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[Qian Yi] In cases where the disease initially presents with deficiency or has already undergone purgation, even if there are indications for purgation, one must first tonify the mother organ and then purge the child organ. For example, in lung deficiency with phlegm excess, which is a condition suitable for purgation, one should first benefit the spleen before purging the lung. Xie Qing Wan (Drain the Liver Pill), also known as Xie Gan Wan (Purge the Liver Pill). Qian Yi stated that the liver has no method of tonification, hence there are no herbs specifically for tonifying the liver in his formulas. Wang Haizang added equal parts of Fangfeng (Saposhnikoviae Radix) and Qianghuo (Notopterygii Rhizoma et Radix) to Siwu Tang (Four Substances Decoction), ground them into fine powder, and formed pills with refined honey, naming it Bu Gan Wan (Tonify the Liver Pill). He further removed Zhizi (Gardeniae Fructus) and Dahuang (Rhei Radix et Rhizoma) from Xie Qing Wan, naming it Zhen Gan Wan (Calm the Liver Pill), used to treat liver deficiency. Dao Chi San (Direct the Red Powder) drains Bing Fire (Small Intestine Fire). Xie Xin Tang (Drain the Heart Decoction) drains Ding Fire (Heart Fire). An Shen Wan (Calming Spirit Pill) treats heart deficiency causing childhood malnutrition heat (Gan Re) and mental confusion. Wang Haizang's Ba Wu Ding Zhi Wan (Eight-Ingredient Calming Will Pill) is the correct medicine for tonifying the heart. Yi Huang San (Benefit Yellow Powder), also known as Bu Pi San (Tonify Spleen Powder), according to Wang Haizang: this formula tonifies the spleen by drying dampness. Li Dongyuan stated: it is the sacred medicine for treating stomach cold-dampness vomiting, abdominal pain, and clear watery diarrhea. Xie Huang San (Drain Yellow Powder), also known as Xie Pi San (Drain Spleen Powder), according to Wang Haizang: drains spleen heat. E'jiao San (Donkey-Hide Gelatin Powder), also known as Bu Fei San (Tonify Lung Powder), according to Wang Haizang: Xingren (Prunus Armeniacae Semen) is originally for draining the lung, unlike Renshen (Ginseng Radix), Tianmendong (Asparagi Radix), and Maimendong (Ophiopogonis Radix) which are tonifying. Xie Bai San (Drain White Powder), also known as Xie Fei San (Drain Lung Powder), according to Wang Haizang: treats lung heat causing bone-steaming tidal fever and spontaneous sweating, using this formula to directly drain it. Zhizi (Gardeniae Fructus) and Huangqin (Scutellariae Radix) can also drain the lung, but differentiation should be made based on Qi and Blood. Dihuang Wan (Rehmannia Pill) is the Bajun Wan (Eight-Ingredient Pill) from *Jinkui Yaolue* minus Rougui (Cinnamomi Cortex) and Fuzi (Aconiti Lateralis Radix Praeparata). According to Wang Haizang: it treats kidney deficiency causing jie lu (delayed closure of fontanelles), also known as ba disease, addressing pulse hairiness and deficiency. Qian Yi stated that the kidney has no method of purgation, hence there are no herbs specifically for purging the kidney. Wang Haizang's Xie Shen Wan (Drain Kidney Pill) treats a洪 (surging) and solid pulse, which is the previous Dihuang Wan with Shudihuang (Rehmanniae Radix Praeparata) changed to Shengdihuang (Rehmanniae Radix), and Shanzhuyu (Corni Fructus) removed; this treats the left hand root pulse. If the right chi pulse is surging and solid, use Fengsui Dan (Phoenix Following Pill) to drain it. (See General Discussion in Each Organ Section).

