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(From *Suwen: Treatise on the Evaluation of Excess and Deficiency*, Appendix: Differentiation of Infants' Pulse)

The Yellow Emperor asked: If an infant suffers from fever, what is the prognosis if the pulse is suspended and small? (Note: "Ruzi" refers to an infant. A febrile disease presenting with a suspended and small pulse constitutes a Yang syndrome manifesting as a Yin pulse, which is fundamentally a major contraindication. However, if the pulse is small yet moderate/slow, it indicates that the pathogenic factor is mild, and recovery will be easy; if the pulse is small yet rapid/tense, it indicates that the pathogenic factor is severe, which is a matter for concern.)

Qibo replied: Survival is indicated if the hands and feet are warm; death is indicated if they are cold. (Note: This generally discusses the internal and external signs in children. Children possess a body of tender Yang, and when complicated by febrile disease, the pulse should not be small. If the pulse is small but the hands and feet are warm, since the four limbs are the root of all Yang meridians, Yang Qi remains present, thus indicating survival; if the four limbs are cold, it means the pathogen has overcome the healthy Qi, and the Primordial Yang has departed, thus indicating death. The *Treatise on the Evaluation of Excess and Deficiency* states: What is referred to as a favorable course is warmth of the hands and feet. What is referred to as an unfavorable course is coldness of the hands and feet.)

The Yellow Emperor asked: When an infant contracts wind-heat and exhibits wheezing with whistling sounds and shoulder breathing, what does the pulse look like?

Qibo replied: In cases of wheezing with whistling sounds and shoulder breathing, the pulse should be full and large. If it is large and moderate/slow, there is survival; if it is full and rapid/tense, there is death. (Note: This discusses exogenous pathogens in children. Wind-heat invading the Yang aspect causes wheezing with whistling sounds and shoulder breathing; the pulse should be full and large. However, if the pulse is large and moderate/slow, it indicates that Stomach Qi is preserved and the pathogen is gradually receding, thus indicating survival; if the pulse is full and rapid/tense, it indicates the manifestation of the Zang organs' true pulse [True Organ Pulse], and the disease progresses daily, thus indicating death. My commentary notes: From the meaning of these two sections, it can be seen that ancient physicians diagnosing children always emphasized pulse diagnosis. Even immediately after birth, there is a pulse available for differentiation. Why do later pediatric texts such as *Shuijing Jue* and *Quanyou Xinjian* propose another method of observing the "Three Passages," while completely ignoring pulse diagnosis? Those Three Passages are merely superficial collaterals of the Yangming Meridian and originally cannot reflect the Qi of the Zang and Fu organs. Moreover, in all infants, whether sick or healthy, the color at this site is a mixture of purple, white, cyan, and red. Although there may be variations in intensity, these four colors are always present together. How can one distinguish purple as wind, red as cold, cyan as fright, and white as malnutrition? Furthermore, how can one accurately distinguish between thunder fright, human fright, water fright, and beast fright? Even I myself used this method in my early years, but it only allowed for speculative guessing of ambiguous symptoms, ultimately leaving me bewildered. Modern physicians have made this habit their norm, completely neglecting pulse diagnosis. How can they hope to rescue critical patients under such circumstances? Upon reviewing the *Neijing*, there is no mention of the "Three Passages." Only the *Meridians Chapter* mentions observing the color of the fish of the hand [thenar eminence], which seems somewhat close; however, that is a general discussion of diagnostic methods, not specific to children. The detailed principles are found in Section 6 of the Meridians Category. Therefore, the theory of the "Three Passages" is merely a heterodox view of later generations and is not reliable. Thus, any physician wishing to diagnose children must certainly examine the pulse at the Qikou point [Radial Artery], the color of the face, the sound of respiration, or alternatively observe the color of the fish of the hand. Furthermore, the pulse of infants is not as complex as that of adults; it need not be overly diversified. One need only analyze the six aspects of size, moderation/rapidity, tension/slackness, deficiency, and excess to fully grasp the pulse pattern. Once the true pulse is diagnosed, treatment effects are achieved as easily as turning over one's hand—clear, simple, and effective. Is this not vastly superior to those other methods? Those who wish to achieve practical results in this field should quickly determine the correct direction to follow.)