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[Listening to Voice]

Heavy and Solid Voice: The voice is heavy, solid, and robust, accompanied by body heat. This indicates Qi stagnation in the Sanjiao (Triple Burner) affecting the Heart and Spleen. If caused by Wind-Cold injury leading to cough and sore throat, with dry and difficult stool passage that is delayed.

Sad and Scorched Voice: The voice is sad and anxious, indicating internal dryness-heat, fear, and a tendency to generate Wind-convulsions. If the voice is heavy, turbid, and quiet, it indicates deafness caused by Gan syndrome (malnutrition/parasitic accumulation) attacking the ears.

Crying and Wailing Voice: Crying without wailing (no tearful or tonal variation) indicates fright. Frequent wailing without crying indicates clear pain. A light, trembling, and hoarse voice indicates Wind-epilepsy. A frequent, urgent voice with vomiting and diarrhea indicates the formation of vomiting and diarrhea syndromes.

"Jian" (Boiling/Agitated) Voice: Restlessness and inability to find comfort indicate severe illness. Dry and urgent voice indicates Cold pathogen invasion. Short speech, faint Qi, and astringent urination indicate various types of dysentery with long, slow, and thin voices.

Slow and Delayed Voice: Short speech and slow voice, with frequent borborygmus and diarrhea. Hoarse and mostly inaudible voice indicates Lung pathology due to Wind-Heat.

[Pulse Diagnosis]

When examining pediatric pulses, use the thumb to palpate the Cun, Guan, and Chi positions on both wrists. Six to seven beats per respiratory cycle indicate a harmonious pulse; eight to nine beats indicate fever; five beats indicate internal Cold.

Xian (Wiry) pulse indicates Wind-epilepsy; Chen-Huan (Deep-Slow) pulse indicates food injury; Cu-Ji (Rapid-Irregular) pulse indicates deficiency fright; Xian-Ji (Wiry-Urgent) pulse indicates Qi disharmony; Chen-Xi (Deep-Fine) pulse indicates Cold; Fu (Floating) pulse indicates Wind; irregular pulse size indicates ominous signs or malevolent influences; Fu-Da-Shu (Floating-Big-Rapid) pulse indicates Wind-Heat; Fu-Jie (Hidden-Knotted) pulse indicates mass accumulation; Dan-Xi (Single-Fine) pulse indicates Gan-Lao (chronic wasting). For abdominal pain, if accompanied by wheezing, vomiting, and a Hong (Surging) pulse, it indicates intestinal parasites. If the pulse is Chen-Chi (Deep-Slow) with tidal fever, it indicates Stomach Cold, which heals with warming treatment. The maxim states: Tight pulse in children indicates Wind-epilepsy; Deep-Slow indicates food injury with much vomiting; Wiry-Urgent indicates Qi disharmony; Urgent-Quick indicates acute fright with loss of spirit possession; Cold presents as Deep-Fine; Wind presents as Floating; Firm-Solid indicates prolonged constipation; Abdominal pain presents as Tight-Wiry; Chaotic pulse is incurable; During Bian-Zheng (metabolic transformation periods), the pulse must be chaotic; no treatment is needed as it will resolve naturally; Single-Fine indicates Gan-Lao; Surging indicates worms; Irregular size is an ominous sign; Deep-Slow with tidal fever indicates internal Stomach Cold; Large pulse with diarrhea/dysentery is hard to treat; careful deliberation is required. (Yun Qizi said: For children under five who cannot communicate well, pulse diagnosis alone is insufficient; only after age five can floating/sinking and slow/rapid be distinguished. Note: Qian Yi's discussion does not strictly adhere to the age of five.)

