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When children reach three or five years of age, pulse diagnosis can be performed. However, their wrists are short and narrow, making it difficult to distinguish the Cun (Inch), Guan (Bar), and Chi (Cubit) positions; thus, only one finger is used to palpate the pulse, which is indeed not easy. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) uses the four pulse qualities of Large (Da), Small (Xiao), Slow/Relaxed (Huan), and Urgent/Rapid (Ji) as standards for pediatric pulse diagnosis. Not daring to overstep my bounds, I have studied its intent and still adhere to the four pulses of Floating (Fu), Deep (Chen), Slow (Chi), and Rapid (Shu), determining deficiency and excess, slackness and urgency, by whether the pulse is Forceful (Youli) or Feeble (Wuli). This approach is clearer and more well-founded.

Essentials of Pulse Diagnosis in the *Neijing*
The Yellow Emperor asked: When an infant suffers from fever, what does a suspended and small pulse indicate?
When an infant has fever and presents a suspended and small pulse, this represents a Yang syndrome manifesting Yin pulses, which is fundamentally a major taboo. However, if the pulse is small yet relaxed (Huan), the pathogenic factor is minimal, and recovery is likely; if the pulse is small yet urgent (Ji), the pathogen has penetrated deeply, which is concerning. Hence, this question was raised.
Qibo replied: Survival is indicated if the hands and feet are warm; death ensues if they are cold.
Children possess tender Yang Qi as their constitutional basis. When ill, the fingerprint and pulse may appear dim and faint. Although the pulse at the limbs may be small, if the hands and feet remain warm, survival is possible because the four limbs are the root of all Yang meridians, indicating that Yang Qi is still present. If the limbs are cold, it signifies that pathogenic factors have overcome healthy Qi, and the Primordial Yang has departed; hence, death is predicted.
The Yellow Emperor asked: When an infant contracts wind-heat, presenting with wheezing, rhonchi, and shoulder breathing, what is the pulse like? Qibo replied: In cases of wheezing, rhonchi, and shoulder breathing, the pulse should be Excessively Large (Shi Da). If the pulse is large yet relaxed (Huan), stomach Qi is robust, pathogens are receding, and survival is possible. If the pulse is excessive and urgent (Ji), the Zang-Fu organs' true nature is exposed, the disease progresses daily, and death results. This discusses external contraction in children. Wind-heat attacking the Yang aspect causes wheezing, rhonchi, and shoulder breathing, where the pulse should be Shi Da. A large yet Huan pulse indicates good Stomach Qi and receding pathogens, leading to survival; a Shi and Ji pulse indicates the appearance of the True Zang pulse and progressive disease, leading to death.

This is the purport of the *Neijing*. The sages spoke concisely and comprehensively. People today fail to comprehend this, treating it as ordinary. If one focuses on these points, half of the essential secrets of pulse diagnosis will be understood. In my clinical practice, regardless of prognosis, most cases align with this principle. It is a matter of intuitive understanding, hard to express fully. Carefully examining the scripture’s mention of "Large, Small, Huan, Ji," it implies implicit meanings. Generally, "Large" belongs to the category of Floating and Surging (Hong); "Small" belongs to Deep and Fine (Xi); "Urgent" refers to Rapid (Shu); "Relaxed" refers to Slow (Chi). Is it not better to directly use Floating, Deep, Slow, and Rapid? Furthermore, combining Jie'an’s (Tao Hua) method of distinguishing Forceful vs. Feeble to identify Exterior/Interior, Deficiency/Excess constitutes a natural and indispensable secret for pediatric pulse diagnosis. Jie'an was but an ordinary person, yet he could distinguish Yin/Yang, Exterior/Interior, Cold/Heat, and Deficiency/Excess through Forcefulness and Feebleness. Though seemingly simple and plain, it is extremely accurate. Does this truly mean ancient and modern people are incomparable?

