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Huang Youli / Anhui

The pediatric index finger collateral vessel diagnostic method involves examining the visibility, clarity, color, and morphology of the collateral vessels on the ventral side of a child's index finger to diagnose the location, severity, and prognosis of diseases. It is a commonly used diagnostic method for infant and toddler illnesses. In the Song Dynasty, Liu Fang referred to it as "examining the pulse of the three passes" in *Youyou Xinshu* (1150). During the Yuan Dynasty, Zeng Shi-rong called it "three passes fingerprint" in *Huoyou Kouyi* (1283). In the Ming Dynasty, Wan Quan named it "observing the purlicue pulse of the index finger" in *Wan's Secret Jade Heart Book*. In the Qing Dynasty, Lin Zhi-han termed it "examining the three passes of the index finger" in *Four Examinations Juwei* (1723), while Wu Qian and others referred to it as "the pulse patterns and colors of the three passes of the index finger" in *Yizong Jinjian: Pediatric Miscellaneous Diseases Essential Formulas* (1742). Later generations collectively called it "pediatric examination of finger venules." The so-called "fingerprint" in this method actually refers to the collateral vessels of the Taiyin lung meridian of the hand. To avoid confusion with the commonly understood concept of "fingerprint," the 1984 edition of the national higher medical textbook *Diagnostics of Chinese Medicine* renamed it "observation of pediatric index finger collateral vessels," which is more accurate.

(1) Discussion on the Origin of the Pediatric Index Finger Collateral Vessel Diagnostic Method

The origin of the pediatric index finger collateral vessel diagnostic method has been the subject of various theories. Some claim it began with the *Huangdi Neijing* (*Maiyi Jianmo*), others suggest it originated between the Five Dynasties and the late Northern Song Dynasty, and some attribute its creation to the Song Dynasty physician Qian Yi. However, these theories lack sufficient evidence to be conclusive. Later, a Tang Dynasty theory emerged, proposing that Wang Chao's *Immortal Water Mirror Diagram Formula* from the Tang Dynasty described the three sections of a child's index finger—wind, qi, and life—as the three passes for pediatric examination of finger venules, along with descriptions of fingerprint patterns called "Eight Brocades." Additionally, Ming Dynasty medical experts such as Xue Ji, Wan Quan, Wang Ken-tang, and Zhang Jing-yue referenced the *Water Mirror Formula*, which they believed to be Wang Chao's *Immortal Water Mirror Diagram Formula*.

Through textual research, we conclude that the *Water Mirror Formula* cited in Ming Dynasty medical texts is not Wang Chao's *Immortal Water Mirror Diagram Formula* from the Tang Dynasty, and thus cannot serve as evidence for the Tang Dynasty origin of the pediatric index finger collateral vessel diagnostic method. We speculate that the *Water Mirror Formula* may have been a compilation by Song and Yuan physicians based on earlier works, or it may have been redefined and named in a dedicated section, similar to Wan Quan's *Wan's Secret Jade Heart Book*. Based on current evidence, it is more likely that the *Water Mirror Formula* was compiled by the Yuan Dynasty physician Zeng Shi-rong and later revised. However, through studies of Wang Chao's *Immortal Mirror Diagram Formula* and Du Guangting's *Zhimifu* cited in *Youyou Xinshu*, as well as Sun Si-miao's related discussions and the Tang Dynasty practice of "fingerprint signatures" in legal documents, we find it credible that the pediatric index finger collateral vessel diagnostic method originated in the Tang Dynasty.

(2) Evolution of the Nomenclature for the Three Passes in the Pediatric Index Finger Collateral Vessel Diagnostic Method

In the early stages of the collateral vessel diagnostic method for children's index fingers, there were two different naming methods for the three passes: one was the "qi, wind, life theory." It was first proposed by Du Guangting in his "Zhimifu": "Qi is in the lower lines, wind resides in the middle, passing the wind pass is called the life pass." Later, some medical texts, such as the anonymous "Xiao'er Weisheng Zongwei Lunfang" (1156), Chen Wenzhong's "Xiao'er Bingyuan Fanglun" (1254) from the Song Dynasty, and Zeng Shirong's "Huoyou Kouyi" and "Yifang Leiju" from the Yuan Dynasty, as well as the "Danliao Fang" and "Yonglei Qianfang" mentioned in them, also held this view. The "Xiao'er Weisheng Zongwei Lunfang" specifically elaborated on the relationship between the names of the three passes and diseases, stating that the lowest section of the index finger is called the qi pass. If there are lines crossing it, the disease is just beginning to become severe. When various diseases arise, the qi is not harmonized, hence it is called the qi pass. The second section is called the wind pass. If there are lines crossing it, infantile convulsions will occur. The condition gradually worsens, hence it is called the wind pass. The third section is called the life pass. If there are lines crossing it, the disease is extremely severe and life is in danger, hence it is called the life pass. Zeng Shirong provided illustrative explanations in his "Huoyou Kouyi."

