen and watery stools; asthma and yellow cheeks require no doctor. Eye swelling, spitting phlegm, and urgent head shaking; do not let the pulse become slow and faint. Patients seek gods and ghosts, refusing good medicine and seeking masters bitterly.

*Xian Ren Shui Jian* (Immortal Water Mirror): Song of Five Gan Disease Syndromes:
Frequent drinking indicates Heart Gan; blue eyes and hard ribs connect to Liver. High abdomen and white lips arise from Spleen; severe coughing and coarse breathing indicate dry Lung. Craving dirt and sour foods; carefully observe Kidney Gan signs. If a good physician knows the divine secret, he can distinguish several fatal syndromes.

*Xian Ren Shui Jian*: Song of Five Gan Fatal Syndromes:
Red veins rise behind the ears, black spots appear on the tongue (spots indicate Heart Gan signs). Severe vomiting reveals eye corners (black spots at eye corners with severe vomiting indicate fatal Liver signs). Black spots cover the whole body (spots like moles over the body indicate fatal Lung signs). Similar spots on teeth (teeth showing spots indicate extreme Gan). Dry earlobes indicate death (earlobes indicate fatal Kidney signs).

*Xian Ren Shui Jian*: Song of Pediatric Fright Syndromes:
Sleeping upon birth, Convulsion Wind originates in the Liver. Night crying and pale face, observe the Lung Zang in detail. Colors change constantly, observe the Heart shape daily. Mild asthma indicates Spleen deficiency, grinding teeth indicates Bone family fright. (Grinding teeth in dreams indicates Bone family Convulsion Wind.)
Another song:
Pale face, swelling, deficiency, frequent blowing of milk; limbs feel hot with frequent sweating. Five colors seen on both cheeks constantly; evil screaming originally belongs entirely to fright.

*Xian Ren Shui Jian*: Song of Accumulation Disease Syndromes:
Abdominal distension, often preferring to sleep on the back; yellowing, red eyes, vomiting and urination. (Urine resembles oil.) Plus severe intestinal rumbling with diarrhea; removing accumulation and eliminating stagnation brings immediate recovery.

*Xian Ren Shui Jian*: Song of Eight Types of Cold Damage in Children:
Nasal congestion, yellow eyes, flowing snot; irregular body heat with ceaseless sweating; asthma, wheezing, spitting water, and choking sounds; this is Cold Damage with a cause.

*Xian Ren Shui Jian*: Song of Five Gan Disease Syndromes:
Skin feels like boiling water, weakness cannot withstand it. Yellow face and red cheeks, fear of cold, loving heavy quilts. Dry mouth and nose with snot, roots gradually deepen. Entirely caused by fright/falling, this disease originates from the Heart.
Head shaking, eye/nose twitching, white membrane over blue pupils. Itchy teeth, rubbing mouth, drooping eyes, coughing while looking at relatives. Greenish-blue facial changes, body covered in ringworm-like patches. Scorched standing hair, this disease originates from the Liver.
Food hard to digest, craving dirt in heart. High abdomen with visible blue veins, thin scattered hair. Asthma with frequent coughing, no joy only loves crying, foul-smelling dysentery, this disease originates from the Spleen.
Cough comes with asthma, sores on mouth/nose. Grain piles in stool, body covered densely like millet. Bloated self-distending abdomen, daily unusual dysentery. Vomiting blood and pus severely, entirely due to original Lung injury.
Frequent diarrhea/dysentery, usually loves being frightened. Upper Jiao inflammation like fire, middle diaphragm vomiting like pouring. Chills and fever occur constantly, sores increase progressively. Urgent Gan is hard to treat, this disease originates from the Kidney.

Wang Shuhe's Song of Fifteen Exterior Signs in Children:
Red veins on eyes, observe pupils below. Fontanelle swells, forming pits. Dry black/brown nose, large abdomen with blue veins. Eyes stare straight, never turning. Black nails, suddenly making crow sounds. Flaccid tongue retreats to anus, biting teeth and people. Fish-mouth gasping, crying without sound. Ascaris expelled, surely a dead form. Medication applied urgently, ten out of ten die.

Mao Xiansheng: Pediatric Miscellaneous Disease Syndromes:
Red lips and face indicate Cold Damage; blue face and black lips indicate Convulsion Wind; blue nose and white face indicate Malaria; yellow-as-earth face indicates Qi attack.

Mao Xiansheng's Differentiation of Five Extinctions in Children:
Neck limp indicates Kidney extinction; eyes straight indicate Liver extinction; throat pulling like a saw indicates Spleen extinction; tongue curled toward heart indicates Heart extinction; black nose with pus indicates Lung extinction; do not need to look further for the Five Extinctions.

