二三岁时看虎口更加中指按高骨浮即风生数主惊系是癞痫洪作热沉细腹痛缓沉虚泻痢多
由此
脉初微迟有积兼虫盛迟墙元来胃脘迂四岁脉不在指端一指高骨按虚实五六衮转寻三部平正关
上
为准则七八稍移指少许九十次第分位取十一十二也同看十四十五三指睹小儿有病脉不多先定
浮
沉迟数(音朔)数(音所)沉迟为阴浮数阳更看面部属何方青色惊风白虚泻赤生痰热黑难当黄是
脾家疳积作医人审度疗何方
凡看小儿初生至半 之间有病即与看额前眉上发际下以名中食三指轻手满曲按之儿头在
左举
右手在右举左手食指为上名指为下若三指俱热感受寒邪鼻塞气粗三指俱冷脏寒吐泻若食中热
上热下冷若名中指热夹惊之候若食指热胸堂不宽若名指热
议曰半 以上方可看虎口周 以上看虎口兼一指脉若五百七十四日变蒸满足只与看一指
脉以
食指衮转分取三部凡言三部者非寸关赤系小儿三部面看气色为一部虎口纹脉二部寸口一指脉
三部五脉者上按额前下诊大冲并前三部谓之五脉凡儿有患不属恶候即不可与诊大冲之脉其脉
定生死之要会也其症候危恶故当诊之不可看恐污人情伤于不任用矣
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未关命门 中关风候 初关气候
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流珠形主鬲热三焦不和气不调顺饮食欲吐或泻作热或肠鸣自利烦躁啼哭
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环珠形主气不和脾胃虚弱饮食伤滞心腹膨满作热夹食虚烦顿闷
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长珠形主夹积伤滞腹肚疼痛或有寒热胁肋膨紧食不克化或虫动不安
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来蛇形主中脘不和积气攻刺饮食不下疳气欲传脏腑不宁膨满干哕
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去蛇卷形主脾虚冷积泄泻或吐或渴烦躁气粗喘息饮食不化神困多睡
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弓反里形脉内感受寒邪头目昏重心神惊悸沉沉点点倦怠昏闲四肢稍冷咳嗽多痰(小便赤
色)
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弓反外形主痰热心神不宁睡卧不稳作热夹惊夹食风痫症候
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枪形主邪热痰盛生风神情恍惚睡下安稳欲发搐搦惊风传授
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鱼骨形主惊风痰热症候已定可以截风化痰利惊退热不作诸恶候若已传过必作它症
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水字形主惊积食积膈热烦躁心神迷闷夜啼三焦不顺痰延壅盛涎潮口噤潮加搐搦
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针形主心肺受热热极主风惊悸烦闷沉沉默默不食神困四肢垂 及惊风暴发(痰延壅盛搐
搦等候)
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透关射指面主惊风痰热四症皆聚停在胸膈不能散其候所受虽重症顺则可疗
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透关射甲主惊风恶候受惊传入经络风热发生并入八候虚痰不下危急恶症难可疗治
两到三岁时,观察虎口指纹更为重要。用中指按压高骨处,若指纹浮起,提示风邪内生;若脉象数(快速),主惊证,属于癫痫范畴;若洪大,主热证;若沉细,主腹痛;若缓而沉虚,主泄泻痢疾。
由此推断:
脉象初现微迟,是有积滞兼有虫盛的表现;脉迟且墙元(此处疑为衍文或特定术语,结合语境指胃脘部)原本胃脘迂曲(气机不畅)。四岁小儿的脉象不在指端,需用一指在高骨处按压以辨别虚实,在五六岁时要反复寻按三部脉,以平正关作为准则。七八岁时稍移动手指少许,九十个月时依次分位取脉。十一十二岁也同此法看诊。十四十五岁时可用三指诊察。小儿有病时脉象不多见,先定浮、沉、迟、数(音朔,意为急迫)、数(音所,意为频繁)等特征。沉迟属阴,浮数属阳。再观察面部颜色所属何方:青色主惊风,白色主虚泻,赤色主痰热,黑色难治,黄色是脾家疳积。医生需审慎度量,决定治疗方药。
凡是看诊,从婴儿初生至半岁之间,若有病即与看诊。方法是观察额前眉上发际下,用名指、食指、中指三指轻手满曲按之。若患儿头在左,则举右手;若在右,则举左手。食指为上,名指为下。若三指俱热,是感受寒邪,表现为鼻塞、气粗;三指俱冷,是脏寒,表现为吐泻;若食中热,则是上热下冷;若名指、中指热,是夹惊之候;若食指热,胸堂不宽;若名指热……
曾世荣议论说:半岁以上方可看虎口指纹。一周岁以上看虎口指纹兼看一指脉。若五百七十四日变蒸满足,只与看一指脉,用食指滚转分取三部。凡言“三部”者,并非寸、关、尺,而是指小儿三部:面看气色为一部,虎口纹脉二部,寸口一指脉三部。五脉者,上按额前,下诊大冲穴,并前三部,谓之五脉。凡是小儿患病,若不属恶候,则不可与大冲脉诊,其脉是定生死的关键所在。因其症候危恶,故当诊之,不可因恐污人情伤于不用而弃之。
流珠形:主膈热,三焦不和,气不调顺,饮食欲吐或泻,作热或肠鸣自利,烦躁啼哭。
环珠形:主气不和,脾胃虚弱,饮食伤滞,心腹膨满,作热夹食,虚烦顿闷。
长珠形:主夹积伤滞,腹肚疼痛,或有寒热,胁肋膨紧,食不克化,或虫动不安。
来蛇形:主中脘不和,积气攻刺,饮食不下,疳气欲传,脏腑不宁,膨满干哕。
去蛇卷形:主脾虚冷积泄泻,或吐或渴,烦躁气粗,喘息,饮食不化,神困多睡。
弓反里形:脉内感受寒邪,头目昏重,心神惊悸,沉沉点点,倦怠昏闲,四肢稍冷,咳嗽多痰(小便赤色)。
弓反外形:主痰热,心神不宁,睡卧不稳,作热夹惊夹食,风痫症候。
枪形:主邪热痰盛生风,神情恍惚,睡下安稳,欲发搐搦,惊风传授。
鱼骨形:主惊风痰热症候已定,可以截风化痰,利惊退热,不作诸恶候。若已传过,必作它症。
水字形:主惊积食积,膈热烦躁,心神迷闷,夜啼,三焦不顺,痰延壅盛,涎潮口噤,潮加搐搦。