Ancient texts state "to know through observation is called divine," and pediatricians are called practitioners of the "mute department" because infants cannot speak. The infant's pulse is rapid and difficult to distinguish clearly under the fingers, making observation of facial color essential; thus, it is narrated first. Infants' faces necessarily display 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 refers to the luster of the eyes. It appears or hides, moves horizontally or vertically, manifests in corresponding positions, and corresponds to the five zang organs. The five colors are green, yellow, red, white, and black, representing the colors of the five zang organs: heart red, liver green, spleen yellow, lung white, kidney black. Diseases governed by the five zang organs accumulate internally and must manifest externally in form and color. Therefore, when an infant 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 Yi] 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 cunkou 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/black indicates pain. Treat according to the syndrome. *Yong Lei Qian Fang* states: Green indicates unsettled fright accumulation, predisposing to wind syndromes. Red/Cherry red indicates heat, excessive phlegm accumulation, worsening fright palpitations and irritability. Yellow also indicates heat, food accumulation injury, predisposing to gan syndromes or pi pi (masses). If mental spirit is dull, symptoms 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烦 (agitated), changes become adverse syndromes, Ying and Wei lose order, indicating critical danger. *Quan Ying Fang* states: Left cheek belongs to the liver, Eastern position. Slight green in spring is normal, deep green is disease, 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 resolving during the day, red dry lips, pulse tight and rapid. Right cheek belongs to the lung, Western position on the right. Slight white in autumn is normal, deep white is disease, 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 curling inward. Forehead belongs to the heart, Southern position. Fire nature flares upward, so it resides above. Slight red in summer is normal, deep red is disease, black is terminal. Red indicates wind-heat in the heart channel, heart irritability and fright palpitations, restless sleep, green-black indicates evil in the heart, convulsive wind abdominal pain, limb twitching and crying, severe green-black indicates heart/abdominal pain, yellow indicates fright gan bone heat and thirst, dry skin/hair, night sweats, scorched yellow hair. Nose belongs to the spleen, Central position residing in the middle. Slight yellow in all seasons is normal, deep yellow is disease, green is terminal. Red indicates body heat, loss of appetite for milk/food, deep yellow indicates urinary retention, dry nostrils, coarse breathing, epistaxis, frequent crying at night, pale white indicates diarrhea and undigested food, green indicates vomiting milk, dry mouth/nose, difficulty urinating/defecating. Chin belongs to the kidney, Northern position. Water nature moistens downward, so it resides below. Slight black in winter is normal, deep black is disease, yellow is terminal. Red indicates heat in the interior and exterior of the bladder and kidney, leading to urinary obstruction. *Yong Lei Qian Fang*: The liver section governs the pupils, which hide the spirit and investigate the five wheels externally. The eye socket belongs to the spleen; heat produces eye discharge. Both eyes belong to the heart; heat causes pain like needles. The sclera belongs to the lungs; heat/redness produces sand-like irritation. The iris/yellowish tint belongs to the liver; dimness and nebula. The center pupil belongs to the kidney; kidney heat causes unclear vision, blinking, darting eyes, wind and fright. The heart section governs the cheekbones and cheeks. Black indicates sinking/depression, green indicates fright palpitations, red indicates heart wind, white indicates gan qi, deficiency yellow with wei accumulation, edema and qi rebellion. Why does heart failure occur? Crying several times, if it stops after passing the pulse point without crying, it will make a crow-like sound; add heat for convulsions, dissipate heat to clear the heart. The spleen section governs the lips and mouth. Renzhong and Chengjiang, surrounding areas, closed mouth is spleen territory, open mouth is heart. Heart-spleen heat causes lip cracking and tongue ulcers. Sanjiao heat accumulation causes lips red