Mao Xiansheng's Song of Fatal Signs in Children Receiving Various Diseases:
Pediatric illness is truly pitiable, medicine down the throat blocked by sticky phlegm. Eyes half-open and half-closed, moxibustion/cautery leaves skin without blood color. Sweat like pearls on the back of the head [missing character], eyes lack luster, nose dry and black. Qi rushing to heart beats connecting both arms, hands/feet like water, sole of foot straight. Unpredictable vomiting/diarrhea, frequent thirst/coughing, turbid pulse extinct like silence. When eye pits sink, heat increases; abdominal dry diarrhea, eye float extremely. Chest swelling, heart protrusion pulling mouth corner, waving hands, shaking head, life is hard to keep. Cannot help when picking up objects, or biting mouth, hard to soothe. Medicine ineffective, intestines perforate directly, crying without tears, evil voice extreme. Throat pulling like saw, blowing flower foam, long sighing breath, stop milk/food. Clear pus diarrhea increases daily, millions return to underworld, stop wasting effort.

Mao Xiansheng's Another Song of Fatal Signs in Children:
Fatal signs in children must be detailed: shaking head away from mother, convulsing to one side. Sweat on nose, belly like bag (Yang Daye says: plus vomiting/tucking). Hands grasping chest/diaphragm, must perish. White sclera penetrating pupil, limbs do not recognize pain, pain is irregular. Five Dries, Five Hards, and Five Softs, frequent downward Qi is also inauspicious. Fontanelle swelling with Qi is hard to treat, fish-mouth evil voice leads to immediate death. Red threads visible inside nails, palm red like sores. Long-term red lips need no treatment, fright with slow eyes is inappropriate. Blue eyes, red face, black earlobes, palm without lines, white teeth indicate death. Red nose tip, drooping mouth corners, drowsy sleep with open mouth. Straight hair, evil voice, dry crying, returning to underworld needs no further thought.

Mao Xiansheng's Twenty-Four External Fatal Signs in Children:
Tai Chong pulse absent, staring straight at people, fish-mouth moving automatically, suddenly making evil sounds. (*Huiyan Guanzheng* note: If occurring intermittently once, death; if rapid breathing with sound, not death.) Full mouth sticky phlegm, frequent evil screaming, black patches on body, five centers convex/swollen, tongue protruding with false convulsion, (*Huiyan Guanzheng* note: Tongue protruding immobile is not death.) Or retracting with sores, latent heat not retreating, hollow sound in throat, black blood in diarrhea, black face with mania, continuous vomiting/diarrhea, eyes half-open, fright shouting biting people, nails blue-black, running horse falling teeth, fontanelle swollen or depressed, diarrhea stops then resumes, erysipema covering body, crying with high voice and hoarseness, fish-interstice uneven.

The aforementioned forms and syndromes, if five or seven signs are violated, ten out of ten die.

*Huiyan Guanzheng* (Benefit Eye Observation of Evidence) states: Whoever obtains these signs is near death; further observe the pulse. If Yang disease obtains this, the pulse reversely becomes fine; if Yin disease obtains this, the pulse reversely becomes surge; death occurs within one day.

Han Dong Wang Xiansheng *Jia Bao* (Family Treasure) Verses on Miscellaneous Disease Syndromes:
Slow Convulsion Wind eyes prefer opening; Slow Spleen Wind eyes prefer closing. Fish-eye fixed gaze dies at night; blue face black lips perish by day. Crying without wailing is vexation; wailing without crying is agitation. Opening mouth protruding tongue is Wind; closing eyes seeming to sleep, not desiring milk/food is Deficiency. Head shaking with stiff neck indicates Three-Jiao congestion; head shaking with soft neck indicates phlegm in Stomach; constant clear snot indicates Lung cold. Stretching hands long indicates Deficiency; hearing words and becoming sad indicates Excess. Abdominal pain full indicates Qi congestion; turning over to lie indicates Spleen disease.

Han Dong Wang Xiansheng *Jia Bao* Song of Pediatric Form/Syndromes: (Mao Xiansheng's Fatal Signs Song is largely identical but slightly different. This has annotations, so both are preserved.)
Pediatric form/syndromes are suddenly hard to measure, full mouth stubborn phlegm blocks throat. (This is Wind-Phlegm blocking the nine orifices, stubborn phlegm only retreats when anus opens.) Vomiting/diarrhea without time plus coughing, (This is Spleen-Stomach dual deficiency unable to transform grain/food, diarrhea without time. Coughing is Stomach generating Wind.) Skin on body lacks blood color. (This is blood vessels not responding.) Sweat like oil, head [missing character] steep, (Sweating indicates Yin-Yang separation, Ying-Wei distinction. Fluids become sweat, thus like oil bran. Head [missing character] steep indicates fontanelle collapse, Heart extinction, i.e., death.) Eyes lack luster, nose black inside. (Nose black inside indicates Lung extinction. Nose is Lung external manifestation; eyes lacking luster indicates Kidney extinction. Kidney governs eye pupils; Kidney extinction means eyes lack luster.) Floating chest, heart protrusion pulling mouth corner, (Protrusion means mound high; Lung distension vessel extinction means chest protrudes.) Hands/feet like ice, sole of foot straight. (Stomach extinction means hands/feet contract/straight.) Convulsions, eyes slanted connecting to lips/mouth, (Sinew extinction causes convulsion, attaching to eyes.) Holding hands to head, hard to save. (Sinews convulse upward, hence holding head. This is a major evil sign.) Blue-green around eyes, much scorched thirst, (This is Liver extinction. Liver governs East Wood Jia-Yi, color green, deficiency causes thirst.) Drinking hundred cups still not resting. (Stomach tube straight, thus water cannot [missing character] enter.) Face swollen, eyes float, pulse does not come, (Heart extinction means face swollen. Heart governs blood, thus blood vessels cannot [missing character] nourish, hence face swells.) Picking up object, body puts mouth to bite. (Stomach-Spleen extinction looks like fish-mouth, often like sucking water.) Crying without tears and evil voice, (This is Liver extinction. Liver governs tearing; if extinct, no tears. Lung governs voice. Lung about to extinct, voice only exits without returning, called evil voice.) Throat pulling like saw, mouth blowing foam. (Throat sound is nine orifices blocked by phlegm, Qi entry/exit impossible, thus like saw sound. Foam is Wei Qi exiting without returning.) This disease is truly hard to treat, avoid being told by contemporaries that you killed the patient with medicine. (Hearing of many evil signs above, do not administer downward medicine; if administered, fools do not know Zang-Fu disease extinction, only think doctor killed patient.)

