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[Preface] Those who govern the state often find it difficult to manage petty people (those of bad character) and women; similarly, those who treat diseases find that women and children are the most difficult to treat. This is because when women and children fall ill, they often cannot describe their suffering themselves, and even if they do, they cannot express it fully. Among the four diagnostic methods used by physicians—inspection (Wang), auscultation and olfaction (Wen), inquiry (Wen), and palpation (Qie)—one method (inquiry) is completely ineffective, hence the difficulty. Knowing this difficulty and adopting alternative approaches to clarify the condition, verifying it through careful and detailed examination, makes what seems easy actually quite challenging. The Master of Henglu has traveled for twenty years, crossing thousands of miles, having served the nation in administrative and judicial capacities. He briefly tried his hand at treating the people's ailments with his skills, but due to the difficult times and adverse circumstances, his great talents could not be fully utilized for long. Thus, he retired to a humble dwelling and devoted himself to medical studies, compiling his insights into two volumes: *Guide to Gynecology and Pediatrics*. By tackling the most difficult aspects first, easier problems naturally resolve themselves; this applies to all matters in the world, not just medicine. With the publication of this book, the diagnosis and treatment of pediatrics and gynecology become as clear as seeing a torch in the dark. Recalling twenty years ago, when the Master of Henglu was young and spirited, he would generously discuss current affairs, waving his arms and glaring, viewing stabilizing the world like a rock and saving the people from water and fire as trivial tasks. Time flies, and human affairs change; before long, he found himself in a situation of seclusion, buried in sorrow and writing books, which cannot be generalized.

Prefaced by Shuxiang Jushi in the early summer of the Yi Chou year, 14th Year of the Republic of China (1925).

General Overview
Pediatrics has been a difficult field since ancient times. This is because children have delicate and fragile constitutions, prone to both deficiency and excess conditions. A slight deviation in treatment can lead to significant errors. Furthermore, children's Qi and Blood are not yet fully developed, so pulse diagnosis alone cannot serve as the sole basis; their mental faculties are not fully developed, so they cannot articulate their symptoms. Diagnosing pediatric diseases relies primarily on facial complexion to identify the cause, and observing the color and shape of the pulse veins at the three gates (Wind, Qi, Life) on the tiger's mouth area to determine if the condition is Heat or Cold; listening to the child's primary complaints, assessing their comfort level, restlessness, desire for food and drink, and bowel/urinary habits; while simultaneously palpating the pulse for floating, sinking, slow, rapid, slippery, choppy, large, small, forceful, or forceless qualities, allowing one to reference exterior-interior, deficiency-excess, and cold-heat patterns based on the syndrome.

Observing Complexion
To understand the origins of various pediatric diseases, one must carefully observe the five zones and five colors on the face. The forehead belongs to the Heart, the chin to the Kidney, the nose to the Spleen, the right cheek to the Lung, and the left cheek to the Liver. Green corresponds to the Liver, red to the Heart, yellow to the Spleen, white to the Lung, and black to the Kidney. A green complexion indicates Wind-Convulsion (Jing Feng); red indicates severe Heat; yellow indicates Spleen injury or food stagnation; white indicates Deficiency-Cold; and black indicates pain, often a sign of a malignant prognosis. In general, bright and distinct colors indicate new diseases with mild syndromes, whereas turbid and dull colors indicate chronic diseases requiring serious attention. If the color generated by the affected zone is supportive (e.g., Spleen disease showing yellow, its proper color), it is favorable. If red appears, Fire generating Earth suggests a smooth progression and ease of treatment. Conversely, if the colors clash (e.g., Spleen disease showing green, Wood overcoming Earth), the disease is difficult to treat. Similarly, if the colors support each other and the Qi and Blood are robust, external pathogens will be easily managed. However, if the colors clash and the patient suffers from chronic illness with deficient Qi and Blood, the healthy Qi cannot withstand the pathogen, making treatment extremely difficult. For instance, a dark green forehead predicts impending Wind-Convulsion; red indicates internal Heat; black indicates a poor prognosis. Green at the Taiyang point indicates Wind-Convulsion; if green extends into the ear, it is fatal. Green at the Yintang point indicates convulsive diarrhea. Green at Fengchi (below the eyebrow) and Qichi (below the eye) indicates Wind-Convulsion; purple indicates vomiting and regurgitation. Green eyebrows suggest good fortune, while red indicates irritability and heat. Red nose indicates Spleen Heat; black nose is fatal. Red lips indicate Spleen Heat; white lips indicate Spleen Cold. Red on the left cheek indicates Liver Heat; red on the right cheek indicates Lung Heat with abundant phlegm. Green at Chengjiang indicates fright; yellow indicates vomiting; black indicates convulsions, suggesting a lingering disease. These are the essentials of observing complexion, which should be combined with pulse and symptom analysis.

