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[Qian] In cases where a disease initially presents as deficiency or has already undergone purgation, even if there are indications for purging, one must first tonify the mother organ before purging the son organ. For example, in lung deficiency with phlegm excess, which is a condition suitable for purging, one should first benefit the spleen, and only then purge the lungs. Xieqing Wan (Purging Green Pill), also known as Xiegan Wan (Purging Liver Pill). Qian stated that the liver has no tonification method, hence there are no specific herbs for tonifying the liver. Wang Haizang added Fangfeng (Saposhnikoviae Radix) and Qianghuo (Notopterygii Rhizoma et Radix) in equal amounts to Siwu Tang (Four Substances Decoction), ground into fine powder, and made into pills with refined honey, naming it Bugan Wan (Tonifying Liver Pill). He further removed Zhizi (Gardeniae Fructus) and Dahuang (Rhei Radix et Rhizoma) from Xieqing Wan, naming it Zhen Gan Wan (Calming Liver Pill), used to treat liver deficiency. Daochi San (Guide Out Red Powder) purges Bing Fire (Small Intestine). Xiexin Tang (Drain Heart Decoction) purges Ding Fire (Heart). Anshen Wan (Calm Spirit Pill) treats heart deficiency causing childhood malnutrition heat (Gan Re) and mental confusion. Haizang's Bawu Dingzhi Wan (Eight-Ingredient Calming Will Pill) is the correct medicine for tonifying the heart. Yihuang San (Benefit Yellow Powder), also known as Buspi San (Tonify Spleen Powder), Haizang said: This formula tonifies the spleen by drying dampness. Dongyuan said: It is the sacred medicine for treating stomach cold-damp vomiting, abdominal pain, and clear watery diarrhea. Xiehuan San (Purging Yellow Powder), also known as Xiepi San (Purging Spleen Powder), Haizang said: It purges spleen heat. Ejiao San (Donkey-Hide Gelatin Powder), also known as Bufei San (Tonify Lung Powder), Haizang said: Xingren (Prunus Armeniaca Seed) is originally used to purge the lungs, unlike herbs such as Renshen (Ginseng Radix), Tianmendong (Asparagi Radix), and Maidong (Ophiopogonis Radix). Xiebai San (Purging White Powder), also known as Xiefei San (Purge Lung Powder), Haizang said: It treats lung heat causing bone-steaming tidal fever and spontaneous sweating, using this formula to directly purge it. Zhizi (Gardeniae Fructus) and Huangqin (Scutellariae Radix) can also purge the lungs, but they should be differentiated according to Qi and Blood. Dihuang Wan (Rehmannia Pill) is the Bajun Wan (Eight-Ingredient Pill) from *Jingui Yaolue* without Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata). Haizang said: It treats kidney deficiency causing Jielu (delayed closure of fontanelles), also known as Ba disease, treating pulse hairiness and deficiency. Qian stated that the kidney has no purging method, hence there are no specific herbs for purging the kidney. Haizang's Xieshen Wan (Purge Kidney Pill) treats a surging and full pulse, which is the aforementioned Dihuang Wan with Shudihuang (Rehmanniae Radix Praeparata) changed to Shengdihuang (Rehmanniae Radix), and Shanzhuyu (Corni Fructus) removed; this treats the pulse at the left hand local position. If the right Chi pulse is surging and full, use Fengsui Dan (Phoenix Following Pill) to purge it. (See General Discussion in each of the Five Viscera sections)

Ancient texts say "to know through observation is called divine," and pediatricians are called the "Mute Department" because children cannot accurately describe their symptoms, pulses beat rapidly, and it is difficult to distinguish clearly under the fingers, making observation of facial color essential; thus, it is narrated first. Infants' faces necessarily show five colors, allowing one to know the source of disease. Among the five body parts, the head is primary; within the head is the face, within the face are the eyes, and within the eyes is Shen (Spirit), which is the luster of the eyes. Shen appears and disappears, moves horizontally and vertically, manifests in corresponding positions, and corresponds to the five viscera. The five colors are green, yellow, red, white, and black, representing the colors of the five viscera: heart red, liver green, spleen yellow, lung white, kidney black. Diseases governed by the five viscera are hidden internally but must manifest externally in form and color. Therefore, when a child is ill, one first observes the form and color of the corresponding region to discuss the auspiciousness or inauspiciousness of the generation and restriction of the Five Elements. If the form and color do not correspond, then one listens to the voice and palpates the pulse.