as 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 irritable crying. How to know spleen failure? Nails turn black, eyes lack spiritual luster, definitely difficult to treat. Five types of mouth-twisting convulsive wind are even worse and incurable. The lung section governs the tip of the nose and nostrils, connected to Shan Gen (root of nose). The inner and outer canthi store lung qi. Nostrils black like coal indicate lung meridian scorching; if black like ink, lung meridian fails. Nostrils red and itchy indicate severe gan with long roundworms, or white nasal discharge. Brain cold causes drowsiness or clear runny nose. Wind-cold causes preference for sleep. Lung heat causes nasal congestion due to inhalation or wind-cold invasion, blocking passages. Rotting nose indicates gan, foul smell indicates heat accumulation. The kidney section governs the area before the ear hole, named Er Hua (Ear Flower). The ear child is named Lun (Wheel), inside is Kuo (Mouth). Scorched black contours indicate kidney deficiency heat; if black as charcoal, kidney fails and death comes at dawn. Sores on the ear gate indicate abnormal wei accumulation. Pus in the ear indicates extreme kidney heat gan, smelly ear, continuous pus, intense itching. Symptoms include deficiency heat, sudden deafness, heart-kidney qi stagnation, constant humming, heat attacking upward, or feeling like insects scraping. Ying deficiency and wei heat make the ear wheel cold (also check for red threads behind the ear). Chickenpox/measles invasion makes ear lobes red and hot, characteristic of typhoid, extreme heat causing internal pain, swelling and qi attacking. Clear heart and cool diaphragm, open/close orifices. Children's two kidneys are often empty without disease; do not attack vigorously, tonification is also of no benefit. [Zhang Yuansu] 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 involves convulsions and adds white face, phlegm saliva, and wheezing, these are all difficult to treat; deduce the rest similarly. Suppose before Spring Equinox, it is wind-cold; use Dihuang, Qianghuo, Fangfeng, or alternate Dihuang Wan and Xie Qing Wan. After Spring Equinox, it is wind-heat; use Qianghuo, Fangfeng, Huangqin, or drain with Xie Qing Wan and Dao Chi San. After Start of Summer, it is heat; use Sanhuang Wan and Dao Chi San. After Summer Solstice, it is damp-heat; use Dao Chi San and Xie Huang San together, or Huangqin, Renshen, Muxiang. After Autumn Equinox use Xie Bai San. After Start of Winter use Dihuang Wan, stating the kidney does not accept purgation. [Xue Ji] Green indicates unsettled fright accumulation predisposing to wind; red indicates phlegm accumulation and fright palpitations; yellow indicates food accumulation injury predisposing to gan/pi; white indicates diarrhea of water/grains predisposing to vomiting; black indicates visceral failure. Yintang (between eyebrows): Green indicates initial fright diarrhea; red indicates great fright and night crying; black indicates external malevolent qi. Shan Gen (nose root): Green indicates irritability after second fright diarrhea; severe black/yellow indicates death. Nian Shou (bridge of nose): Flat/sunken indicates premature death; green indicates fever generating fright; black indicates death from diarrhea; red indicates death from irritability; slight yellow is normal, severe yellow indicates cholera. Chengjiang (below lower lip): Green indicates fright during eating; yellow indicates vomiting/reversal, also bloody diarrhea; black indicates convulsive wind. Face/eye black sclera yellow indicates heat; white sclera yellow indicates food accumulation gan; white sclera green indicates convulsive wind; black sclera yellow indicates typhoid. Above eyebrows: Green is auspicious; sudden red indicates irritability and night crying; yellow indicates cholera; chronic red indicates death. Fengqi Two Pools: Green indicates wind syndrome; 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 indicates death; red indicates bloody strangury. Both cheeks (upper): Green indicates external malevolent qi; yellow indicates phlegm overflow; red indicates wind-heat. Both cheeks (lower): Red indicates typhoid. Both jaw angles: Green indicates vomiting worms. Two Jing Kui: Green indicates third convulsive wind. Black around mouth for two days indicates death. Green connecting eye to ear for seven days indicates death. Two Fengmen: Red indicates wind-heat; black indicates hernia; green indicates water fright. Black from eyebrow to ear indicates death on