The second is the "Wind, Qi, Life Theory." This theory first appeared in Youyou Xinshu, "The second finger of a child's hand has three sections, and the shape of the pulse emerges above them. Near the purlicue position, it is called the wind pass, followed by the qi pass, and the fingertip is called the life pass. Whenever there is an illness, one should observe the pulse of the three passes to diagnose the disease." Since then, it has gained many followers. For example, during the Yuan Dynasty, Hua Shou pointed out in Zhenjia Shuyao (1359): "For children under three years old, observe the color of the three passes of the index finger: purple indicates heat, red indicates cold-damage disease, green indicates infantile convulsion, and white indicates infantile malnutrition. Only a faint yellow or faint red color is considered normal. If black appears, it is dangerous. Other colors, if seen at the wind pass, indicate a mild condition; at the qi pass, a more severe condition; and at the life pass, a critical condition." This theory was also followed by many physicians during the Ming and Qing dynasties. For example, Wan Quan said: "The first section of the second finger is called the wind pass; if the pulse appears here, the disease is in its early stages. The second section is the qi pass; if the pulse appears here, the disease is difficult to treat. The third section is the life pass; if the pulse appears here, death is imminent." Others, such as Lin Zhi-han in his "Four Examinations Juewei," Wu Qian and others in "Yizong Jinjian: Pediatric Zabing Xinfa Yaojue," and Zhang Zhen in "Lizheng Anmo Yaoshu," also adhered to this theory, which continues to this day.

(3) The Development of Understanding the Morphology of the Collateral Vessels in Children's Index Fingers

Regarding the understanding of the morphology of the collateral vessels in children's index fingers, Liu Fang first proposed eight pulse shapes in Youyou Xinshu: "fishbone shape," "hanging needle shape," "water character shape," "乙 character shape," "curved worm shape," "ring shape," "chaotic pattern shape," and "flowing pearl shape." Each shape corresponds to different diseases. For example, "a shape like a hanging needle indicates frequent diarrhea, while a water character shape indicates a need for urgent treatment to restore peace." Liu also included illustrations of various collateral vessel shapes in the book. Liu also cited Zhuang's 11 pulse shapes in the book, such as "curved inward," "curved outward," "slanted to the right," "slanted to the left," "double hook," "triple curve like a long worm," "double curve like a hook," "one end like a ring," "face with black spots," "head, face, and belly with vessels," and "like chaotic worms." During the Yuan Dynasty, Zeng Shi-rong in "Huoyou Kouyi" expanded the morphology of children's index finger collateral vessels to 13 shapes, such as "flowing pearl shape," "ring pearl shape," "long pearl shape," "coming snake shape," "going snake shape," "bow inward shape," "bow outward shape," "spear shape," "fishbone shape," "water character shape," "needle shape," "penetrating pass toward the finger surface," and "extension through passes toward the nail." He also included illustrations, further expanding the range of diseases associated with children's index finger collateral vessels. During the Ming Dynasty, Wan Quan inherited Zeng Shi-rong's ideas and followed Zeng's 13 pulse shapes and their corresponding diseases in "Wan's Secret Transmission Pianyu Xinshu." During the Qing Dynasty, Wu Qian and others in "Yizong Jinjian: Pediatric Zabing Xinfa Yaojue" expanded the morphology of children's index finger collateral vessels to 20 shapes, each accompanied by illustrations, further extending the range of diseases associated with children's index finger collateral vessels and pushing the development of this diagnostic method to a new peak.

(4) Discussion on the First Medical Text to Record the Diagnostic Method of Children's Index Finger Collateral Vessels