Listening to Sounds
The method for diagnosing children involves listening to the five sounds, which correspond to the emotions of the five Zang organs. Heart (Fire) disease manifests as urgent speech, excessive talking, and laughter; Lung (Metal) disease manifests as sad, muddy, and unclear sounds; Liver (Wood) disease manifests as shouting and wild screaming; Spleen (Earth) disease manifests as singing with trembling, light tones; Kidney (Water) disease manifests as prolonged, thin moaning. These five sounds clearly reveal the syndrome. Crying without tears, short cries, or crying without wailing indicates blocked Qi and abdominal pain. Crying with tears, long wails, or wailing without sobbing indicates urgent Qi, irritability, and impending convulsions. Restlessness stems from internal Heat in the Heart meridian, causing agitation. Hoarse, muddy sounds indicate external contraction of Wind-Cold. Excess syndromes feature strong, loud, and vigorous voices due to robust Qi. Deficiency syndromes feature short, timid, and weak voices due to deficient Qi. Excessive talking and body heat belong to Yang, governing Fu organ syndromes. Reluctance to speak and cool body belong to Yin, governing Zang organ forms. Delirious speech and irritability indicate flourishing pathogenic Heat. Delirium and confusion indicate Heat invading the Heart, a critical condition. A quacking sound in the throat indicates approaching death of Qi. A straight, urgent voice without return and without tears indicates imminent death. All pediatric deficiency-excess and cold-heat conditions can be distinguished by voice; listening allows one to perceive the truth without concealment.

Inquiring about Illness
Inquiring about pediatric illnesses requires detailed investigation, focusing on daily life, comfort, restlessness, and desires. First, ask about diet: appetite and thirst. Second, ask about urination and defecation: normal, loose, constipated, or dry. Fever without sweating indicates pathogen in the Exterior; internal heat with loose stools indicates pathogen in the Interior. Irritability and heat during the day with calmness at night indicate Yang flourishing in the Yang aspect (disease in Yang); calmness during the day with irritability and heat at night indicates Yang sinking into the Yin aspect (disease in Yin), requiring careful distinction. Preference for warmth and aversion to cold indicate Yin/Cold syndromes. Aversion to warmth and preference for cold indicate Yang/Heat syndromes. Good appetite indicates strong Stomach; poor appetite indicates weak Stomach. Lack of thirst indicates dampness in the Stomach; thirst indicates dryness in the Stomach. Thick, sticky, foul-smelling stool indicates internal stagnant Heat transforming into Heat. Clear, non-red urine indicates Cold transforming into Cold. Coldness in the ears, sacrum, and limbs indicates impending eruption of smallpox/varicella. Coldness in a single finger indicates epilepsy/fright. Heat and stuffiness in the abdomen indicate internal Heat. Cold extremities indicate Middle Jiao Cold. Unfurrowed brows, curved back, and crying in children indicate internal abdominal pain. Constantly hot ears indicate external entanglement by Wind-Heat. Abdominal pain must be palpated for softness or hardness; aversion to pressure indicates Deficiency, while preference for pressure indicates Excess. Only by considering these factors can one accurately prescribe formulas. Therefore, to treat infants, sincere and thorough inquiry is essential for effective treatment.