针形:主心肺受热,热极主风,惊悸烦闷,沉沉默默,不食,神困,四肢垂软及惊风暴发(痰延壅盛,搐搦等候)。
At two or three years of age, observing the fingerprint on the tiger's mouth (the radial aspect of the thumb) is even more important. Pressing the high bone area with the middle finger: if the fingerprint floats, it indicates wind pathogen generation; if the pulse is rapid (Shu), it signifies fright syndrome, which relates to epilepsy; if it is surging (Hong), it indicates heat; if it is deep and thin (Chen Xi), it indicates abdominal pain; if it is slow, deep, and deficient (Huan Chen Xu), it indicates diarrhea and dysentery.
From this, we deduce:
If the pulse initially appears slightly delayed (Chi), it implies accumulation accompanied by abundant parasites; a delayed pulse at the "Qiang Yuan" (likely referring to the epigastric region) suggests original stomach obstruction. For four-year-old children, the pulse is not at the fingertip; one should press the high bone with one finger to distinguish deficiency and excess. At five or six years old, repeatedly search the three positions (San Bu), taking the level Guan position as the standard. At seven or eight years old, shift the fingers slightly; at ninety months, take the pulse by sequential positioning. The same method applies to eleven and twelve-year-olds. At fourteen and fifteen years old, use three fingers for observation. Pediatric pathological pulses are not numerous; first determine floating (Fu), deep (Chen), slow (Chi), and rapid (Shuo/Suo) characteristics. Deep and slow belong to Yin; floating and rapid belong to Yang. Further observe the facial color corresponding to the Five Elements: bluish-green indicates wind-fright; white indicates deficiency and diarrhea; red indicates phlegm-heat; black is difficult to treat; yellow indicates spleen-related malnutrition (Gan Ji). Physicians must carefully assess and decide on the treatment formula.
Generally, for diagnosis from infancy up to half a year of age, if there is illness, examine the area below the hairline between the forehead and eyebrows. Use the ring, index, and middle fingers to gently press with curved hands. If the child's head is to the left, raise the right hand; if to the right, raise the left hand. The index finger represents the upper position, and the ring finger represents the lower position. If all three fingers feel hot, it indicates cold pathogen invasion, manifesting as nasal congestion and coarse breathing; if all three are cold, it indicates internal cold, manifesting as vomiting and diarrhea; if the middle finger is hot, it indicates upper heat and lower cold; if the ring and middle fingers are hot, it is a sign of combined fright; if the index finger is hot, the chest feels tight; if the ring finger is hot...