[Qian] Facial signs: The left cheek belongs to the liver. (Corresponds to the Guan position of the left hand, liver and gallbladder division, associated with Wind-Wood, the first Qi.) The right cheek belongs to the lung. (Corresponds to the Cun position of the right hand, lung and large intestine division, associated with Dryness-Metal, the fifth Qi.) The forehead belongs to the heart. (Corresponds to the Kou position of the left hand, heart and small intestine division, associated with Ministerial Fire, the second Qi.) The nose belongs to the spleen. (Corresponds to the Guan position of the right hand, spleen and stomach division, associated with Damp-Earth, the fourth Qi.) The chin belongs to the kidney. (Corresponds to the Chi position below the left hand, kidney and bladder division, associated with Cold-Water, the final Qi.) Red indicates heat, yellow indicates accumulation, white indicates cold, green and black indicate pain; treat according to the syndrome. *Yonglei Qianfang* says: Green indicates unsettled fright and accumulation, predisposing to wind syndromes. Red indicates heat, excessive phlegm accumulation, worsening fright palpitations and irritability. Yellow also indicates heat, food accumulation damaging the syndrome, predisposing to Gan syndromes or forming Pi Pi (masses). If mental state is dull, signs include tidal fever, coarse breathing, fatigue, vomiting, or diarrhea/dysentery. White indicates cold, lung qi obstruction, intestinal slippage, predisposing to vomiting and diarrhea. Black indicates pain; if transmission is not restless, changes become adverse syndromes, Ying and Wei lose order, indicating critical danger. *Quanying Fang* says: The left cheek belongs to the liver, Eastern position. Slight green in spring is normal, deep green is pathological, white is terminal, red indicates body heat and stiffness, liver heat generating wind, green-black indicates fright palpitations and abdominal pain, light red indicates tidal fever occurring at night and stopping during the day, lips red and dry, pulse tight and rapid. The right cheek belongs to the lung, Western position on the right. Slight white in autumn is normal, deep white is pathological, red is terminal, light color indicates tidal fever, or hard stool with coarse breathing and cough, green-white indicates cough and nausea, green indicates wind entering the lung with frequent coughing, green-black indicates impending convulsive wind or abdominal pain with intestines coiling inward. The forehead belongs to the heart, Southern position. Fire nature flares upward so it resides above. Slight red in summer is normal, deep red is pathological, black is terminal. Red indicates wind-heat in the heart meridian, heart irritability and fright, restlessness in sleep. Green-black indicates evil in the heart, convulsive wind and abdominal pain, twitching and crying. Severe green-black indicates heart and abdominal pain. Yellow indicates fright-Gan bone heat and thirst, dry skin and hair, night sweats, scorched yellow hair. The nose belongs to the spleen, Central position residing in the middle. Slight yellow in all seasons is normal, deep yellow is pathological, green is terminal. Red indicates body heat and loss of appetite for milk/food, deep yellow indicates urinary retention, dry nostrils, coarse breathing and epistaxis, frequent crying at night, pale white indicates diarrhea and undigested food, green indicates vomiting milk, dry mouth and nose, difficulty in urination and defecation. The lower chin belongs to the kidney, Northern position. Water nature moistens downward so it resides below. Slight black in winter is normal, deep black is pathological, yellow is terminal. Red indicates heat in the interior and exterior of the bladder and kidney, leading to urinary obstruction (*Longbi*). *Yonglei Qianfang* Liver section