脉经曰小儿四五岁脉呼吸八至细数者吉 小儿脉呼吸八至者平九至者伤十至者困 诊小
儿脉
法多雀关要以三部脉为主若紧为风痫沉者乳不消弦急者客忤气 小儿是其日数应变蒸之时身
热而脉乱汗不出不欲食食辄吐 者脉乱无苦也小儿脉沉而数者骨间有热欲以腹按冷清也 小
儿大便赤青瓣飧泄脉小手足寒难已脉小手足温易已 小儿病困汗出如珠着身不流者死 小儿
病其头毛皆上逆者必死耳间青脉起者 痛 小儿病而腮限其口唇干目皮反口中气出冷手足四
垂其卧如缚掌中冷皆死不治
脉诀启蒙曰凡诊小儿脉当大指按三部一息六七至为平和八九至为发热五至为内寒弦脉为
风痫
沉缓为伤食促急为虚惊弦急为气不和沉细为冷浮为风大小不调为鬼祟浮大数为风热伏结
为物聚单细为疳痨风肠痛多喘呕而脉洪为有虫浮而迟潮热者胃寒也
按此本钱氏脉法也颇详
虎口脉歌曰紫风红伤寒青惊白色疳黑时因中恶黄即困脾端
按全婴等书云小儿三岁以前虎口第二指上寅卯关有脉纹见者可验病状男左女右视之脉纹
从寅
关起不至卯关者病易治若连于卯关者有病难治如寅连卯卯侵过辰关者十难救一若脉纹小或短
者病易治也宜参视之
钱氏曰面上证左腮为肝右腮为肺额上为心鼻为脾颏为肾赤者热也随证治之 目内证赤者
心热
导赤散主之淡红者心虚热生犀散主之青者肝热泻青丸主之浅淡者补之黄者脾热泻黄散主之无
精光者肾虚地黄丸主之洁古曰青是腹痛桂芍药洁古曰肝病面白 肺病面赤 脾病面青 肾病
面黄
心病面黑若肝病惊搐而又加面白痰涎喘急之类此皆难治余皆仿此推之叔和云春得秋脉定知
死亦此意也
按钱氏云者本病也洁古则兼胜已制化言之故后五脏形证不容不辩也
《脉经》说:小儿四五岁时,脉搏在一呼一吸间跳动八次,且脉象细数,这是吉兆。小儿脉搏一呼一吸间跳动八次是平和之象,九次为受伤,十次为困顿。
诊察小儿脉法,大多以雀口脉(虎口脉)为主,关键在于三部脉(寸、关、尺)的表现。如果脉紧,主风痫;脉沉,主乳食不消;脉弦急,主客忤气。小儿处于应变蒸的时期,身体发热而脉象紊乱,不出汗,不想吃东西,吃了就吐,这是脉乱,无大碍。小儿脉象沉而数的,说明骨间有热,可以用腹部按压来感知冷热。小儿大便颜色赤青相间,呈瓣状,属于飧泄(完谷不化的腹泻),如果脉小且手足寒冷,则难治;如果脉小但手足温暖,则易治。小儿病重,出汗如珠,附着在身上且不流动,这是死证。小儿患病,头毛全部向上逆立,必死无疑;耳间出现青色脉络,主疼痛。小儿患病,腮部肿胀,口唇干燥,眼睑闭合,口中呼出冷气,四肢下垂,手掌心冷,这些都是死证,无法治疗。
《脉诀启蒙》说:凡是诊察小儿脉象,应当用大拇指按诊三部脉,一息跳动六七次为平和,八九次为发热,五次为内寒。弦脉主风痫;沉缓主伤食;促急主虚惊;弦急主气机不和;沉细主冷证;浮脉主风邪;脉大小不调主鬼祟(怪病);浮大数主风热;伏结主物聚(积聚);单细主疳痨;风肠痛多伴有喘呕,若脉洪大则有虫;浮而迟,潮热,是胃寒。
按语:这是钱乙(钱氏)的脉法,颇为详细。
《虎口脉歌》说:紫纹主风,红纹主伤寒,青纹主惊,白纹主疳,黑纹主中恶,黄纹主脾困。
按语:全婴等书记载,小儿三岁以前,在虎口第二指上的寅、卯关处有脉纹显现,可以验证病情。男看左手,女看右手。观察脉纹,从寅关起,不到卯关的,病易治;如果连及卯关的,有病难治;如果寅连卯,卯侵过辰关的,十难救一。如果脉纹细小或短的,病易治。应当参合视诊。
钱乙说:面部的证候,左腮属肝,右腮属肺,额上属心,鼻属脾,颏下属肾。色赤为热,应随证治疗。目内眦赤,是心热,用导赤散主治;淡红色,是心虚热,用生犀散主治;青色,是肝热,用泻青丸主治;浅淡色,应补益;黄色,是脾热,用泻黄散主治;眼神无精光,是肾虚,用地黄丸主治。张元素(洁古)说:青色主腹痛,可用桂枝、芍药。张元素还说:肝病面色白,肺病面色赤,脾病面色青,肾病面色黄,心病面色黑。如果肝病出现惊搐,又加上面白、痰涎、喘急等症状,这些都难治。其余情况都仿照此理推演。王叔和说:春季见到秋季的脉象,定知死亡,也是这个意思。
The *Mai Jing* (Pulse Classic) states: For children aged four or five, if the pulse beats eight times per respiration and is fine and rapid (Xi Shu), it is auspicious. If the pulse beats eight times per respiration, it indicates a healthy state; nine times indicates injury; ten times indicates exhaustion.
