凡小儿有病。皆须身热。其证不一。今条而具之。
小儿于某时间发热。过时即退。至来日根据时发热。（昼夜同）此为潮热。欲发惊也。
小儿身热。但一向壮热不已者。此为壮热。甚则发惊也。
小儿身热。但温而不甚壮热。此为温热。
小儿身热。口中气热。叫哭无时。呵欠顿闷。面目青色。此为风热。甚亦发惊。
小儿身热。饮水悸惕。手足摇动。上视弄舌。印内青筋见。掌中赤。怕物生涎。此为惊热。
小儿身热。面赤时久不退。睡觉颠叫。气急发渴。胸高热壅。此为积热。与壮热相似。但胸高涎壅为异。乃
脏腑积蕴热毒。三焦鬲脘壅滞也。又摇头顶硬者。亦三焦鬲脘壅也。以上皆甚则发搐。（治在惊痫门中）
小儿身体发热。气促鼻塞。清涕嚏喷。寒毛立。眼泪出。或出痰水。此为伤寒。（治在伤寒门中）
小儿身热。时发时退。退但肚热。或夜发熟，面黄腹胀吐泻。乳食不化。粪酸臭异常。此为食伤。（治在伤
食门中）
小儿夜发热。晓即如故。多涎喜睡。此肺虚发热也。此与食伤夜发热相似。须要识之。况二证余候各皆不
同。食伤者可下。肺虚者不可下。下之则失津液。发渴引饮。昔钱乙治朱监簿子五岁。
夜发热。晓即如故。众医作热。以凉药解之不愈。其候多涎喜睡。又以药下其涎。病益甚。至五六日。大引
饮。请乙治之。乙曰不可下。乃取白术散煎汤三升。使任意取足服。朱曰。饮多
不作泻否。乙曰。无生水不能作泻。纵痢亦不足怪。但不可下耳。朱又曰。先治何病。乙曰。止泻治痰。退热清
神。皆此药也。服尽。又作两次与服，其子不渴无痰。又投阿胶散二服而安。是此证也。钱乙方本集载之。小儿
每早食后发热。至夜则凉。此为血热。（治方在后）
小儿身热。形瘦多渴。饮食不为肌肉。此为疳热。（治在疳门中）
小儿血气旺盛。发渴引饮。大便黄坚。小便赤少。四肢身体翕然而热。此为胃实热也。（治宜下之）
小儿身热微惊。耳冷KT 冷。上唇头有白泡起。如鱼目珠子。或汗或不汗。此为变蒸。（治在变蒸门中）
小儿身热。昏睡惊悸。喜嚏喷。耳KT 冷。此为疮疹候。（治在疮疹门中）此与食伤变蒸相似。伤寒耳KT 皆
热。变蒸唇上有白疣泡珠子为异。
小儿身热者。更有内外。在内者多饮水得之。在外者多因风寒得之。钱氏有云。小儿身热饮水者热在内。
身热不饮水者热在外。此大概之验也。在内者宜下之。在外者宜散之。若小儿积蕴内外。感伤表里。浑身俱热。
颊赤口干。小便赤。大便焦黄少者。先以四顺清凉饮子。利动脏腑。热即退矣。既而复热者。是里热已解。而
表热未除。复以惺惺散。或红绵散加麻黄。微发其汗。表热乃去。既去又复发热者。世医尽不能晓。再下再表。
皆为不可。误伤多矣。此表里俱虚。气不归元。阳浮于外。所以再发热也。但以六神散和其胃气。则收阳
归内。身便凉矣。
阎孝忠论小儿壮热。伤风温疫。伤寒风热。疮疹伤食。率皆相
似。未能辨认之间。但与升麻葛根汤惺惺散小柴胡汤服之。甚验。盖此数药通治之。不致误也。惟伤食者。则大
便酸臭。乳不化。畏食或吐。宜与微下之。
孙真人论小儿内外气盛。眠时小惊。或微觉伤风伤食。又虑变蒸身热者。但以紫丸。（方已在前变蒸门中）
或龙胆汤为治。此二药无所不疗。虽微利动。以减盛气。亦不虚人。小儿粪黄而臭者。此腹中有伏热也。宜服龙
胆汤。若粪白而酸臭者。此挟寒不消也。宜服紫丸。但少与。令内俏。甚者小增。令微稀溏。皆须节乳哺一两
日。令胃气平和。若不节。则病易复。复则复下。伤其胃气。令腹胀满。若至再三下之。则过伤矣。
凡是小儿患病，必然会出现身体发热的症状。其临床表现各不相同，现在逐一列举说明。
小儿在特定时间发热，过了那个时间热势就消退，到了第二天同一时间又再次发热（无论白天黑夜都一样）。这称为潮热，是即将发生惊风的前兆。
小儿身体发热，如果一直持续高热不退的，称为壮热，严重时会导致惊风。
小儿身体发热，口中呼出热气，不时哭闹，打哈欠且神情困顿，面目呈现青色，这称为风热，严重时也会引发惊风。
小儿身体发热，喝水时感到惊恐不安，手足摇动，眼睛上翻，弄舌，印堂内青筋显露，手掌发红，害怕异物并流口水，这称为惊热。
小儿身体发热，面色红赤长时间不退，睡醒后惊叫，呼吸急促且口渴，胸部高耸、痰涎壅盛，这称为积热。这与壮热相似，但区别在于胸部高耸和痰涎壅滞，这是由于脏腑积聚蕴藏热毒，导致三焦膈脘气机壅滞所致。又有摇头、头顶僵硬者，也是三焦膈脘壅滞的表现。以上情况严重时都会引发抽搐。（治疗方法见惊痫门）
小儿身体发热，气促鼻塞，流清鼻涕、打喷嚏，寒毛竖起，流泪，或者吐出痰水，这称为伤寒。（治疗方法见伤寒门）
小儿身体发热，时发时退，退热后仅腹部发热，或者夜间发热，面色黄、腹胀、呕吐腹泻，乳食不消化，粪便酸臭异常，这称为食伤。（治疗方法见伤食门）