governs the pupils, hiding the spirit inside, investigating the Five Wheels outside. Eye sockets belong to the spleen; heat produces eye discharge. Both eyes relate to the heart; heat causes pain like needles. Whites belong to the lungs; heat-red produces sand-like deposits. Yellow relates to the liver; dimness and opacity. Center pupil relates to the kidney; heat causes unclear vision, blinking, darting eyes, wind and fright. Heart section governs the cheekbones and cheeks. Black indicates sinking and heaviness, green indicates fright palpitations, red indicates heart wind, white indicates Gan Qi, deficiency-yellow with Wei accumulation, edema and Qi rebellion. Why does heart termination occur? Crying several times, passing the pass without crying,必定 making crow sounds. Add heat and convulsions, dissipate heat and clear the heart. Spleen section governs the lips and mouth. Renzhong and Chengjiang, surrounding areas, closed mouth is spleen territory, open mouth belongs to the heart. Heart-spleen heat causes lip fissures and tongue ulcers, Sanjiao heat accumulation makes lips red like blood, deep red with severe thirst, goose-mouth, wooden tongue, double tongue. Spleen-lung heat causes foul breath. Spleen-kidney Qi cold makes color like dead liver. Great fright causes dry mouth and white lips. Chronic fright accumulation gradually transmits to the heart. Heart Qi deficiency causes irritability and crying. How to know spleen termination? Nails all black, eyes lack spiritual luster, definitely difficult to treat. Five types of mouth-grasping convulsive wind are even worse and untreatable. Lung section governs the tip of the nose and both nostrils, connected to Shangen. Inner and outer canthi store lung Qi. Nostrils black like coal indicate lung meridian scorching; black like ink means lung meridian termination. Nostrils red and itchy, severe Gan with long roundworms, or white nasal discharge, brain cold causing drowsiness, or clear nasal discharge, wind-cold preferring sleep. Lung heat nasal congestion caused by breathing cold air or contracting wind-cold also closes passages. Nose rot is Gan, nose odor is heat accumulation. Kidney section governs the area before the ear hole, named Erhua. Ear child is called Lun, inside Lun is called Kuo. Scorched black contours indicate kidney deficiency heat; black like charcoal means kidney termination death next morning. Ear gate sores indicate abnormal Wei accumulation. Pus from ears indicates extreme kidney Gan heat, smelly ear, unceasing pus, sore itching like烈. Signs are deficiency heat, sudden deafness. Heart-kidney Qi stagnation causes constant humming. Heat Qi attacks upward, or feels like insect scraping. Ying deficiency and Wei heat make ear lobes ice-cold (also check for red threads behind ears). Measles and chickenpox invade, ear lobes red and hot, this is the sign of Shanghan. Extreme heat causes internal pain, swelling Qi attacks. Clear heart and cool Diaphragm, open and close orifices. Children's two kidneys are often empty and disease-free; do not attack them, tonification is also useless. [Zhang] Liver disease shows white face. Lung disease shows red face. Spleen disease shows green face. Kidney disease shows yellow face. Heart disease shows black face. If liver disease has convulsions and adds white face, phlegm saliva, and panting, these are all difficult to treat; infer the rest similarly. Suppose before Spring Equinox, it is wind-cold; use Dihuang, Qianghuo, Fangfeng, or alternate Dihuang Wan and Xieqing Wan. After Spring Equinox, it is wind-heat; use Qianghuo, Fangfeng, Huangqin, or purge with Xieqing Wan and Daochi San. After Start of Summer, it is heat; use Sanhuang Wan and Daochi San. After Summer Solstice, it is damp-heat; use Daochi San and Xiehuan San together, or Huangqin, Renshen, Muxiang. After Autumn Equinox use Xiebai San. After