the same day; black lips unable to eat indicates death. Green face and green eyes indicate liver disease. Red face indicates heart disease. White face indicates lung disease. Yellow face indicates spleen disease. Black face indicates kidney disease. Forehead: Red indicates heart channel heat, irritability, and fright palpitations. If drinking water or crying, it belongs to excess heat of the original channel; use Xie Xin San to clear heart fire. Slight red with drowsiness and fright palpitations, thirst for hot drinks indicates deficiency heat; use Mizhi Anshen Wan to generate heart blood. Green-black indicates convulsive wind abdominal pain or twitching/crying; use Wuyi Yigong San plus Muxiang, Chaihu, Gouteng Hook to tonify spleen and liver. Green-black indicates heart/abdominal pain caused by cold water invading the heart; use Yi Huang San. Slight yellow indicates fright gan; use Anshen Wan. Left cheek: Green or mixed red indicates liver channel wind-heat, stiff neck, dizziness, eye twitching; use Chaihu Qinggan San. Slight red with sudden fever and grinding teeth indicates deficiency heat; use Dihuang Wan. Green-black indicates liver restricting spleen causing convulsions and abdominal pain; use Liu Junzi plus Jiang (Ginger) and Gui (Cinnamon). 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, cough, fever with drinking water indicating excess heat; use Xie Bai San. If gas choking, shortness of breath, white lips indicate deficiency heat; use Wuyi Yigong San. If transmitted from spleen heat, use Qingwei San. If punished by heart fire, use Renshen Pingfei San. Pale red indicates tidal fever, heart irritability, or hard constipation; use *Xuanming* Chaihu Yinzi to guide out; if tidal fever persists, use Gouteng Yin to clear liver. Green-white indicates cough and nausea; first use Xingxing San to release exterior pathogen and strengthen spleen earth, then Liujunzi Tang to regulate middle qi. Green-black indicates convulsive wind abdominal pain, intestines curling inward; use Liujunzi and 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 Xie Huang San to clear heat and regulate spleen. Slight red indicates spleen channel deficiency heat, cool body, desire for hot drinks, poor appetite; use Wuyi Yigong San to tonify middle and strengthen spleen. Deep yellow indicates urinary retention, dry nose, coarse breathing, epistaxis, spleen heat transmitting to lung/kidney; first use *Jisheng* Xijiao Dihuang Tang, then Dihuang Wan. Pale white indicates spleen deficiency diarrhea, undigested food; use Liujunzi Tang to regulate middle qi. Green indicates spleen earth deficiency cold, overcome by liver wood; use Wuyi Yigong San plus Muxiang, Paojiang (Baked Ginger) to warm middle and calm liver. Black is a death sign. Chin: Red indicates qi stagnation and heat binding in kidney/bladder, urinary retention; use Wuling San to separate and drain. Tip of nose slight yellow combined with slight red on right cheek indicates spleen/lung dry-heat unable to generate kidney water; use Huangqin Qingfei Yin. Bladder yin deficiency with no yang to generate; use Zishen Wan. If chin slight red indicates bladder yang deficiency with no yin to transform; use Liuwei Dihuang Wan. If lower abdomen fullness or scrotal swelling indicates yin deficiency with damp-heat stagnation; use Liuwei Wan plus Cheqian, Niuxi. Spleen/lung qi deficiency unable to regulate water passages also uses the previous medicines. Red urine persisting to hematuria also indicates liver/kidney qi deficiency with heat; use Liuwei Dihuang Wan. If ineffective, use Buzhong Yiqi Tang to benefit spleen/lung and generate liver/kidney. If white fluid exits after urination or pain in the penis indicates liver channel damp-heat; first use Longdan Xiegan Tang, then Liuwei Dihuang Wan. Yintang: Green-black indicates abdominal pain and night crying due to spleen qi deficiency cold. Spleen is supreme yin, hence abdominal pain and crying at night; use Gouteng Yin. Pale white indicates diarrhea and undigested milk/food due to spleen qi weakness; use Wuyi Yigong San plus Muxiang. Renzhong: Yellow indicates milk injury and stomach reversal. Green indicates diarrhea of 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, vomiting/reversal, or hematemesis/melena due to spleen qi deficiency unable to control saliva and blood; urgently use Liujunzi Tang. Red, dry, wrinkled indicates spleen channel heat/thirst, constipation, irritability, insomnia; first use Qingwei San to treat heat, then Sijunzi, Huanglian, Zhizi to regulate