脉诀启蒙曰凡诊小儿脉当大指按三部一息六七至为平八九至为内寒弦脉为风痫沉缓为伤
食促
急为虚惊弦急为气不和沉细为冷浮为风大小不均为鬼祟浮大数为风热伏结为物张单细为疳劳
风肠痛多喘呕脉洪为有虫浮而迟潮热者为胃寒也
脉经曰小儿四岁呼吸八至细数者吉又云呼吸八至者平九至者伤十至者困诊小儿脉法多雀
斗要
以三部脉为主若急为风痫沉者乳不消弦急为客忤气小儿是其日数应变蒸之时身热而脉乱无汗
不欲食乳辄吐 者脉乱无苦也脉沉而数者骨间有热欲以腹按清冷也宝鉴云小儿三岁以上五
岁
以下五百七十六日变蒸毕乃成人血脉骨肉皆坚牢方可诊候也盖小儿纯阳故脉息数促如大人为
不同也故病多见七表脉为属阳脉然也是以八里脉多不经见为属阴脉耳当知此理
按半 以上方可看虎口周 以上看虎口兼以一指脉若五百七十六日变蒸满足只与看一指
脉以
食指衮转分取三部凡言三部者非寸关尺系小儿三部面看气色为一部虎口脉纹为二部寸口一指
脉为三部也
小儿有病须凭脉一指三关定有息浮洪风盛热多惊虚冷沉迟实有积小儿三岁至五岁呼吸须
得八至看九至为迟十至困长短大小有邪干
小儿脉大多风热沉细元因乳食结弦长多是肝膈风紧数惊风四肢掣浮洪胃口如火烧沉紧腹
中痛
不歇虚濡有气又兼惊脉芤大小便中血四至洪来若烦满沉细腹中痛切切滑中露湿冷所伤弦急客
忤明分说
小儿乳后辄呕逆更兼脉乱无忧虑弦急之时被气缠脉缓即是不消乳紧数细数亦少苦虚濡邪
风惊风助痢下宣肠急痛时浮大之脉归泉路
伤寒脉大最相宜肿满浮洪病可医微细心痛终是顺沉迟吐泻必须危虫攻紧滑皆知吉渴饮微
沉势已衰惊搐浮洪多易治喘粗涎盛滑为奇
*Juefa Qimeng* (Enlightenment on Pulse Diagnosis) states: When diagnosing the pulse of children, one should use the thumb to press the Cun, Guan, and Chi positions. Six to seven beats per respiration indicate a normal pulse; eight to nine beats indicate internal cold; a Wiry pulse (Xian Mai) suggests Wind Epilepsy (Feng Xian); a Deep and Slow pulse indicates Food Retention (Shang Shi); a Choppy and Rapid pulse indicates Deficiency Palpitations (Xu Jing); a Wiry and Rapid pulse indicates Disharmony of Qi; a Deep and Fine pulse indicates Cold; a Floating pulse indicates Wind; an irregular pulse in size suggests Gui Sui (demonic influence or unexplained pathological conditions); a Floating, Large, and Rapid pulse indicates Wind-Heat; a Hidden and Knotted pulse indicates accumulation of pathogenic substances; a Single and Fine pulse indicates Gan Lao (chronic malnutrition syndrome). If Wind pathogens, intestinal pain, frequent wheezing, or vomiting are present, a洪 (Hong/Full) pulse suggests the presence of parasites; a Floating and Slow pulse accompanied by tidal fever indicates Stomach Cold.
*Mai Jing* (Pulse Classic) states: For a four-year-old child, eight beats per respiration with a Fine and Rapid quality is auspicious. It further states that eight beats per respiration is normal; nine beats indicates pathology; ten beats indicates critical condition. In pediatric pulse diagnosis, although certain specific patterns like Que Zhuo (Sparrow Pecking) are noted, the primary focus should be on the three positions (Cun, Guan, Chi). A Rapid pulse suggests Wind Epilepsy; a Deep pulse suggests indigestion of milk; a Wiry and Rapid pulse suggests Ke Wu Qi (Qi disturbance caused by external shock or fright), common in children. If a child is undergoing "Bian Zheng" (physiological growth cycles), they may have fever, chaotic pulse, no sweat, refusal to nurse, and vomiting after feeding. This chaotic pulse is benign and not a cause for concern. A Deep and Rapid pulse indicates heat within the bones; abdominal palpation can help distinguish between cold and heat. *Baojian* (Treasure Mirror) states: Children aged three to five years undergo 576 days of Bian Zheng cycles. Only after this period, when blood vessels and bones become firm and solid like adults, can comprehensive diagnosis be performed. Generally, children possess Pure Yang constitution, so their pulses are rapid and hurried, differing from adults. Therefore, diseases often manifest as Seven Exterior Pulses (Yang pulses), while Eight Interior Pulses (Yin pulses) are rarely seen. This principle must be understood.
For diagnosis, if the child is over one and a half years old, observe the Tiger's Mouth (web between thumb and index finger) veins; if under one and a half years, observe the Tiger's Mouth veins combined with the One-Finger Pulse method. If the 576-day Bian Zheng cycle is complete, only the One-Finger Pulse is needed. Use the index finger to roll and rotate, assessing the three positions. The term "three positions" here does not refer to the adult Cun, Guan, Chi, but rather: Observation of facial complexion constitutes the first position; observation of Tiger's Mouth vein patterns constitutes the second position; observation of the One-Finger Pulse at Cun Kou constitutes the third position.
When children are ill, pulse diagnosis is essential. Positioning the finger across the three segments of the Tiger's Mouth vein determines the respiratory rate. Floating and Full pulses indicate excess Wind, Heat, Palpitations, or Deficiency-Cold; Deep and Slow pulses indicate Excess and Accumulation. For children aged three to five, the respiratory rate should be eight beats per respiration; nine beats indicates Slowness (pathology), and ten beats indicates Exhaustion (critical state). Variations in length and size indicate pathogenic interference.
Pediatric pulses are mostly due to Wind-Heat; Deep and Fine pulses are often due to milk food stagnation; Wiry and Long pulses suggest Liver/Gallbladder Wind; Tight and Rapid pulses suggest Wind Convulsions with limb twitching; Floating and Full pulses indicate burning stomach heat; Deep and Tight pulses indicate persistent abdominal pain; Weak and Soft pulses indicate Qi stagnation combined with fright; Hollow (Kou) pulses indicate blood in stool or urine; Four beats per respiration with Fullness suggests irritability and fullness; Deep and Fine pulses indicate abdominal pain; Slippery pulses suggest exposure to damp-cold; Wiry and Rapid pulses indicate Ke Wu (external shock), which can be clearly explained.
If a child vomits immediately after nursing and has a chaotic pulse, there is no need for worry. If the pulse is Wiry and Rapid, it is entangled by pathogens; a Slow pulse indicates undigested milk; Tight, Rapid, Fine, and Rapid pulses indicate less suffering. Weak and Soft pulses are aided by Evil Wind and Wind Convulsions; dysentery involves clearing the intestines; urgent pain with a Floating and Large pulse leads to death (returning to the spring road).
In Shang Han (Cold Damage), a Large pulse is most favorable; Edema and Fullness with a Floating and Full pulse are treatable; Micro and Fine pulses with heart pain are ultimately favorable; Deep and Slow pulses with vomiting and diarrhea are critical; Parasitic attack with Tight and Slippery pulses is auspicious; Thirst with drinking and a Micro-Deep pulse indicates declining disease intensity; Convulsions with Floating and Full pulses are easy to treat; Wheezing with profuse phlegm and a Slippery pulse is a positive sign.