Start of Winter use Dihuang Wan mainly, saying the kidney does not accept purging. [Xue] Green indicates unsettled fright accumulation predisposing to wind signs. Red indicates phlegm accumulation and fright palpitations. Yellow indicates food accumulation damaging the syndrome predisposing to Gan Pi masses. White indicates diarrhea of water and grain predisposing to vomiting. Black indicates visceral termination. Yintang, green indicates initial fright diarrhea, red indicates great fright night crying, black indicates Ke Wu (alien influence). Shangen, green indicates agitation after second fright diarrhea, severe black-yellow is fatal. Nianshou, flat and sunken indicates premature death, green indicates fever generating fright, black indicates death from diarrhea, red indicates death from agitation, slight yellow is normal, severe yellow is Huoluan. Chengjiang, green indicates fright during eating, yellow indicates vomiting/reversal, also indicates bloody diarrhea, black indicates convulsive wind. Face and eye black sclera yellow indicates heat, white sclera yellow indicates food accumulation Gan, white sclera green indicates convulsive wind, black sclera yellow indicates Shanghan. Above eyebrows, green is auspicious, sudden red indicates irritability and night crying, yellow indicates Huoluan, chronic illness red is fatal. Fengqi Two Pools, green indicates wind signs, purple indicates vomiting/reversal or fever, yellow indicates vomiting/reversal, red indicates irritability and night crying. Both cheekbones, red indicates guest heat in the lung. Both temples, green indicates second fright, green entering ear from temple is fatal, red indicates blood strangury. Both faces, green indicates Ke Wu, yellow indicates phlegm overflow, red indicates wind-heat. Both cheeks, red indicates Shanghan. Both jaws, green indicates vomiting worms. Two Jingui, green indicates third convulsive wind. Black around mouth dies in two days. Green connecting eye to ear dies in seven days. Two Fengmen, red indicates wind-heat, black indicates hernia, green indicates water fright. Black from eyebrow to ear dies same day, black lips not eating dies. Face green eye green is liver disease. Face red is heart disease. Face white is lung disease. Face yellow is spleen disease. Face black is kidney disease. Forehead, red indicates heart meridian heat, irritability and palpitations. If drinking water or crying, it belongs to excess heat of this meridian; use Xiexin San to clear heart fire. Slight red with drowsiness and palpitations, heat-thirst drinking soup belongs to deficiency heat; use Mizhi Anshen Wan to generate heart blood. Green-black indicates convulsive wind and abdominal pain, or twitching and crying; use Wuyi Yigong San plus Muxiang, Chaihu, Gouteng Hook to tonify spleen and liver. Green-black indicates heart and abdominal pain, this is cold-water attacking the heart; use Yihuang San. Slight yellow indicates fright-Gan; use Anshen Wan. Left cheek, green or mixed red indicates liver meridian wind-heat, neck stiffness and stuffiness, eye twitching and convulsions; use Chaihu Qinggan San. Color slightly red, sudden heat and grinding teeth belongs to deficiency heat; use Dihuang Wan. Green-black indicates liver restricting spleen causing convulsions and abdominal pain; use Liu Junzi plus Jiang Gui. Slight red indicates tidal fever, blood deficiency, heart irritability; first use Mizhi Anshen Wan, then Dihuang Wan. Right cheek, red indicates wind pathogen, coarse breathing and cough, fever and drinking water is excess heat; use Xiebai San. If choking gas and exhalation, white lips and shortness of breath belongs to deficiency heat; use Wuyi Yigong San. If transmitted by spleen heat; use Qingwei San. Punished by heart fire; use Renshen Pingfei San. Pale red indicates tidal fever, heart irritability or hard