小儿夜间发热，天亮后即恢复正常，多涎唾、喜欢睡觉，这是肺虚发热。这与食伤导致的夜间发热相似，必须仔细辨别。况且这两种证候的其他伴随症状各不相同。食伤证可以使用下法，肺虚证则不可使用下法，若误用下法会损伤津液，导致口渴引饮。过去钱乙治疗朱监簿的五岁儿子，夜间发热，天亮即如常，众医生当作实热证，用凉药清热却未见效。其症状表现为多涎喜睡，医生又用药攻下其痰涎，病情反而加重。到了第五六天，孩子大量饮水。请钱乙诊治。钱乙说不可用下法，于是取白术散煎汤三升，让孩子随意喝足。朱氏问：“喝多了不会腹泻吗？”钱乙说：“没有生水就不能形成泄泻，即使出现痢疾也不足为怪，只是不可用下法罢了。”朱氏又问：“先治疗什么病？”钱乙说：“止泻、化痰、退热、清神，都靠这个药。”服完药后，又开了两次方子服用，孩子不再口渴也无痰了，随后又投服阿胶散两剂而痊愈。这就是该证候的案例。钱乙的本集中有记载。
小儿每天早晨进食后发热，到了夜晚则热退身凉，这称为血热。（治疗方法在后面）
小儿身体发热，形体消瘦、多渴，饮食不能转化为肌肉营养，这称为疳热。（治疗方法见疳门）
小儿气血旺盛，口渴引饮，大便干结呈黄色，小便短少色赤，四肢身体突然发热，这称为胃实热证。（治疗适宜用下法）
小儿身体发热伴有轻微惊悸，耳朵和手脚心冷，上唇头有白色小泡突起，像鱼目珠子一样，或有汗或无汗，这称为变蒸。（治疗方法见变蒸门）
小儿身体发热，昏睡惊悸，喜欢打喷嚏，耳朵和手脚心冷，这是疮疹的先兆。（治疗方法见疮疹门）这与食伤、变蒸相似。伤寒证的耳朵和手脚心都是热的，变蒸证的上唇有白色疣状水泡珠粒，以此作为区别。
小儿身体发热，更有内外之分。在内者多因饮水不当引起，在外者多因风寒侵袭引起。钱氏曾说：“小儿身体发热且想喝水的，热邪在内；身体发热不想喝水的，热邪在外。”这是一般性的验证方法。在内者适宜用下法，在外者适宜用发散法。如果小儿体内积蕴，外感表里，浑身俱热，脸颊红赤，口干，小便赤色，大便焦黄量少，先用四顺清凉饮子，通利脏腑，热势即可消退。如果热退后又复发，说明里热已解，但表热未除，再用惺惺散，或红绵散加麻黄，微微发汗，表热才能去除。如果热去后又再次发热，世间的医生都不能理解，再次用下法或发散法，都是错误的，误伤人命很多。这是因为表里俱虚，气不归元，阳气浮越于外，所以再次发热。只需以六神散调和胃气，就能收敛阳气回归体内，身体自然凉爽。
阎孝忠论述小儿壮热，无论是伤风温疫、伤寒风热，还是疮疹伤食，大多表现相似，在未能辨认清楚之间，只给予升麻葛根汤、惺惺散或小柴胡汤服用，非常有效。因为这些药物能通用治疗，不至于出错。只有伤食证，大便酸臭，乳食不化，畏食或呕吐，适宜轻微攻下。
孙真人论述小儿内外气盛，睡眠时有轻微惊悸，或微觉伤风伤食，又担心是变蒸引起的发热，只用紫丸（方剂已在前面变蒸门中列出）或龙胆汤来治疗。这两种药无所不疗，虽然轻微通利以减弱盛气，也不会损伤人体正气。小儿粪便黄而臭的，这是腹中有伏热，宜服用龙胆汤。若粪便白而酸臭的，这是挟寒不消化，宜服用紫丸。但要少量给予，使大便稍微通畅；严重者稍增加剂量，使大便微稀溏。都必须节制乳食一两天，使胃气平和。如果不节制，病情容易复发，复发后再攻下，会损伤胃气，导致腹胀满。如果反复多次攻下，就会过度损伤了。
Whenever a child falls ill, fever is invariably present. The clinical manifestations vary; they are listed and explained below.
If a child develops fever at a specific time of day and the fever subsides after that time, only to recur at the same time the next day (regardless of whether it is day or night), this is termed tidal fever (Chao Re). It indicates an impending onset of convulsions (Jing Feng).
If a child has a fever that persists continuously with high intensity without abating, this is termed robust fever (Zhuang Re). In severe cases, it may lead to convulsions.
