仲阳云∶小儿脉法∶脉乱不治。气不和,弦急。伤食,沉缓虚。惊促急。风浮,冷沉细。水镜诀∶夫以阴阳运命,
男女成形,已分九窍四肢,乃生五脏六腑,位分三部,逆顺难明,若凭寸口之浮沉,必乃横亡于孩子,须明虎口,辨别
三关,消详用药,必无差误。未至三步,看男左女右,虎口第二指根,第一节名初关,一名风关,若脉见初交病;第二
节为中关,又名气关,脉见病深重;第三节为末关,又名命关,脉见死不治。三关青,是四足惊;三关赤是水惊;三
关黑是人惊;紫色泻利,黄色雷惊;三关有通度脉,是极惊之证,必死;余病可治。或青或红,有纹如线一直者,是乳
食伤脾,及发惊热;左右一样者,是惊与积齐发。有三条或散,是肺生风痰,或似 之声。有赤是伤寒及嗽,如红火
是泻,有黑相兼主下痢,红多白痢,黑多赤痢。有紫相兼,加渴不虚。虎口脉纹乱,乃气不和也,青惊积,青黑发慢惊。
脉入掌乃内吊。指纹曲里,风盛;弯外,食积上蒸。此论三岁以上脉法。小儿一岁至二岁,看虎口,更用指按高骨,乃
一指分三关,定其息数呼吸,八至为平脉,九至不安,十至危困。短长大小,各有邪干∶浮主风生,数主有惊;沉迟主
虚冷;实主有热;紧是癫痫;洪主热盛;沉细主腹痛;沉缓主虚泻;微迟有积有虫;迟涩主胃脘不和;沉主乳化难;沉
细主乳食结;紧弦主腹热痛;牢实主大便秘;沉而数者骨中有热;弦长是鬲肝有风;紧数惊风,四肢掣战;浮洪胃口有
热;沉紧主腹痛不歇;虚濡有气,又兼慢惊;芤多痢,大便有血。四岁用一指按虚实;五岁六岁用一指滚转,寻三
部平正,关上为准;七岁八岁,稍移指少许,寻三部;九岁十岁次第根据三关部位寻取;十一十二岁亦同十岁看;十四步、
十五岁,方根据大方脉部位诊视。凡看脉,先定浮、沉、迟、数,阴、阳、冷、热,皆根据大方也,沉迟为阴,浮数为阳。
更兼看面部,青色主惊风,白色主虚泻,赤色主痰热,黑色病势难当,黄色是脾家疳积。以此相参,察其病源,审度治
疗,必无疏失矣。
鲁仲阳说:小儿的脉法要点是:脉象紊乱者难以治愈。气机不和,脉象弦而急。伤食,脉象沉、缓且虚。受惊,脉象急促而快。风邪侵袭,脉浮;寒邪侵袭,脉沉细。
《水镜诀》说:依靠阴阳来运行命运,男女形成形体,九窍四肢已分,从而产生五脏六腑。脉诊部位分为三部,逆顺难以辨明,如果仅凭寸口脉的浮沉来判断,必然会导致孩子的横死。必须明确观察虎口(食指桡侧),辨别三关(风关、气关、命关),仔细斟酌用药,才不会有差错。
未满三岁的小儿,看男左女右的虎口第二指根处。第一节名为初关,又名风关,若脉纹见于此处,表示病轻;第二节为中关,又名气关,脉纹见于此处,表示病深重;第三节为末关,又名命关,脉纹见于此处,表示病情危重不治。
三关颜色青,是四足惊风(由惊吓引起的抽搐);三关颜色赤,是水惊风;三关颜色黑,是人惊风;紫色主泻利;黄色主雷惊风(一种严重的惊风证候);三关有贯通的脉纹,是极度惊风的证候,必死无疑;其他病症可以治疗。
或者青色或者红色,有一条直线如线的脉纹,是乳食损伤脾胃,以及发生惊热;左右手一样的,是惊风与积滞同时发作。有三条脉纹或散乱的,是肺生风痰,或者发出类似“呷嗽”的声音。有赤色是伤寒及咳嗽,如火红色是腹泻,有黑色相兼主下痢,红多白痢,黑多赤痢。有紫色相兼,伴有口渴但不虚弱。虎口脉纹乱,是气机不和的表现,青色主惊积,青黑色主慢惊风。脉纹入掌乃内吊(一种痉挛性疾病)。指纹弯曲向里,风盛;弯曲向外,食积上蒸。
这是论述三岁以上儿童的脉法。小儿一岁至二岁,看虎口,更用指按压高骨(桡骨茎突处),这是一指分三关的方法,测定其呼吸次数,八至为平脉,九至不安,十至危困。
短长大小,各有邪气干扰:浮脉主风生,数脉主有惊;沉迟主虚冷;实脉主有热;紧脉是癫痫;洪脉主热盛;沉细主腹痛;沉缓主虚泻;微迟主有积有虫;迟涩主胃脘不和;沉脉主乳化困难;沉细主乳食结聚;紧弦主腹热痛;牢实主大便秘结;沉而数者骨中有热;弦长是膈肝有风;紧数主惊风,四肢掣动颤抖;浮洪胃口有热;沉紧主腹痛不止;虚濡有气,又兼慢惊;芤脉多痢,大便有血。
四岁用一指按虚实;五岁六岁用一指滚转,寻找三部平正,以关上为准;七岁八岁,稍移指少许,寻找三部;九岁十岁次第根据三关部位寻取;十一十二岁也同十岁一样看;十四步、十五岁,才根据大方脉(成人脉法)的部位诊视。
凡看脉,先定浮、沉、迟、数,阴、阳、冷、热,都依据大方脉的标准,沉迟为阴,浮数为阳。更要兼看面部,青色主惊风,白色主虚泻,赤色主痰热,黑色病势难当,黄色是脾家疳积。以此相互参照,察其病源,审度治疗,必定没有疏漏失误了。
Lu Zhongyang stated: The principles of pediatric pulse diagnosis are as follows: A chaotic pulse indicates a difficult-to-treat condition. Disharmony of Qi presents with a wiry and rapid pulse. Food stagnation presents with a deep, slow, and deficient pulse. Shock or fright presents with an hurried and rapid pulse. Wind pathogen invasion presents with a floating pulse; Cold pathogen invasion presents with a deep and fine pulse.
