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Xia Yuzhu said: Inspection (Wang), Auscultation and Olfaction (Wen), Inquiry (Wen), and Palpation (Qie) are indeed indispensable diagnostic methods for physicians. This applies to adult internal medicine (Da Fang Mai); however, in pediatrics, the primary method is Inspection (Wang), followed by Inquiry (Wen), then Auscultation and Olfaction (Wen), while Palpation (Qie) is virtually non-existent.

The classics state: "Knowing through palpation is called 'skill' (Qiao)." (Since a child's pulse is not fully formed, there is little to palpate, so the 'skill' has no place to be demonstrated.) "Knowing through inquiry is called 'craftsmanship' (Gong)." (When a child cannot speak, inquiry is impossible; even when they can speak, they often do not answer truthfully, so inquiry need not be forced, and the 'craftsmanship' has no place to be demonstrated.) "Knowing through auscultation and olfaction is called 'sagacity' (Sheng)." (In the early stages of illness, a child's voice may remain normal, but after prolonged illness, vital energy is depleted, leading to changes in voice; thus, there is nothing to hear through auscultation, and how can 'sagacity' be demonstrated?)

Moreover, ancient texts state: "A weak cry indicates the depletion of Yin, yet there are cases where this does not apply." Why is this? It arises from doubt regarding the voice, unable to determine whether Lung Qi is exhausted or not. Therefore, I say that Inspection (Wang) should be the primary method.

One might ask: "The organs of the Five Zang are hidden, and their principles are subtle; from where can one observe them?" The answer is: "Although the physical form is hidden, its manifestations in the sensory orifices and complexion are comprehensive; although the principles are subtle, their revelations outside the four limbs and five senses are unmistakable." This aligns with what *Zhong Yong* (The Doctrine of the Mean) describes as "the manifest nature of the subtle," which should be used to elucidate each other. Thus, internal diseases in children must manifest externally; the external is the manifestation of the internal. By observing the form and examining the orifices, one can naturally know the disease; prescribing medication based on the disease yields results as swift as an echo responding to a sound.

Inside are the Zang organs: Heart, Spleen, Lung, Kidney, and Liver. Since the Zang organs themselves are difficult to inspect directly, one must inspect their "buds" (Miao) and "orifices" (Qiao). The tongue is the bud of the Heart: red or purple indicates Heart Heat; swollen and black indicates extreme Heart Fire; pale white indicates Deficiency. The tip of the nose and the gums are the orifices of the Spleen: a red and dry nasal tip indicates Spleen Heat; a sallow yellow complexion indicates Spleen Failure; red and swollen gums indicate Heat; axillary ulceration indicates Stomach Fire. The lips are the orifice of the Spleen: red or purple indicates Heat; pale white indicates Deficiency; black indicates impending Spleen exhaustion. Deviation of the mouth corner to the right indicates Liver Wind; deviation to the left indicates Phlegm in the Spleen. The nostrils are the orifices of the Lung: dryness indicates Heat; clear runny nose indicates Cold. The ears and teeth are the orifices of the Kidney: tinnitus indicates Disharmony of Qi; purulent discharge from the ear indicates Kidney Heat; teeth resembling dried soybeans indicate exhaustion of Kidney Qi. The eyes are the orifice of the Liver: staring with moving eyeballs indicates Wind; fixed gaze with immobile eyeballs indicates impending exhaustion of Liver Qi.

Specifically regarding the parts of the eye, they also correspond to the orifices of the Five Zang: The black part (around the pupil) belongs to the Liver; if purely yellow, it is a ominous sign. The white part (sclera) belongs to the Lung; bluish-green indicates Liver Wind insulting the Lung; pale yellow indicates Spleen stagnation; dark yellow indicates Lung affected by Damp-Heat. The pupil belongs to the Kidney; lackluster and yellowish indicates Kidney Qi Deficiency. The inner canthus (large angle) belongs to the Large Intestine; ulceration indicates Wind in the Lung. The outer canthus (small angle) belongs to the Small Intestine; ulceration indicates Heat in the Heart. The upper eyelid belongs to the Spleen; swelling indicates Spleen injury. The lower eyelid belongs to the Stomach; bluish color indicates Wind in the Stomach. Sleeping with eyes open indicates extreme Deficiency of the Spleen and Stomach.

The face has five regions, each corresponding to a Zang organ: The forehead belongs to the Heart, corresponding to Li Fire. The left cheek belongs to the Liver, corresponding to Zhen Wood. The right cheek belongs to the Lung, corresponding to Dui Metal. The area below the mouth belongs to the Kidney, corresponding to Kan Water. The nasal tip belongs to the Spleen, corresponding to Kun Earth. The Zang organs are Interior; the Fu organs are Exterior.

The Small Intestine is the exterior of the Heart: short, yellow, scanty, and painful urination indicates Heart Heat; clear, long, and free urination indicates Heart Deficiency. The Stomach is the exterior of the Spleen: red lips with vomiting indicate Stomach Heat; pale white lips with vomiting indicate Stomach Deficiency; normal lip color with vomiting suggests Stomach injury due to food retention. The Large Intestine is the exterior of the Lung: constipation indicates Fire in the Lung; constipation without Lung Heat indicates Blood Dryness, and purgatives should not be used; rectal prolapse indicates Lung Deficiency. The Gallbladder is the exterior of the Liver: bitter taste indicates Gallbladder Fire; startle response to sound indicates Liver Deficiency. The Bladder is the exterior of the Kidney: tendon swelling and pain indicate Cold Qi entering the Bladder.

There are five colors of the face: Red corresponds to the Heart; facial redness indicates Heat. Green/Blue corresponds to the Liver; facial green/blue indicates Pain. Yellow corresponds to the Spleen; facial yellowing indicates Spleen injury. White corresponds to the Lung; facial pallor indicates Internal Cold. Black corresponds to the Kidney; facial blackness without luster indicates exhaustion of Kidney Qi. If the observed complexion differs from usual, and the color of the sensory orifices does not match the facial complexion, then the Deficiency or Excess of the Zang and Fu organs will be accurately diagnosed.