Zeng Shirong commented: Only above half a year of age can the tiger's mouth fingerprint be examined. Above one year of age, examine both the tiger's mouth fingerprint and the single-finger pulse. If the child has completed the 574-day developmental cycles (Bian Zheng), only the single-finger pulse needs examination, using the index finger to roll and divide into three positions. When referring to "three positions," it does not mean Cun, Guan, Chi, but rather three pediatric diagnostic aspects: observing facial complexion is one part; the tiger's mouth fingerprint is the second part; the Cun position single-finger pulse is the third part. The "five pulses" refer to pressing the forehead above, diagnosing the Da Chong point below, plus the aforementioned three parts. For sick children, if the condition is not malignant, do not diagnose the Da Chong pulse, as its pulse is critical for determining life and death. Because the symptoms are critical and malignant, it must be diagnosed; one should not refuse due to fear of offending or causing harm.
[Image] Not reaching the Life Gate (Wei Guan): Middle section indicates Wind Syndrome, Initial section indicates Climate/Pathogen status.
[Image] Bead-like shape (Liu Zhu Xing): Indicates diaphragmatic heat, disharmony of the Triple Burner, qi stagnation, desire to vomit or have diarrhea after eating, fever, intestinal rumbling and spontaneous diarrhea, irritability, and crying.
[Image] Ring-bead shape (Huan Zhu Xing): Indicates qi disharmony, spleen and stomach weakness, food stagnation, abdominal distension, fever combined with food retention, empty irritability, and sudden oppression.
[Image] Long bead shape (Chang Zhu Xing): Indicates combined accumulation and stagnation, abdominal pain, possible chills and fever, tightness in the hypochondrium, indigestion, restless movement of parasites.
[Image] Incoming Snake shape (Lai She Xing): Indicates disharmony of the Middle Jiao (Epigastrium), attacking accumulated qi, inability to eat, transmission of Gan Qi (malnutrition qi), visceral unrest, abdominal distension, and dry heaving.
[Image] Outgoing Coiled Snake shape (Qu She Juan Xing): Indicates spleen deficiency with cold accumulation leading to diarrhea, vomiting or thirst, irritability, coarse breathing, panting, indigestion, mental fatigue, and excessive sleepiness.
[Image] Bow Reversing Inward shape (Gong Fan Li Xing): Cold pathogen invading internally, heavy dizziness, palpitations, lethargy, mental dullness, slight coldness in limbs, cough with profuse phlegm (red urine).
[Image] Bow Reversing Outward shape (Gong Wai Xing): Indicates phlegm-heat, mental restlessness, unstable sleep, fever combined with fright and food retention, wind-phlegm epilepsy syndromes.
[Image] Spear shape (Qiang Xing): Indicates evil heat and abundant phlegm generating wind, trance-like state, stability when lying down, impending convulsions, transmission of wind-fright.
[Image] Fish Bone shape (Yu Gu Xing): Indicates established wind-fright and phlegm-heat syndromes; wind can be stopped, phlegm resolved, fright calmed, and heat reduced without malignant complications. If the pathogen has transmitted further, other syndromes will arise.
[Image] Water Character shape (Shui Zi Xing): Indicates fright, accumulation, food stagnation, diaphragmatic heat, irritability, mental confusion, night crying, Triple Burner disharmony, overflowing phlegm, salivary flooding, locked jaw, and convulsions.
[Image] Needle shape (Zhen Xing): Indicates heart and lung heat, extreme heat generating wind, palpitations, irritability, lethargy, anorexia, mental fatigue, flaccid limbs, and sudden onset of wind-stroke (with overflowing phlegm and convulsions).
[Image] Penetrating Joint Shooting Finger Face (Tou Guan She Zhi Mian): Indicates the aggregation of four conditions—wind-fright, phlegm, and heat—in the chest and diaphragm, unable to disperse. Although severe, if compliant with treatment principles, it can be cured.
[Image] Penetrating Joint Shooting Nail (Tou Guan She Jia): Indicates malignant wind-fright, fright transmitted to meridians, occurrence of wind-heat, involvement of the Eight Signs (Ba Hou), deficiency with non-discharging phlegm, critical malignant syndrome, difficult to treat.