Han Dong Wang Xiansheng *Jia Bao* Pediatric Miscellaneous Disease States:
Pediatric fright crying, voice deep not loud, indicates severe disease, hard to cure with medicine. If voice floats, light regulation of fright brings cure. (What is fright crying? Suddenly waking from sleep, crying/shouting incessantly, called fright crying.)
Scalp dry/withered, sinews/vessels tense, lip outside red inside white, ulcers present as if no fluid arrives, plus fright hard to recover. This is heat exceeding extremity. (Why hard to cure? Thin skin means sinews/vessels tense outward; lip outside red inside white means Spleen deficiency about to extinguish cannot [missing character] nourish; long term mostly dies. Ulcers mean Lung deficiency dryness, cannot nourish body, thus not cured; urgent medicine prevents loss.) Red eyes are Liver accumulated heat. (Eyes are Liver external manifestation. Accumulation means gathering. Having accumulation, eyes also red; when seasonal Qi returns to Liver, thus accumulation also causes red eyes.) Fear of brightness, Heart-Liver have fright. (Heart belongs to South Fire, fright pathogen harms Heart, Liver-Kidney, Tai Yang then counter-controls.) Tooth Gan, poison of milk/food. (Tooth Gan is bleeding from teeth with bad odor. Just because eating greedily then [missing character] giving milk, thus causing bad odor. Must give cooling medicine and eliminate food poison.) Eating food not digesting is Spleen accumulated cold. (Spleen governs transformation; food long cold, thus food not digests. Warm Spleen is suitable.) Deafness is Kidney accumulation. (Ear belongs to Kidney. Attacked by accumulated Qi. Thus cannot hear human voice. Suitable to put transforming medicine into sheep kidney to roast, take orally.) Fetal ringworm is Lung accumulated wind. (Fetal ringworm grows on lower body, skin rises into ringworm. Just because parents have Lung disharmony, or raising child avoids wind/cold, bathing gets it, is accumulation doing it.) Tidal fever is obtained due to fright. (Tidal fever just because fright in chest/diaphragm; not entering Zang-Fu, thus fever irregular, suitable to give fright medicine.) Throat inside like saw, is guest wind from Diaphragm entering Lung and due to fright entering Large Intestine. (Lung is cover of all Zang, also governs Qi. Large Intestine is Lung Fu, receives external wind, Large Intestine receives fright, thus so, this is夾惊 Cold Damage.) Either sadness or singing is pathogen entering Spleen. (Pathogen enters Spleen, naturally sings and cries without time, thus know pathogen enters Spleen Zang.) Mouth sores, abdominal distension Gan Qi reversal. (Mouth sores is Qi not smooth attacking Heart. Heart responds to mouth/tongue, upward reversal causes sores. Qi reversal causes abdominal distension, suitable to give downward Gan medicine then Qi medicine take.) Spitting worms, Heart and Large Intestine heat. (Heart and Large Intestine both heat thus cannot settle, worms thus not in Large Intestine, rush up and roundworm exit mouth, long term causes yellow emaciation.) Malaria is Spleen accumulation. (Malaria is Spleen receiving old food remaining, again new food rushes in, either often sleep not grinding/digesting, thus conflicts with Spleen Qi. Spleen Qi is Zheng Qi, victory then heat, Xie Qi victory then cold. Xie-Zheng conflict, thus chills/fever arise. Also say: Some travelers, then Summer receive heat, Qi in Spleen meets cool, blown by Autumn wind then arises, also Xie-Zheng struggle, Yin-Yang intersection, thus chills/fever arise, four seasons generally same.) Sleeping with open mouth is Five Zang toxin excess. (Five Zang receive toxic gas thus Qi knots, mouth opens not closes.)
Frequent crying is Convulsion Wind entering Lung. (Lung governs sound, thus frequent crying.)
Craving dirt is Spleen generating worms. (Spleen belongs to Earth, generated worms, due to sweet items and glutinous rice food born, thus make original like eating dirt.) Night frequent nocturnal sweating is Deficient Heat Gan Qi not smooth. (Qi governs Lung, Lung