If a child has a fever that is warm but not intensely high, this is termed mild heat (Wen Re).
If a child has a fever, hot breath from the mouth, frequent crying and wailing, yawning with lethargy, cyanosis of the face and eyes, this is termed wind-heat (Feng Re). In severe cases, it may also trigger convulsions.
If a child has a fever, exhibits fearfulness when drinking water, tremors of the hands and feet, upward deviation of the eyes, tongue protrusion, visible blue veins in the glabella (Yin Tang), red palms, aversion to objects, and salivation, this is termed fright-heat (Jing Re).
If a child has a fever, persistent facial redness, waking up with startled cries, rapid breathing, thirst, chest distension with phlegm obstruction, this is termed accumulated heat (Ji Re). This resembles robust fever, but differs by chest distension and phlegm stagnation. It arises from heat toxins accumulating within the Zang-Fu organs, causing stagnation in the San Jiao (Triple Burner) and diaphragm. Cases involving head shaking and nuchal rigidity also indicate San Jiao and diaphragmatic stagnation. Severe cases of the above may result in spasms/twitching (Chu Tou). (Treatment is detailed in the section on Fright Epilepsy).
If a child has a fever, shortness of breath, nasal congestion, clear rhinorrhea, sneezing, piloerection, lacrimation, or expectoration of phlegm-water, this is termed cold damage (Shang Han). (Treatment is detailed in the section on Cold Damage).
If a child has a fever that comes and goes, with residual abdominal heat upon subsidence, or nocturnal fever accompanied by sallow complexion, abdominal distension, vomiting, diarrhea, indigestion of milk and food, and unusually sour-smelling feces, this is termed food injury (Shang Shi). (Treatment is detailed in the section on Food Injury).