Diseases Governed by the Four Pulses
Floating (Fu) pulse governs Exterior patterns (disease outside); Deep (Chen) pulse governs Interior patterns (disease inside). Slow (Chi) pulse governs Zang organs (Cold disease); Rapid (Shu) pulse governs Fu organs (Heat disease). Four to five beats per respiration cycle constitute Slow (Chi), indicating Cold and Deficiency. Seven to eight beats per respiration cycle constitute Rapid (Shu), indicating Heat and Excess.
Floating and Slow indicate Exterior Cold; Deep and Slow indicate Interior Cold. Forceful indicates Excess Cold; Feeble indicates Deficiency Cold.
Floating and Rapid indicate Exterior Heat; Deep and Rapid indicate Interior Heat. Forceful indicates Excess Heat; Feeble indicates Deficiency Heat.
Main Symptoms: Floating and Forceful indicates Wind-Heat; Feeble indicates Yin Deficiency. Deep and Forceful indicates Phlegm-Food retention; Feeble indicates Qi Stagnation. Slow and Forceful indicates Pain; Feeble indicates Deficiency-Cold. Rapid and Forceful indicates Excess Heat; Feeble indicates Carbuncles and Sores.

Song Summarizing Pulse Essentials
At the Taoyuan point (Taiyuan, LU9), one finger determines safety or peril; six beats per cycle indicate harmony, five beats indicate deficiency. Seven to eight beats indicate much Heat; three to four beats indicate much Cold. Floating, Deep, Slow, and Rapid require detailed deduction. Forceful indicates Yang, Excess, and Heat; Feeble indicates Deficiency and Cold. If one pays attention to the Middle Extraction technique, why lament before the vastness of Qi-Bai (Huangdi and Qibo)?
Floating and Forceful combines Wind (Wind-Heat are Yang, representing Exterior Excess). Feeble indicates Yin Deficiency with profuse sweating (Yin fluids leaking excessively, representing Exterior Deficiency). Forceful and Deep indicates harm from Phlegm and Food stagnation (Phlegm congealing and food retaining, knotting in the Interior). Deep and Feeble indicates Qi stagnating in the chest (Qi stagnant in the middle, failing to transform). Slow and Forceful often indicates pain (Floating-Slow indicates exterior pain, Deep-Slow indicates interior pain). Feeble indicates Deficiency-Cold with Qi and Blood depletion (Weak Qi and declining Blood, a state of extreme deficiency). Rapid pulse usually involves Heat and ends with Forcefulness (Rapid and Forceful, how can Excess Heat be doubted?). Carbuncles without Forcefulness are attacked by Deficient Heat (Yin Deficiency causing injury, resulting from Deficient Heat).

Song on Pulse-Symptom Compatibility and Taboos
Floating pulse with body heat: Release via sweating (Yang pathogen resides in the Exterior, heat resolves through sweat). Deep and Fine pulse with cool body: Do not forcibly attack (Regardless of Exterior or Interior, not suitable for purgative/attacking methods). Cough is unfavorable with Floating and Rapid pulse (Floating-Slow is appropriate; Floating-Rapid is a major taboo). Fine and Deep pulse with swelling indicates ominous prognosis (Spleen-Stomach Deficiency-Cold, further failing to transform).
Deep and Slow pulse with dysentery is auspicious (Qi and Blood both injured, greatly disliking Surging and Rapid). Surging and Rapid pulse is suitable for encountering smallpox/rash (Yin and Yang sufficient, toxins cannot remain). Abdominal pain is incompatible with Floating and Forceful pulse (Diseases affecting the Three Yin, Floating is abnormal). Floating and Surging pulse with vomiting blood or nosebleeds yields no benefit (Yang Fire too excessive, Yin Blood further injured).

Tao Jie'an stated: The essence of pulse diagnosis lies in distinguishing Forceful from Feeble, regardless of Floating, Deep, Slow, or Rapid. Forceful indicates Yang, Excess, and Heat; Feeble indicates Yin, Deficiency, and Cold. Profound words! Later scholars must not neglect this.