Regarding the question of which existing medical text is the earliest to record the collateral vessel diagnostic method of the child's index finger, it is generally believed that the earliest existing medical book containing the collateral vessel diagnostic method of the child's index finger is the Xu Shu-wei’s Puji Benshi Fang, completed in 1132, which is 18 years earlier than Youyou Xinshu. This view is debatable. According to Chen Zhensun: Xu Shu-wei "was the sixth-ranked scholar in the Jinshi examination in the third year of Shaoxing (1133)"; or it is said that "he passed the examination as the fifth-ranked scholar in the Renzi year of Shaoxing (1132)". The "Summary of the Complete Library of the Four Treasuries" also states: "He was a Jinshi in the second year of Shaoxing, and medical practitioners refer to him as Xu Xueshi." It is evident that 1132 was the year Xu passed the imperial examination. The "Summary of the Complete Library of the Four Treasuries" further states: Xu Shu-wei "in his later years, compiled the formulas he had tested throughout his life and recorded their actual effects, thus creating the Benshi Fang." Although according to the entry for Xu Shu-wei in the "Concise Dictionary of Chinese Medicine," Xu's birth and death years are 1079 - 1154?, with a lifespan of about 76 years, by the time he passed the examination, he was already advanced in age (54 years old); but at that time, he still had three-quarters of his life ahead, and for Xu Shu-wei, "later years" would likely be after the age of 60. From this, it can be inferred that the compilation of Puji Benshi Fang should have occurred after Xu's "passing the examination." Furthermore, according to Yan Xiaozhong's postscript to the book, dated the Yisi year of Chunxi (1185), which should be the year the book was printed. Therefore, it is reasonable to believe that the compilation of Puji Benshi Fang took place between 1132 and 1185. Hence, Guo Aichun's assertion that Xu Shu-wei’s Puji Benshi Fang was completed in 1150 is relatively credible. That is to say, the compilation dates of Puji Benshi Fang and Youyou Xinshu are the same.

Currently, the most accurate record of the collateral vessel diagnostic method for children's index fingers is found in Youyou Xinshu. The content compiled in this book is more detailed and comprehensive than that in Puji Benshi Fang. It not only includes a dedicated chapter on "Three Passes Brocade Patterns," compiling the theories of eight scholars including Yang Daye, but also contains a piece titled "Du Guangting's Zhimi Fu" from the Tang Dynasty. Judging from the content of the collateral vessel diagnostic method for children's index fingers recorded in this fu, it is more rudimentary compared to the theories cited by Youyou Xinshu. It only mentions colors such as green, purple, red (crimson), and black; the description of the collateral vessels on the index finger is also limited to intuitive observations, without specific names being established; the names of the three passes, as mentioned earlier, also differ from the concepts of wind, qi, and life. Therefore, if we consider individual documents, "Du Guangting's Zhimi Fu" from the Tang Dynasty is undoubtedly the earliest existing document that records the collateral vessel diagnostic method for children's index fingers.

(V) Debate on the Practical Value of the Collateral Vessel Diagnostic Method for Children's Index Fingers

Regarding the practical value of the collateral vessel diagnostic method for children's index fingers, there has been a debate since the Song Dynasty about whether it is "useful" or "useless." As mentioned earlier, after its inception, the collateral vessel diagnostic method for children's index fingers received widespread attention from pediatricians during the Song and Ming dynasties. Not only was this diagnostic method considered one of the primary methods for clinical diagnosis in pediatrics (for children under 3 years old), such as "from one month after birth to before the age of 3, it is necessary to observe the purlicue pulse, with the second finger's joint as the life pass, followed by the qi pass, and then the wind pass." Moreover, the forms of collateral vessels described in this diagnostic method evolved from eight types in Youyou Xinshu of the Song Dynasty to thirteen types in the Yuan and Ming dynasties, as seen in works like Zeng Shi-rong's "Huoyou Kouyi" from the Yuan Dynasty and Wan Quan's "Wan's Secretly Transmitted Pianyu Xinshu" from the Ming Dynasty; by the Qing Dynasty, Wu Qian and others in "Yizong Jinjian" expanded it to twenty types, elucidating the diseases indicated by different forms of collateral vessels. The collateral vessel diagnostic method for children's index fingers has proven its usefulness in pediatric clinical emetic therapy, as evidenced by these developments. Other works, such as Zeng Shi-rong's "Huoyou Kouyi" (1294) and Hua Shou's "Zhenjia Shuyao" (1359) from the Yuan Dynasty, not only summarize previous experiences with the animation of finger venules in children but also include personal insights, further developing the practice. For example, Hua Shou stated: "For children under three years old, observe the patterns and colors of the three passes on the index finger. Purple indicates heat, red indicates cold-damage disease, green indicates infantile convulsion, and white indicates infantile malnutrition. Only a faint yellow or faint red is considered normal. The appearance of black is dangerous. Other colors, when seen at the wind pass, are less severe, at the qi pass they become more serious, and at the life pass they are most severe."

