（《素问·通评虚实论》 附∶乳子脉辨）
帝曰∶乳子而病热，脉悬小者何如？（乳子，婴儿也。病热脉悬小者，阳证阴脉，本为大禁。但小而缓者，邪之微
也，其愈则易；小而急者，邪之甚也，为可虑耳。）岐伯曰∶手足温则生，寒则死。（此统言小儿之内外证也。小儿以稚
阳之体，而加之病热，脉不当小。若脉虽小而手足温者，以四肢为诸阳之本，阳犹在也，故生；若四肢寒冷，则邪胜其
正，元阳去矣，故死。《通评虚实论》曰∶所谓从者，手足温也。所谓逆者，手足寒也。）帝曰∶乳子中风热，喘鸣肩息
者，脉何如？岐伯曰∶喘鸣肩息者，脉实大也，缓则生，急则死。（此言小儿之外感也。风热中于阳分，为喘鸣肩息者，
脉当实大。但大而缓，则胃气存，邪渐退，故生；实而急，则真藏见，病日进，故死。愚按∶此二节之义，可见古人之
诊小儿者，未尝不重在脉也。即虽初脱胞胎，亦自有脉可辨。何后世幼科如《水镜诀》及《全幼心鉴》等书，别有察三
关之说，于脉则全置不问。夫三关乃阳明之浮络，原不足以候脏腑之气。且凡在小儿，无论病与不病，此脉皆紫白而兼
乎青红，虽时有浓淡之异，而四色常不相离也。何以辨其紫为风，红为寒，青为惊，白为疳？又何以辨其雷惊、人惊、
水惊、兽惊之的确乎？即余初年，亦用此法，然惟测摸疑似，终属茫然。奈何近代医家习此为常，全不知脉，欲济其危，
胡可得也？及遍考《内经》，则并无三关名目，惟《经脉篇》有察手鱼之色者，若乎近之；然乃概言诊法，亦非独为小儿
也。义详经络类六。然则三关之说，特后世之异端耳，不足凭也。故凡欲诊小儿者，在必察气口之脉，面部之色，呼吸
之声，或兼察手鱼亦可也。且小儿之脉，原非大方之比，不必多岐，但求于大小缓急虚实六者之间，可以尽之，诊得其
真，取如反掌，既明且易，岂不大愈于彼哉？欲求实济于此者，速当知所从也。
（出自《素问·通评虚实论》，附录：婴儿脉象辨析）
黄帝问道：婴儿患病发热，如果脉象悬细而小，情况如何？（注：乳子，即婴儿。患热病而脉象悬小，属于阳证见阴脉，本是大忌。但如果脉小而兼缓，说明邪气轻微，痊愈容易；如果脉小而兼急，说明邪气深重，令人担忧。）
岐伯回答说：手足温暖则生，手足寒冷则死。（注：这是统括论述小儿的内外证候。小儿本是稚阳之体，又加上患热病，脉象不应当细小。如果脉虽然细小但手足温暖，因为四肢是诸阳之本，阳气尚存，所以能生；如果四肢寒冷，则是邪气胜过正气，元阳已脱，所以死亡。《通评虚实论》说：所谓顺证，就是手足温暖。所谓逆证，就是手足寒冷。）
黄帝问道：婴儿感受风热，出现喘息有声、耸肩呼吸的症状，脉象会怎样？
岐伯回答说：出现喘息有声、耸肩呼吸的症状，脉象应当实大。如果脉象大而缓，则生；如果脉象实而急，则死。（注：这是论述小儿的外感病。风热侵袭阳分，导致喘息有声、耸肩呼吸，脉象应当实大。但如果脉大而缓，说明胃气尚存，邪气逐渐消退，所以能生；如果脉象实而急，说明真脏脉现，病情日益加重，所以死亡。我按语道：从这两段经文的意义来看，可见古人诊治小儿，未曾不重视脉诊。即使婴儿刚脱离母体，也自有脉象可以辨别。为什么后世的儿科著作如《水镜诀》和《全幼心鉴》等书，另有观察“三关”的说法，而对脉诊完全置之不问？那三关不过是阳明经的浮络，原本不足以候察脏腑之气。而且凡是小儿，无论有病无病，此处的脉色都是紫白兼有青红，虽然有时浓淡不同，但这四种颜色常不相离。凭什么辨别紫色为风，红色为寒，青色为惊，白色为疳？又凭什么辨别雷惊、人惊、水惊、兽惊的确切区别呢？就连我早年，也曾使用这种方法，然而只是推测摸拟疑似之症，终究感到茫然不解。近代医家习以为常，全然不懂脉诊，想要救治危重病人，怎么可能做到呢？等到遍考《内经》，并没有“三关”这一名目，只有《经脉篇》中有观察手鱼际部位色泽的方法，似乎比较接近；但那是一般性的诊法论述，并非专为小儿设立。义理详见经络类第六节。那么，“三关”之说，不过是后世的异端邪说罢了，不值得信赖。所以凡是想要诊治小儿的医生，必须察看病人口部的气口脉象，面部的色泽，呼吸的声音，或者兼察手鱼际的色泽也可以。况且小儿的脉象，本来就不像成人那样复杂，不必多歧，只要在大小、缓急、虚实的六者之间进行辨析，就可以穷尽脉理，诊得真脉，取效如同反掌般容易，既明了又简易，难道不是比那些方法好得多吗？想要在此方面求得实际疗效的人，应当迅速知道该遵循的方向。）
(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.)