The *Shuijing Jue* (Water Mirror Manual) states: Relying on Yin and Yang to govern destiny, male and female form their bodies, nine orifices and four limbs are divided, thereby generating the five zang organs and six fu organs. Pulse diagnosis sites are divided into three positions; determining favorable or unfavorable outcomes is difficult. If one relies solely on the floating or sinking nature of the cunkou (radial artery at the wrist) pulse, it will inevitably lead to the premature death of the child. One must clearly observe the tiger's mouth (the radial side of the infant's index finger) and distinguish the three gates (Feng Guan, Qi Guan, Ming Guan), carefully deliberating medication to avoid errors.
For children under three years old, examine the left hand for boys and the right hand for girls at the base of the second finger of the tiger's mouth. The first segment is named the Initial Gate, also known as the Wind Gate; if the vein pattern appears here, the illness is mild. The second segment is the Middle Gate, also known as the Qi Gate; if the vein pattern appears here, the illness is deep and severe. The third segment is the Terminal Gate, also known as the Life Gate; if the vein pattern appears here, the condition is critical and untreatable.
If all three gates appear green, it indicates convulsions caused by fright (Si Zu Jing); if red, it indicates water-related fright; if black, it indicates human-related fright; purple indicates diarrhea and dysentery; yellow indicates thunder fright (a severe type of convulsion). If the veins across the three gates are continuous, it signifies extreme fright syndrome, which is fatal; other diseases are treatable.
If the color is either green or red, with a single straight line like a thread, it indicates spleen damage from milk and food stagnation, along with the onset of fright-heat. If both hands show the same pattern, it indicates simultaneous occurrence of fright and accumulation. Three lines or scattered patterns indicate wind-phlegm generated in the lungs, or sounds resembling "xia sou" (coughing with phlegm). Redness indicates cold damage and cough; fire-red indicates diarrhea; black mixed with red indicates dysentery, where more red implies white dysentery and more black implies bloody dysentery. Purple mixed with other colors, accompanied by thirst but without deficiency, suggests specific internal imbalances. Chaotic tiger's mouth vein patterns indicate Qi disharmony; green indicates fright and accumulation; green-black indicates slow convulsions. Veins entering the palm indicate nei diao (a spasmodic disease). Curved veins bending inward indicate excess wind; bending outward indicates steaming upward from food accumulation.
This discusses pulse diagnosis for children over three years old. For infants aged one to two years, examine the tiger's mouth and additionally press the high bone (radial styloid process) with one finger, dividing the gate into three parts, to count breaths. Eight pulses per breath is a normal pulse; nine indicates unease; ten indicates critical danger.
Variations in length, size, and depth each indicate different pathogenic influences: Floating indicates wind generation; Rapid indicates fright; Deep and Slow indicates deficiency-cold; Excess indicates heat; Tight indicates epilepsy; Surging indicates excessive heat; Deep and Fine indicates abdominal pain; Deep and Slow indicates deficiency-diarrhea; Micro and Slow indicates accumulation and parasites; Delayed and Choppy indicates stomach epigastrium disharmony; Deep indicates difficulty in nursing; Deep and Fine indicates milk/food stagnation; Tight and Wiry indicates abdominal heat-pain; Firm and Solid indicates constipation; Deep and Rapid indicates heat within the bones; Wiry and Long indicates wind in the diaphragm and liver; Tight and Rapid indicates convulsions with limb twitching; Floating and Surging indicates heat in the stomach opening; Deep and Tight indicates unceasing abdominal pain; Deficient and Soggy indicates Qi issues combined with slow convulsions; Hollow indicates dysentery with blood in stool.
At four years old, use one finger to assess excess and deficiency; at five and six years old, roll one finger to locate the three positions correctly, using the Guan position as the standard; at seven and eight years old, shift the finger slightly to locate the three positions; at nine and ten years old, sequentially search according to the three-gate locations; eleven and twelve years old are examined similarly to ten years old; only at fourteen or fifteen years old should the adult pulse diagnosis sites be used.
In general pulse diagnosis, first determine floating, deep, slow, and rapid, as well as Yin, Yang, cold, and heat, following adult standards: Deep and Slow are Yin; Floating and Rapid are Yang. Additionally, observe the face: Green indicates convulsions; White indicates deficiency-diarrhea; Red indicates phlegm-heat; Black indicates a severe and difficult-to-handle disease state; Yellow indicates spleen-related gan accumulation (malnutrition syndrome). By correlating these signs, investigating the source of the disease, and planning treatment accordingly, no omissions or errors will occur.