Pulse Correspondence with Miscellaneous Diseases:
All Shu (Rapid) pulses: Indicate Heat, belonging to the Fu organs.
All Chi (Slow) pulses: Indicate Cold, belonging to the Zang organs.
Yang Shu pulse: Indicates vomiting and regurgitation; if no vomiting, fever ensues.
Yin Wei (Micro) pulse: Indicates diarrhea; if no diarrhea, night sweats ensue.
Chen-Shu (Deep-Rapid) pulse: Indicates alternating cold and heat, more cold than heat, also indicates bone-steaming heat.
Jin-Shu (Tight-Rapid) pulse: Indicates alternating cold and heat, more heat than cold, also indicates bone heat; if urgent, convulsions and epilepsy occur.
Chen-Jin (Deep-Tight) pulse: Indicates heart and abdominal pain; Duan-Shu (Short-Rapid) is similar, also indicates cough.
Chen-Xi (Deep-Fine) pulse: Indicates undigested milk/food, also indicates abdominal pain and dysentery.
Chen-Fu (Deep-Hidden) pulse: Indicates accumulations and masses, also indicates cholera-like disorder.
Wei-Huan (Micro-Slow) pulse: Indicates undigested milk/food and diarrhea; Chen-Huan (Deep-Slow) is similar.
Wei-Se (Micro-Astringent) pulse: Indicates convulsions and muscle cramps.
Wei-Ji (Micro-Tight) pulse: Indicates alternating cold and heat with blood in saliva.
Fu-Hua (Floating-Slippery) pulse: Indicates retained food not digesting, also indicates cough.
Fu-Jin (Floating-Tight) pulse: Indicates Gan-Qi (Gan syndrome Qi) and deafness.
Fu-Xian (Floating-Wiry) pulse: Indicates headache and body heat.
Jin-Hua (Tight-Slippery) pulse: Indicates hematemesis and ominous signs.
Heart pulse Ji-Shu (Urgent-Rapid): Indicates fright-epilepsy. If no fright, indicates Gan-lin (Gan syndrome with strangury).
Liver pulse Ji-Shen (Very Urgent): Indicates Dian-Xian (Epilepsy) and Feng-Xian (Wind-Epilepsy), with flowing phlegm-saliva.
Lung pulse Fu-Shi (Floating-Solid): Indicates nasal congestion and obstruction of both large and small bowels.
Guan pulse Jin-Hua (Tight-Slippery): Indicates roundworms; Chi pulse Chen (Deep) also indicates roundworms.
Chi pulse Wei-Xi (Micro-Fine): Indicates loose stools and cold dysentery, undigested milk/food.
Chi pulse Wei-Se (Micro-Astringent): Indicates blood in stool; if no blood, night sweats ensue.
Pulse extending past Cun into Yuji (LU10): Indicates enuresis.