Palpating the Pulse
Even for one-year-old children with illness, pulse palpation is necessary. However, due to small wrist size, three fingers cannot be used; instead, one finger is used to assess the Cun, Guan, and Chi positions. Floating pulse is felt lightly above the skin. Sinking pulse is felt heavily between muscle and bone. Six beats per breath indicate a balanced pulse and health. Seven to eight beats indicate Rapid pulse; four to five beats indicate Slow pulse. Slippery pulse feels like pearls rolling on a plate, flowing smoothly. Choppy pulse feels hesitant and difficult. Weakness in all three depths (Floating, Middle, Sinking) indicates Deficiency pulse; strength in all three indicates Excess pulse. Weakness in the middle position indicates Hollow pulse. Fine pulse is faint, thin, intermittent, or barely perceptible. Surging pulse is strong upon arrival but weak upon departure. Irregular pauses with slow rate indicate Knotted pulse; irregular pauses with rapid rate indicate Cramped pulse. Tight pulse feels like a twisting rope; Wiry pulse is straight and taut like a bowstring. These describe pulse images and rates. Floating pulse indicates Exterior syndrome (external Wind-Cold); Sinking pulse indicates Interior syndrome (internal dietary injury). Rapid pulse indicates Fu organ syndromes and Yang-Heat; Slow pulse indicates Zang organ syndromes and Yin-Cold. Slippery indicates Phlegm abundance; Surging indicates Fire-Heat; Fine indicates weakness; Wiry indicates Phlegm-fluid retention; Knotted indicates accumulation; Cramped indicates fright/epilepsy; Hollow indicates blood loss; Choppy indicates blood deficiency; Sinking-Tight indicates abdominal pain; Floating-Tight indicates cold contraction; Deficient indicates various deficiencies; Excess indicates various excesses. Eruptive diseases show Surging-Tight pulses. Uneven pulses indicate sudden evil invasion. Three beats per breath indicate extreme deficiency; nine to ten beats indicate intense Fire-Heat. One or two beats per breath, or eleven to twelve beats, are death pulses. Floating-scattered rootless or deep-hidden pulses that do not respond to pressure are difficult to treat. Exterior-interior, Yin-Yang, deficiency-excess can be diagnosed, but must be cross-referenced with inspection, auscultation, and inquiry.

Color and Shape of Tiger's Mouth Veins
For newborns, observe the webbing of the thumb and index finger. For boys, look at the inner side of the left hand's second finger; for girls, the right hand's second finger. The three segments of the second finger are divided into the Wind, Qi, and Life gates. If the vein color is mixed red and yellow, hidden and faint, the child is healthy. Visible changes in shape and color indicate disease. Purple indicates internal Heat; red indicates Cold Damage; yellow indicates Spleen disease; black indicates sudden evil invasion; green indicates Wind-Convulsion; white indicates Malnutrition syndrome (Gan Zheng). Veins at the Wind gate indicate mild disease; at the Qi gate, severe disease; reaching the Life gate indicates difficult-to-treat disease. Observe the vein's shape and curvature. Curved and purple indicates food stagnation with internal Heat; curved and green indicates fright from humans or animals; red indicates fright from water/fire/birds; yellow indicates thunder fright; black indicates Yin epilepsy. Round and long shape called "Long Pearl" indicates food injury. A single red dot called "Flowing Pearl" indicates internal Heat. Pointed top, slightly larger bottom called "Departing Snake" indicates food injury with vomiting/diarrhea. Large top, pointed bottom called "Arriving Snake" indicates damp-heat leading to malnutrition. Curved inward like a bow indicates cold contraction; curved outward toward the thumb indicates abundant internal phlegm-heat. Vein slanting left toward middle finger indicates Wind-Cold; slanting right toward thumb indicates cold contraction. Straight like a hanging needle (short) or spear (long) indicates phlegm-heat. Vein extending directly to the nail tip indicates severe Spleen Qi failure and danger to life. "Yi" character shape indicates convulsions. Two curves like a hook indicate injury from raw/cold foods. Three curves like an insect indicate injury from hard objects. Water-like waves indicate cough. Ring-like connections indicate vomiting/diarrhea leading to malnutrition. Fish-bone shape indicates fright-heat. Curved insect shape indicates stagnation. Chaotic insect shape indicates roundworm infestation. Combining vein color, shape, and location prevents medical errors.