constipation; use *Xuanming* Chaihu Yinzi to guide and drain. If tidal fever does not stop, further use Gouteng Yin to clear the liver. Color green-white indicates cough and nausea; first use Xingxing San to resolve exterior pathogen and tonify spleen earth, further use Liu Junzi Tang to regulate and tonify middle Qi. Color green-black indicates convulsive wind and abdominal pain, intestines coiling inward; use Liu Jun, Gouteng Hook to calm liver and tonify spleen. Nose, slight yellow is normal. Red indicates spleen-stomach excess heat, body heat, drinking water, normal milk/food intake; use Xiehuan San to clear heat and regulate spleen. Slight red indicates spleen meridian deficiency heat, cool body, drinking soup, little desire for milk/food; use Wuyi Yigong San to tonify middle and strengthen spleen. Deep yellow indicates urinary retention, dry nose, coarse breathing and epistaxis, spleen heat transmitting to lung and kidney; first use *Jisheng* Xijiao Dihuang Tang, then Dihuang Wan. Pale white is spleen deficiency diarrhea, undigested milk/food; use Liu Junzi Tang to regulate and tonify middle Qi. Green indicates spleen earth deficiency-cold, overcome by liver wood; use Wuyi Yigong San plus Muxiang, Paojiang to warm middle and calm liver. Black is a death sign. Chin, red indicates kidney and bladder Qi stagnation and heat binding, urinary retention; use Wuling San to separate and drain. Nose tip slight yellow, combined with right cheek slight red, spleen-lung dry-heat unable to generate kidney water; use Huangqin Qingfei Yin. Bladder Yin deficiency with Yang having nothing to generate; use Zishen Wan. If chin slight red, bladder Yang deficiency with Yin having nothing to transform; use Liuhuang Dihuang Wan. If lower abdomen fullness or scrotal swelling, belongs to Yin deficiency damp-heat stagnation; use Liuhuang Wan plus Cheqian, Niuxi. Spleen-lung Qi deficiency unable to regulate water pathways also uses the former medicines. Urine red color, long-term hematuria, also belongs to liver-kidney Qi deficiency with heat; use Liuhuang Dihuang Wan. If ineffective, use Buzhong Yiqi Tang to benefit spleen-lung and generate liver-kidney. If white fluid comes out after urination, or pain in the glans, belongs to liver meridian damp-heat; first use Longdan Xiegan Tang, then Liuhuang Dihuang Wan. Yintang, green-black indicates abdominal pain and night crying, this is spleen Qi deficiency-cold. Spleen is Supreme Yin, hence abdominal pain and crying at night; use Gouteng Yin. Pale white indicates diarrhea undigested milk/food, spleen Qi deficiency; use Wuyi Yigong San plus Muxiang. Renzhong, yellow indicates milk injury and stomach reversal. Green indicates diarrhea undigested milk/food, sour belching, spleen deficiency stagnation; first use Da'an Wan to digest food, then Yigong San to strengthen spleen. Black indicates roundworm biting pain. Lips, white indicates spitting saliva and vomiting/reversal, or hematemesis and hematochezia, spleen Qi deficiency unable to control saliva and unify blood returning to source; urgently use Liu Junzi Tang. Red, dry and wrinkled indicates spleen meridian heat-thirst, constipation, irritability and insomnia; first use Qingwei San to treat heat, then Four Gentlemen, Huanglian, Shanzhi to regulate spleen. Yellow indicates food accumulation diarrhea, undigested milk/food; use Liu Junzi Tang to strengthen spleen. Red mixed with white indicates epistaxis, spleen-lung deficiency heat unable to control blood returning to source; use *Shengji* Xijiao Dihuang Tang to clear heat and nourish blood, use Four Gentlemen Tang to tonify spleen Qi. If long-term ineffective, use Maidong San or Renshen Anwei San. Corner of mouth, yellow indicates spleen meridian heat accumulation; use Qingwei San. Chronic illness use Siwei Fei'er Wan to treat Gan heat. Lip/mouth twitching indicates fright-heat