Examining Pulse Reversal and Compliance:
Fright-Convulsion pulse: Fu-Shu (Floating-Rapid) is compliant; Chen-Xi (Deep-Fine) is reversed; Warm body is compliant; Cold limbs are reversed.
Night-crying pulse: Wei-Xiao (Micro-Small) is compliant; Hong-Da (Surging-Big) is reversed; Cold body is reversed.
Heart-Abdominal Pain: Chen-Xi (Deep-Fine) is compliant; Fu-Da (Floating-Big) is reversed; Warm body is compliant; Cold limbs are reversed.
Shang-Han (Cold Damage) pulse: Hong-Xian (Surging-Wiry) is compliant; Chen-Xi (Deep-Fine) is reversed; Fu-Da (Floating-Big) is compliant; Wei-Fu (Micro-Hidden) is reversed.
Post-Sweating pulse: Chen-Xi (Deep-Fine) is compliant; Hong-Jin (Surging-Tight) is reversed; Sleepiness is compliant; Mania/restlessness is reversed.
Wen-Bing (Warm Disease) pulse: Hong-Da (Surging-Big) is compliant; Chen-Xi (Deep-Fine) is reversed; Body heat is compliant; Abdominal pain is reversed.
Cough pulse: Hua-Fu (Slippery-Floating) is compliant; Chen-Xi (Deep-Fine) is reversed; Warm body is compliant; Cold limbs are reversed.
Huo-Luan (Cholera-like) pulse: Fu-Hong (Floating-Surging) is compliant; Chi-Wei (Slow-Micro) is reversed; Warm body is compliant; Cold limbs are reversed.
Vomiting pulse: Fu-Da (Floating-Big) is compliant; Chen-Xi (Deep-Fine) is reversed; Warm body is compliant; Cold limbs are reversed.
Diarrhea pulse: Huan-Xiao (Slow-Small) is compliant; Fu-Da (Floating-Big) is reversed; Warm body is compliant; Cold limbs are reversed.
All Dysentery pulses: Chen-Xi (Deep-Fine) is compliant; Fu-Da (Floating-Big) is reversed; Warm body is compliant; Cold limbs are reversed.
All Thirst pulses: Hong-Shu (Surging-Rapid) is compliant; Wei-Xi (Micro-Fine) is reversed; Warm body is compliant; Cold limbs are reversed.
All Edema pulses: Fu-Da (Floating-Big) is compliant; Chen-Xi (Deep-Fine) is reversed; Organ excess is compliant; Intestinal leakage is reversed.
Abdominal Distension pulse: Fu-Da (Floating-Big) is compliant; Xu-Xiao (Deficient-Small) is reversed; Organ excess is compliant; Diarrhea is reversed.
Phlegm-Asthma pulse: Hua-Da (Slippery-Big) is compliant; Chen-Xi (Deep-Fine) is reversed; Warm body is compliant; Cold limbs are reversed.
Alternating Cold-Heat pulse: Jin-Shu (Tight-Rapid) is compliant; Chen-Xi (Deep-Fine) is reversed; Lassitude is compliant; Rigidity is reversed.
Gan-Lao pulse: Jin-Shu (Tight-Rapid) is compliant; Chen-Xi (Deep-Fine) is reversed; Organ excess is compliant; Spleen diarrhea is reversed.
Worm-Pain pulse: Jin-Hua (Tight-Slippery) is compliant; Fu-Da (Floating-Big) is reversed; Warm body is compliant; Blue lips are reversed.
All Blood Loss: Chen-Xi (Deep-Fine) is compliant; Fu-Shu (Floating-Rapid) is reversed; Warm body is compliant; Fever is reversed.
Zhong-E (Evil Strike) Abdominal Distension: Jin-Xi (Tight-Fine) is compliant; Fu-Da (Floating-Big) is reversed; Body heat is compliant; Body cold is reversed.
Jaundice pulse: Fu-Da (Floating-Big) is compliant; Chen-Xi (Deep-Fine) is reversed; Wide abdomen is compliant; Diarrhea is reversed.
Fire Jaundice pulse: Fu-Hong (Floating-Surging) is compliant; Chen-Xi (Deep-Fine) is reversed; Body heat is compliant; Body cold is reversed.