spleen. Yellow indicates food accumulation diarrhea, undigested food; use Liujunzi Tang to strengthen spleen. Red mixed with white indicates epistaxis due to spleen/lung deficiency heat unable to control blood; use *Shengji* Xijiao Dihuang Tang to clear heat and nourish blood, use Sijunzi Tang to tonify spleen qi. If ineffective long-term, use Maimendong San or Renshen Anwei San. Corner of mouth: Yellow indicates spleen channel heat accumulation; use Qingwei San. Chronic disease use Siwei Fei'er Wan to treat gan heat. Lip/mouth twitching indicates fright heat unrest; use Yigong San plus Zhizi, Gouteng Hook to tonify spleen and calm liver. Saliva flow with purple lips indicates spleen qi deficiency cold; use Yigong San plus Paojiang, Muxiang. Abdominal pain with saliva spitting indicates worm pain; first use Wuyi San, then Tiaozhong Wan. No saliva spitting indicates accumulation pain; use Yigong San. Cold limbs use Lizhong Tang plus Wumei to warm and tonify middle qi, pain stops spontaneously. Pain stopping 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 incurable. Behind ear slight red indicates Shaoyang channel wind-heat; use Chaihu Yinzi to clear liver and generate blood. Slight yellow indicates fright palpitations and teeth grinding during sleep; use Sijunzi plus Xiong (Chuanxiong), Gui (Danggui), Shengma to regulate spleen qi. Dry ears indicate bone gan steaming heat, thirst, night sweats; use Dihuang Wan. If white fluid exits after urination or glans itching/pain indicates liver channel damp-heat; first use Longdan Xiegan Tang, then Liuwei Dihuang Wan. If innate kidney qi is insufficient, or early sexual activity causes dysuria or painful urination like strangury, urgently use Dihuang Wan and Buzhong Yiqi Tang to nourish the source of transformation. If pain pulls after urination/defecation, deficiency is even greater; use previous pill plus Niuxi, Cheqian, Rougui. If cold limbs or aversion to cold/poor appetite indicates yang qi deficiency cold; urgently add Fuzi, likely to survive. Generally, this is mostly due to innate uneven viscera qi, or irregular milk/food in cold/heat, or pregnancy, nursing mother, diet, daily life, six excesses, and seven emotions. If initial disease yuan qi is not depleted, milk/food normal, fever/high fever, constipation of both bowels, thirst for drinking water, sleeping with eyes not fully exposed, all belong to form and disease both excess; treat the pathogenic qi. If disease is long-term and yuan qi is depleted, poor appetite, fever, dry mouth desiring hot drinks, vomiting/diarrhea, limb aversion to cold with eyes exposed, all belong to form and disease both deficiency; tonify the righteous qi. Furthermore, examine the excess/deficiency of fetal qi and the overcoming relationship of viscera to treat accordingly, thus avoiding errors.

[Qian Yi] Signs within the eyes: Red indicates heart heat; treat with Dao Chi San. Pale red indicates heart deficiency heat; treat with Shengxi San. Green indicates liver heat; treat with Xie Qing Wan. Pale/light indicates deficiency; tonify it. Yellow indicates spleen heat; treat with Xie Huang San. Lack of luster indicates kidney deficiency; treat with Dihuang Wan. If face and eyes are swollen, it indicates chronic cough due to spleen affected by gan accumulation.

If an infant's lips are white, it indicates spitting saliva, vomiting/reversal, hematemesis, or melena. Red lips indicate thirst, drinking, irritability; if lips are red after prolonged thirst and diarrhea, it is a deficiency syndrome; do not use cooling medicines. Yellow lips indicate spleen swelling after accumulation. Purple lips/mouth with spitting saliva indicate worm pain. No spitting saliva indicates accumulation pain. Lips yellow like orange around the edges indicate bad breath due to spleen heat accumulation. Green lips indicate blood deficiency and spleen cold, attacked by cold. Since lips govern spleen earth, wood overcoming earth indicates spleen weakness and inability to eat.

Dry tongue, white tongue, rough tongue, coated tongue, yellow tongue, red/swollen tongue in infants all indicate constipation, or if loose, the color must be scorched yellow. Tongue cracks, prickles on tongue, bleeding from tongue all indicate extreme heat and yang toxin. Sores on the tongue indicate heart-spleen heat. Rolled tongue indicates fright. Chronic diarrhea with black tongue must be moist; do not consider it heat, as chronic disease causes upper jiao deficiency heat. Chronic dysentery with black tongue indicates death.