unrest; use Yigong San plus Shanzhi, Gouteng Hook, tonify spleen and calm liver. If mouth flows saliva and lip color purple, spleen Qi deficiency-cold; use Yigong San plus Paojiang, Muxiang. If abdominal pain and mouth spits saliva, worm pain; first use Wuyi San, then Tiaozhong Wan. Not spitting saliva is accumulation pain; use Yigong San. Cold extremities use Lizhong Tang plus Wumei to warm and tonify middle Qi, pain stops naturally. Or pain stops after vomiting or defecation; first use Xiaji Wan, then Yigong San. White indicates death from blood loss. Green indicates death from convulsive wind. Black around mouth is untreatable. Behind ear slight red, Shaoyang meridian wind-heat; use Chaihu Yinzi to clear liver and generate blood. Slight yellow indicates sleep fright palpitations and grinding teeth; use Four Gentlemen plus Xiong, Gui, Shengma to regulate spleen Qi. Ear dryness indicates bone-Gan steaming heat, thirst and night sweats; use Dihuang Wan. If white fluid comes out after urination, or glans itching/pain, liver meridian damp-heat; first use Longdan Xiegan Tang, then Liuhuang Dihuang Wan. If innate kidney Qi insufficient, or early sexual activity causing dysuria or pain like strangury, urgently use Dihuang Wan, Buzhong Yiqi Tang to nourish transformation source. Or pain pulling in anus after urination/defecation, deficiency is even more severe; use former pill plus Niuxi, Cheqian, Rougui. If cold extremities or fear of cold and little food, Yang Qi deficiency-cold; urgently add Fuzi, mostly can survive. Generally due to innate organ Qi imbalance, or milk/food cold/heat irregularity, or pregnancy, nursing mother, diet/lifestyle Six Evils and Seven Emotions causing it. If initial illness Yuan Qi not depleted, milk/food normal, fever/high fever, two bowels constipated, thirsty drinking water, sleeping with eyes not fully closed, all belong to shape and disease both excess, treat pathogenic Qi. If illness long-term Yuan Qi depleted, little food fever, dry mouth drinking soup, vomiting diarrhea, limbs fear cold and eyes exposed, all belong to shape and disease both deficiency, tonify righteous Qi. Further examine fetal Qi excess/deficiency, organ overcoming relationships and treat accordingly, thus avoiding errors.

[Qian] Internal eye signs: Red indicates heart heat, Daochi San governs. Pale red indicates heart deficiency heat, Shengxi San governs. Green indicates liver heat, Xieqing Wan governs. Pale/light tonify it. Yellow indicates spleen heat, Xiehuan San governs. Lack of luster indicates kidney deficiency, Dihuang Wan governs. If face and eyes swollen, indicates long-term cough, spleen affected by Gan accumulation.

Whenever children have white lips, it indicates spitting saliva, vomiting/reversal, hematemesis, hematochezia. Red lips, thirst/drinking irritability, if long-term thirst/diarrhea with red lips, this is deficiency syndrome, do not use cooling medicines. Yellow lips indicate spleen affected by accumulation then swelling. Purple lips/mouth and spitting saliva indicate worm pain. Not spitting saliva is accumulation pain. Lips/mouth edges yellow like orange indicate bad breath, spleen heat accumulation. Green lips indicate blood deficiency spleen cold, attacked by cold. Lips govern spleen earth, wood overcomes earth, knowing spleen weak cannot eat.

Whenever children have dry tongue, white tongue, dry tongue, coated tongue, yellow tongue, red/swollen tongue, all indicate constipation, or if loose, must be scorched yellow. Tongue fissures, prickles on tongue, bleeding on tongue, all indicate extreme heat Yang toxin. Sores on tongue indicate heart-spleen heat. Rolled tongue indicates fright. Long-term diarrhea/dysentery, black tongue must be moist, do not consider it heat, long-term illness upper Jiao deficiency heat causes this. Long-term dysentery black tongue,必定 death.