Qian Zhongyang said: In children, Qi disharmony presents as Wiry-Urgent; Food injury as Deep-Slow; Deficiency Fright as Rapid-Irregular; Wind as Floating; Cold as Deep-Fine; Chaotic pulse is incurable. *Shui Jing Jue* says: Yin and Yang combine, male and female form, nine orifices and four limbs are divided, then Five Zang and Six Fu organs arise. Once parts are distinct, reversal and compliance are hard to discern. Relying solely on Cun/Guan floating/sinking will surely lead to the child's sudden death. One must understand the Tiger Mouth (thenar eminence) and distinguish the Three Passages (Guan) to prescribe medication without error. Under three years old, observe the Tiger Mouth index finger: The first segment is the Wind Passage (Feng Guan); appearance of pulse here is easy to treat. The second segment is the Qi Passage (Qi Guan); appearance here indicates deep disease, hard to treat. The third segment is the Life Passage (Ming Guan); appearance here indicates death, incurable. Green in all three passages indicates Four-Footed Fright (animal-related fright); Red indicates Water Fright; Black indicates Human Fright; Purple indicates diarrhea/dysentery; Yellow indicates Thunder Fright. All three passages penetrated indicates extreme fright, fatal. Green or red with a straight line like a thread indicates milk/food injuring Spleen, leading to fright-heat. Identical on left and right indicates simultaneous Fright and Accumulation. Three lines or scattered indicates Lung generating Wind-Phlegm, resembling slow-fright sounds. Red indicates Shang-Han and cough. Like bright fire indicates diarrhea. Red and black mixed indicates dysentery; more green means white dysentery; more red means bloody dysentery; purple mixed with thirst. Chaotic Tiger Mouth pulse texture indicates Stomach Qi disharmony. Green indicates Fright and Accumulation. Green-black indicates Slow Fright. Pulse entering palm indicates Internal Hooking. Texture curving inward indicates Excess Wind; curving outward indicates Food Accumulation. This applies to children over three. For under three, use one finger to press the high bone to divide the three passages and count breaths: Eight beats per breath is normal; nine is uneasy; ten is critical. Floating indicates Wind. Deep-Slow indicates Deficiency-Cold. Solid indicates Heat. Tight indicates Epilepsy. Surging indicates Excess Heat. Deep-Slow indicates Deficiency Diarrhea. Micro-Slow indicates Accumulation and Worms. Slow-Astringent indicates Stomach Disharmony. Deep indicates Hard-to-digest milk/food. Deep-Fine indicates Milk/Food Stagnation. Tight-Wiry indicates Abdominal Heat-Pain. Firm-Solid indicates Constipation. Deep-Rapid indicates Heat in bones. Wiry-Long indicates Wind in Liver/Diaphragm. Tight-Rapid indicates Fright-Wind causing limb twitching. Floating-Surging indicates Heat in Stomach opening. Deep-Tight indicates Abdominal Pain with Cold. Deficient-Soft indicates Qi presence and Slow Fright. Kou (Hollow) indicates profuse loose stools with blood. Under four years, use one finger rolling to find the three positions, using Guan as standard. Seven-eight years, shift fingers slightly. Nine years, follow the three passages sequentially. Eleven-twelve years same. Fourteen-fifteen years, diagnose according to adult methods. Generally, first determine Floating/Sinking, Slow/Rapid, Yin/Cold, Yang/Heat. Deep-Slow is Yin; Floating-Rapid is Yang. Also observe color: Green indicates Fright-Wind; White indicates Deficiency Diarrhea; Red indicates Phlegm-Heat; Black indicates severe disease; Yellow indicates Spleen Gan. By combining these, observe disease and treat, avoiding errors. *Quan You Xin Jian* says: For infants half-year-old with illness, press the forehead, between eyebrows, and hairline with ring, middle, and index fingers bent. If head is left, raise right hand; if right, raise left. Index is Upper, Middle is Middle, Ring is Lower. Heat in all three indicates Wind-Evil invasion, nasal congestion, rough breathing, fever, cough. Cold in all three indicates External Wind-Cold and Internal Food Injury, fever, vomiting, diarrhea. Heat in Middle and Ring fingers indicates Upper Heat/Lower Cold. Heat in Ring and Middle fingers indicates夹杂 Fright disease. Heat in Index finger indicates Chest fullness and Food Stagnation. Further analyze pulse shape. Bead Shape (Liu Zhu): Indicates food injury, internal heat with desire to vomit, borborygmus, spontaneous diarrhea, restlessness, crying. Use Zhu Wei Gao to digest food and separate Yin/Yang. If food digests but illness persists, use Xiang Sha Zhu Wei Gao to tonify Spleen/Stomach. Ring Bead Shape (Huan Zhu): Indicates Spleen Deficiency with retained food, chest/diaphragm distension, irritability, thirst, fever. Use Wu Wei Yi Gong San plus Shan Zha and Zhi Shi to strengthen Spleen and digest food, followed by Liu Jun Zi Tang to regulate Middle Qi. Long Bead Shape (Chang