When diagnosing pediatric pulses, the method mostly relies on the Tiger Gate pulse (Hu Kou Mai, pulse at the base of the thumb), focusing primarily on the three positions (Cun, Guan, Chi). A tight pulse indicates wind epilepsy (Feng Xian); a deep pulse indicates undigested milk; a wiry and urgent pulse indicates external shock qi (Ke Wu Qi). During the period of physiological transformation (Ying Zheng), a child may have fever with chaotic pulse, no sweating, anorexia, and vomiting after eating. This chaotic pulse is not harmful. If the pediatric pulse is deep and rapid, there is heat in the bones; this can be assessed by pressing the abdomen to feel coldness or warmth. If a child has loose stools with red and green fragments (Sun Xie), a small pulse, and cold hands and feet, the condition is difficult to cure; if the pulse is small but the hands and feet are warm, it is easy to cure. If a critically ill child sweats like pearls that adhere to the body without flowing, it is a death sign. If a sick child's head hair stands upward, death is certain; bluish vessels appearing behind the ears indicate pain. If a sick child has swollen cheeks, dry lips, closed eyelids, cold breath from the mouth, flaccid limbs, and cold palms, these are all death signs and incurable.
The *Mai Jue Qi Meng* (Enlightenment of Pulse Secrets) states: When diagnosing pediatric pulses, use the thumb to palpate the three positions. Six to seven beats per respiration indicate peace; eight to nine beats indicate fever; five beats indicate internal cold. A wiry pulse indicates wind epilepsy; deep and slow indicates food retention; hurried and urgent indicates deficiency fright; wiry and urgent indicates disharmony of qi; deep and fine indicates cold; floating indicates wind; irregular size indicates strange ailments (Gui Sui); floating, large, and rapid indicates wind-heat; hidden and knotted indicates accumulation; thin and single indicates malnutrition consumption (Gan Lao); intestinal wind pain often accompanied by wheezing and vomiting, if the pulse is surging, indicates parasites; floating and slow with tidal fever indicates stomach cold.
Note: This is the pulse method of Qian Yi (Qian Shi), which is quite detailed.
The "Tiger Gate Pulse Song" states: Purple indicates wind; red indicates cold damage; green indicates fright; white indicates malnutrition; black indicates malignant evil; yellow indicates spleen distress.
Note: According to texts such as *Quan Ying*, for children under three years old, pulse lines visible on the Yin and Mao gates of the second finger of the Tiger Gate can verify symptoms. Observe males on the left hand and females on the right. If the pulse line starts from the Yin gate and does not reach the Mao gate, the disease is easy to treat. If it connects to the Mao gate, the disease is difficult to treat. If Yin connects to Mao, and Mao invades past the Chen gate, one in ten cannot be saved. If the pulse line is small or short, the disease is easy to treat. These should be consulted together.
Qian Yi stated: Facial signs correspond to organs: the left cheek corresponds to the Liver, the right cheek to the Lung, the forehead to the Heart, the nose to the Spleen, and the chin to the Kidney. Redness indicates heat, to be treated according to the syndrome. Redness in the inner canthus indicates Heart heat, treated with Dao Chi San (Decoction for Guiding Out Fire); pale red indicates deficient Heat of the Heart, treated with Sheng Xi San (Decoction of Raw Rhinoceros Horn); green indicates Liver heat, treated with Xie Qing Wan (Pill for Draining Green); pale light color indicates deficiency, requiring tonification; yellow indicates Spleen heat, treated with Xie Huang San (Decoction for Draining Yellow); lack of luster in the eyes indicates Kidney deficiency, treated with Di Huang Wan (Pill of Rehmannia Root). Zhang Yuansu (Jie Gu) stated: Green indicates abdominal pain, treat with Guizhi Tang (Cinnamon Twig Decoction) and Shaoyao (Peony Root). Zhang Yuansu also stated: Liver disease manifests as pale face; Lung disease as red face; Spleen disease as green face; Kidney disease as yellow face; Heart disease as black face. If Liver disease presents with convulsions and fright, accompanied by pale face, phlegm-drool, and wheezing, these are difficult to treat. The rest can be deduced similarly. Wang Shuhe said: In spring, finding an autumn pulse indicates certain death, following this same logic.
Note: What Qian Yi said refers to diseases of the primary organ; Zhang Yuansu discusses the relationships of overcoming and controlling (Sheng Ke). Therefore, the manifestations of the five Zang organs must be distinguished clearly.