However, during the Ming and Qing dynasties, some physicians questioned the clinical application value of the collateral vessel diagnostic method on children's index fingers. "For example, Zhang Jing-yue and Xia Yu-zhu both stated that it was unnecessary to use this method." Among them, the argument of Xia Yu-zhu from the Qing dynasty was particularly typical. He once pointed out in "Youke Tiejing": "Observing the finger veins is a heterodox practice of physicians. The veins on the finger surface are determined at birth. How could they change into a reverse bow due to cough, transform into fish bones due to fright accumulation, or form flowing beads due to diaphragm heat, or take on a snake-like shape due to liver qi obstruction?" Clearly, Xia confused the collateral vessel patterns with the finger ridge patterns. Chen Fu-zheng, after systematically discussing the principles, methods, and clinical significance of the collateral vessel diagnostic method on children's index fingers, believed that the collateral vessels on children's index fingers "are the collateral branches of the Taiyuan (LU9) pulse. Therefore, the changes in the patterns are also the changes in Taiyuan (LU9), and there is no need to establish another theory to confuse people. We should only use the floating and sinking to differentiate the exterior and interior, the red and purple to distinguish cold and heat, and the light and stagnant to determine deficiency and excess. Then, the method can be used endlessly. If we abandon this and mistakenly adhere to false theories, not examining the source of the disease in clinical practice, and erroneously attributing it to human or animal fright, we deceive the ignorant." He did not advocate complicating the collateral vessel diagnostic method on children's index fingers and opposed exaggerating its clinical value. He believed that the collateral vessel diagnostic method on children's index fingers had significant diagnostic value for diseases in children under three years old. Clinically, the nature and depth of pathogenic factors, the rise and fall of qi and blood, and the prognosis of the disease's severity and outcome could be diagnosed based on the visibility, lightness, color, position, and shape of the collateral vessels. However, this should not be the sole basis for diagnosis. A comprehensive analysis of the four examinations is necessary to make a thorough and accurate diagnosis. This viewpoint is reasonable.

(6) Modern Research on the Diagnostic Method of Infant Index Finger Collateral Vessels

Modern research indicates that in normal infants and young children, the collateral vessels of the index finger are often short and straight, commonly visible at the purlicue. The mechanism behind the elongation of these collateral vessels is related to increased venous pressure, peripheral vascular dilation, and malnutrition. Clinically, elevated venous pressure manifests as blood stasis; for instance, poor cardiac function can slow blood flow, leading to diminished peripheral circulation and blood stasis in the veins, causing the dilation of small veins that are not usually visible at the distal end. Children with pneumonia, due to hypoxia and increased pulmonary circulation pressure, are prone to acute or subacute cor pulmonale, which can cause capillary circulation disorders, blood stasis, and increased venous pressure, leading to the elongation of the index finger collateral vessels due to increased filling.

The colors of the index finger collateral vessels include yellow, red, purple, blue, and black. In normal infants and young children, the collateral vessels of the index finger typically show a faint yellow-red hue, with a crystalline blood color, mostly appearing red, light purple, or faintly visible. The color of the collateral vessels can reflect the quality and quantity of blood and the degree of hypoxia. In cases of anemia and malnutrition, the hemoglobin content in the blood decreases, red blood cells are reduced, metabolic rate is lowered, and oxygen consumption is decreased, leading to less hemoglobin and reduced hemoglobin, hence the collateral vessels often appear light red. During high fever, the body's demand for oxygen increases, red blood cells increase accordingly, and the carbon dioxide content in the veins also rises, causing the blood color to darken, and the collateral vessels often appear purple.

Generally, the collateral vessels of the index finger in healthy infants and young children are short and small, with few branches or extensions, and no significant curvature. However, in illness, the morphology of these collateral vessels can change, often closely related to circulatory, respiratory, and nervous system dysfunctions, as well as malnutrition. Circulatory and respiratory disorders often cause blood stasis in small veins, increased venous pressure, and slow blood flow, leading to the collateral vessels becoming stagnant and not extending, resulting in various shapes such as horizontal, straight, curved, or twisted.

Regarding the issue of the floating and sinking, as well as the faintness and stagnation of the index finger collateral vessels. In healthy infants and young children, the collateral vessels of the index finger are faintly visible, neither floating nor sinking; once illness occurs, changes in qi and blood can cause variations in the floating and sinking of these vessels. If the blood vessels are overly filled, the collateral vessels often appear floating; if the blood vessels are insufficiently filled, the collateral vessels often appear sinking. Faint collateral vessels are commonly seen in children with weak physique, insufficient qi and blood, malnutrition, and chronic functional decline, mostly belonging to deficiency pattern; stagnant collateral vessels are commonly seen in cases of blood circulation disorders, obstructed venous return, and slowed blood flow, mostly belonging to excess pattern.

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