Zhu): Indicates Spleen injury with food accumulation, abdominal pain, alternating cold/heat, anorexia. First use Da An Wan to eliminate accumulation, then Yi Gong San to strengthen Spleen Qi. Coming Snake Shape (Lai She): Indicates Spleen/Stomach Damp-Heat, epigastric discomfort, dry heaving, anorexia. This is Gan Evil acting internally. First use Si Wei Fei Er Wan to treat Gan, then Si Jun Zi Tang to tonify Spleen. Going Snake Shape (Qu She): Indicates Spleen Deficiency with food accumulation, vomiting/diarrhea, irritability/thirst, shortness of breath, rapid breathing, anorexia, sleepiness. First use Liu Jun Zi Tang plus Zhi Shi to strengthen Spleen and eliminate accumulation, then Qi Wei Bai Zhu San to regulate/tonify Stomach Qi. Bow Reversing Inside Shape (Gong Fan Li): Indicates Cold-Evil invasion, choking gas/exhalation, fright palpitations, lassitude, slight cold limbs, red urine, cough with salivation. First use Xing Xing San to assist Stomach Qi and dispel external evil, then Wu Wei Yi Gong San plus Fu Ling and Dang Gui to nourish Heart Blood and assist Stomach Qi. If external evil resolves but fright/cold fingers persist, Spleen Qi is injured; use Qi Wei Bai Zhu San to tonify. If confused, rough breathing, panting, and choking persist, it is hard to treat due to severe Spleen Deficiency. Bow Reversing Outside Shape (Gong Fan Wai): Indicates Phlegm-Heat with mental confusion,夹杂 Fright and Food, Wind-Epilepsy with abundant phlegm. First use Tian Ma Fang Feng Wan to dispel external evil, then Wu Wei Yi Gong San to regulate Middle Qi. Spear Shape (Qiang): Indicates Wind-Heat generating Phlegm and convulsions. First use Bao Long Wan. If ineffective, use Niu Huang Qing Xin Wan. If transmitting to Spleen/Lung or due to overuse of Wind-Phlegm drugs causing various symptoms, focus on tonifying Spleen/Stomach. Fish Bone Shape (Yu Gu): Indicates Fright-Phlegm fever. First use Bao Long Wan. If ineffective, indicates Liver Fire Excess-Heat; use little Yi Qing Wan to clear Liver, then Liu Wei Wan to tonify Liver. Or fever/anorexia, or abundant phlegm/convulsions, indicating Liver Wood overcoming Spleen Earth; use Liu Jun Zi Tang plus Chai Hu to tonify Spleen Earth to control Liver Wood. Water Character Shape (Shui Zi): Indicates Fright-Wind and Food Accumulation, chest/diaphragm irritability, sudden stuffiness, anorexia, or night crying with abundant phlegm, locked jaw, convulsions. This is Spleen/Stomach weakness, food accumulation, and Wood overcoming Earth. First use Da An Wan to guide out food, then Liu Jun Zi, Gou Teng Gou, and Bu Zhong to clear Liver. If food-clearing/phlegm-resolving agents fail, use Si Jun Zi, Sheng Ma, Chai Hu, Gou Teng Gou to raise/tonify Spleen Qi and level/control Liver Wood. Needle Shape (Zhen): Indicates Extreme Heat in Heart/Liver generating Wind, fright palpitations, sudden stuffiness, lassitude, anorexia, abundant phlegm/convulsions. First use Bao Long Wan to dispel Wind and resolve Phlegm, then Liu Jun Zi plus Gou Teng Gou to level Liver and solidify Spleen. Penetrating Passage Shooting Finger Shape (Tou Guan She Zhi): Indicates Fright-Wind Phlegm-Heat gathering in chest/diaphragm, Spleen/Lung deficiency, Phlegm Evil accumulating. First use Niu Huang Qing Xin Wan to clear Spleen/Lung and resolve phlegm, then Liu Jun Zi Tang plus Jie Geng and Shan Yao to tonify Spleen Earth and benefit Lung Metal. Penetrating Passage Shooting Nail Shape (Tou Guan She Jia): Indicates敗症 (Intractable Syndrome) of Fright-Wind where Liver Wood overcomes Spleen Earth. Urgently use Liu Jun Zi, Mu Xiang, Gou Teng Gou, Guan Gui to warm/tonify Spleen Earth. If ineffective, add Fu Zi to restore Yang Qi; many survive. I have heard ancients say: Children are like sprouts, like grass shoots, like water foam, because their Zang-Fu are fragile and tender, they cannot speak, making prescription difficult. One must first observe complexion to know the organ involved, then examine the Tiger Mouth to identify the cause. This is truly a concise method of treatment.

[Images: Tiger Mouth Three Passages Pulse Texture; Thirteen Finger Shapes]

Bead Shape: Only a dot of red. Ring Bead: Slightly larger. Long Bead: Round and long. These do not mean circles, but rather red pulses penetrating Qi in these shapes. Coming Snake is like Long Bead, scattered, one end big, one end sharp. Going Snake is similar, dividing upper/lower directions, hence "Coming/Going". Archaic Back Extension (Gong Fan Zhang), inward is compliant, outward is reversed. Spear Shape: Straight up. Fish Bone: Split apart. Water Character: Three pulses running parallel. Needle Shape: Passing the passage by 1-2 rice grains. Shooting Nail: Life pulse outward. Penetrating Finger: Life pulse curving inward. Although, I often treat without strictly adhering to these shapes/pulses for prescription. Basically, if there is this symptom, take this medicine, and it is often effective.