If a child has fever at night which resolves by morning, accompanied by excessive saliva and somnolence, this is lung deficiency fever (Fei Xu Fa Re). This resembles nocturnal fever due to food injury and must be distinguished. The accompanying symptoms differ: food injury can be treated with purgatives, whereas lung deficiency cannot. Purgation in lung deficiency damages body fluids, leading to thirst and excessive drinking. For instance, Qian Yi treated the five-year-old son of Supervisor Zhu, who had nocturnal fever resolving by morning. Other physicians treated it as excess heat with cooling herbs without success. The symptoms included excessive saliva and somnolence; another physician attempted to purge phlegm, worsening the condition. By the fifth or sixth day, the child drank excessively. Qian Yi advised against purgation, prescribing Baizhu San (Atractylodes Macrocephala Decoction) decocted in three sheng of water for free consumption. When asked if excessive drinking would cause diarrhea, Qian Yi replied that without raw water, diarrhea cannot occur, and even dysentery would not be surprising, but purgation is contraindicated. When asked what disease to treat first, Qian Yi stated that stopping diarrhea, resolving phlegm, reducing fever, and calming the spirit are all achieved by this medicine. After completing the course, two more doses were given, resulting in cessation of thirst and phlegm. Finally, Ejiao San (Donkey-Hide Gelatin Decoction) was administered twice, leading to recovery. This case is recorded in Qian Yi's collection.
If a child develops fever every morning after eating, which cools down by night, this is termed blood heat (Xue Re). (Treatment follows later).
If a child has a fever, emaciation, excessive thirst, and poor muscle gain despite adequate intake, this is termed gan heat (Gan Re). (Treatment is detailed in the section on Gan Syndrome).
If a child has vigorous qi and blood, thirst with excessive drinking, dry yellow stools, scanty dark urine, and sudden warmth of the limbs and body, this is termed stomach excess heat (Wei Shi Re). (Treatment should involve purgation).
If a child has a fever with slight fright, cold ears and extremities, white blisters on the upper lip resembling fish eggs, with or without sweating, this is termed bian zheng (Bian Zheng / Physiological Fever). (Treatment is detailed in the section on Bian Zheng).
If a child has a fever, deep sleep with palpitations, frequent sneezing, and cold ears and extremities, this is a sign of exanthema (Chuang Zhen Hou). (Treatment is detailed in the section on Exanthema). This resembles food injury and bian zheng. In cold damage, ears and extremities are hot; in bian zheng, white wart-like blisters appear on the lips.
Regarding fever in children, there is internal and external differentiation. Internal causes often relate to improper fluid intake, while external causes relate to wind-cold invasion. Qian stated: "Fever with thirst indicates internal heat; fever without thirst indicates external heat." This is a general rule. Internal heat is suitable for purgation; external heat is suitable for dispersion. If a child has internal accumulation and external contraction, presenting with generalized fever, flushed cheeks, dry mouth, dark urine, and scanty dark yellow stools, first administer Sishun Qingliang Yinzi (Four-Obedience Clearing and Cooling Drink) to unblock the fu organs, which will reduce the fever. If fever recurs, it indicates resolved interior heat but lingering exterior heat. Administer Xingxing San (Xingxing Powder) or Hongmian San (Red Cotton Powder) with Ephedrae Herba (Mahuang) to induce slight sweating, thereby removing exterior heat. If fever recurs again after resolution, contemporary physicians often fail to understand this. Repeated purgation or dispersion is incorrect and harmful. This recurrence is due to deficiency of both exterior and interior, failure of qi to return to its origin, and floating yang. Administer Liushen San (Six-Spirit Powder) to harmonize stomach qi, allowing yang to return inward, thus cooling the body.
Yan Xiaozhong discussed robust fever in children, noting that wind-warmth epidemic, wind-cold wind-heat, and exanthema with food injury often present similarly. Until clearly differentiated, administering Shengma Gegen Tang (Bupleurum and Pueraria Decoction), Xingxing San, or Xiaochaihu Tang (Minor Bupleurum Decoction) is effective, as these are broad-spectrum remedies that minimize error. However, for food injury, characterized by sour-smelling stools, undigested milk/food, anorexia, or vomiting, mild purgation is appropriate.
Sun Simiao discussed vigorous qi and blood in children, slight fright during sleep, minor wind-cold or food injury, or suspected bian zheng fever. He recommended Ziwu (Purple Pill) or Longdan Tang (Gentiana Decoction). These two formulas are universally applicable; although they cause mild purgation to reduce excess qi, they do not damage healthy qi. Yellow, foul-smelling stools indicate latent heat in the abdomen, suitable for Longdan Tang. White, sour-smelling stools indicate cold-induced indigestion, suitable for Ziwu. Dosage should be small to achieve mild bowel movement; increase slightly for severe cases to achieve loose stools. Milk and food intake should be restricted for one to two days to stabilize stomach qi. Failure to restrict diet leads to relapse. Relapse followed by purgation damages stomach qi, causing abdominal distension. Repeated purgation causes excessive damage.