经曰∶阳胜则热，阴胜则寒。重寒则热，重热则寒。寒伤形，热伤气。又曰∶气实者，热也。小儿之病，
多有发热，然幼科论证太繁，来学眩目，莫得其要。予谓小儿之证，惟宜明显简切，有裨于治疗足矣。今以小
儿发热，分为四大证∶一曰表热，一曰里热，一曰虚热，一曰实热。表里虚实既明，则大纲在手，然后逐证辨
认，又岂能逃其冰鉴乎？
一、小儿无故发热，多由外感风寒。其证喜人怀抱，畏缩，恶风寒，不欲露出头面，面带惨色，不渴，清便
自调，吮乳口不热，或鼻塞流涕，或喷嚏，浑身拘急。此表热也。初起时一汗可解，桂枝汤加柴胡、粉葛，热
服，取微汗效。若元气怯弱者，四君子汤加防风、柴胡、粉葛。
一、发热时，喜露头面仰身卧，扬手掷足，揭去衣被，渴欲饮水，吮乳不休者，口渴也，吮乳口热，小便
赤，大便闭。此里热也。宜解利之，导赤散煎送泻青丸。
一、虚热者，多从大病之后，或温热，或潮热，如潮汐有定期也，或渴或不渴，大小便如常。宜补之，竹
叶调元汤。
一、实热者，面赤腮燥，鼻孔干焦，喜
就冷，或合面卧，或仰面卧，露出手足，揭去衣被，大渴不休，大小便秘。宜微下，集成沆瀣丹。
以上四热为纲，其下杂证为目，有纲有目，而犹不能辨别者，未之有也。
伤风发热，其证自汗身热，呵欠，目赤多睡，恶风喘急。此因解换褓裳，受风所致。治宜解肌，柴葛桂枝
汤，热退之后，略宜滋阴。
伤寒发热，其证无汗身热，呵欠顿闷，项急面赤，喘急恶寒，口中气热。此因脱换受寒所致。治宜惺惺散。
热退后，微服沆瀣丹，以防内热。
既伤风寒，发热，又兼吐泻者，不可发散。此脾胃虚怯也。但以五苓散煎送理中丸。
伤热发热，多在夏月。其证身热自汗，作渴昏睡，手足俱热。此因天气过热，而包裹过浓，受其热也。人
参白虎汤以解其热，次以调元生脉散补之。
伤暑发热，夏月有之。其证身热自汗，作渴昏睡，手足冷。此由高堂广厦，阴冷太过，中气受伤所致。先
以调元生脉散补其气，次服四君子汤以防吐泻。
心热者，浑身发热，面青自汗，心悸不宁，脉数烦躁，狂叫恍惚，此心热也。导赤散加黄连。
夜热者，夜间作热，旦则退去，此血虚也。六味地黄汤加龟板、当归、白芍，敛纳阴气。
伤寒无汗，服表药而汗出，其热不退，又复下之，热仍不退，乃表里俱虚，气不归元，阳浮于外，此为虚
热，不可误用寒凉，即当和其胃气，裨阳气收敛，其热自退。四君子汤加炮姜。
疳热者，形色黄瘦，食不长肌，骨蒸盗汗，泄泻无恒，肚大脚小。多起于大病之后，失于将息，又或伤饥
食饱，脾气受伤。六君子汤加当归、白芍。
壮热者，一向热而不已。由气血壅实，五
脏生热。郁蒸于内，则睡卧不安，精神恍惚；蒸发于外，则表里俱热，燥急喘粗，甚则搐搦。以导赤散煎汤送
泻青丸，大小便秘者，集成沆瀣丹。
烦热者，躁扰不安，五心烦躁，四肢温壮，小便赤涩。此心经有热，宜导赤散加麦冬、栀仁。
积热者，面赤口疮，大小便黄赤。此表里俱实。或因内伤酒面，煎炒炙 ，或误投峻补之药；或外因浓棉
炉火，温暖过度，皆能生热。此人事所致，宜沆瀣丹清解之。
虚热者，或汗下太过，津液枯焦，或大病之后，元气受伤，皆能生热。其证困倦少力，面色青白，虚汗自
出，神慢气怯，四肢软弱，手足厥冷。此气虚发厥，血虚发热，大虚证也。四君子汤加炮姜，甚则加附子，热
退以平剂调之。
客热者，乍有乍无。邪热干心，则热形于额，故先起于头面，而后身热，恍惚多恐，闻声则惕。此正气虚而
热邪胜，故邪正交争，发热无定，乍进乍退，如客之往来莫测也。导赤散先彻其邪，后以团参散护其正气。
血热者，每日已午时发热，过夜则凉。此心经血热也。轻则导赤散，重则四顺散。
《黄帝内经》说：阳气偏胜就会发热，阴气偏胜就会发冷。寒极生热，热极生寒。寒邪损伤形体，热邪损伤气机。又说：气机实盛的表现就是热证。小儿的疾病，大多有发热的症状，然而儿科辨证过于繁杂，让初学者眼花缭乱，抓不住要领。我认为小儿的病症，应当简明清晰，对治疗有帮助就足够了。现在将小儿发热分为四大证型：一是表热，二是里热，三是虚热，四是实热。表、里、虚、实既然明确，就能掌握大纲，然后逐一辨证，难道还能逃过医生的法眼吗？
一、小儿无故发热，多由外感风寒引起。其症状是喜欢让人抱着，畏缩怕冷，厌恶风寒，不想露出头面部，面色惨淡，不口渴，大小便正常，吸吮乳汁时口不热，或者鼻塞流鼻涕，或者打喷嚏，全身拘紧急迫。这是表热证。初起时通过发汗可以解除，用桂枝汤加柴胡、粉葛根，热服，取微汗即见效。如果元气虚弱怯懦的，用四君子汤加防风、柴胡、粉葛根。
二、发热时，喜欢露出头面部仰卧，扬手踢脚，掀开衣被，口渴想喝水，吸吮乳汁不停（因为口渴），吸吮乳汁时口热，小便颜色深红，大便闭塞不通。这是里热证。适宜用解利的方法，用导赤散煎汤送服泻青丸。
三、虚热证，多在大病之后出现，或者是温热，或者是潮热（像潮汐一样有定期），或者口渴或者不口渴，大小便如常。适宜用补益的方法，用竹叶调元汤。
四、实热证，面颊红赤，腮部干燥，鼻孔干焦，喜欢靠近冷处，或者趴着睡，或者仰面睡，露出手足，掀开衣被，大渴不止，大小便秘结。适宜用轻微攻下的方法，用集成沆瀣丹。
以上四种热证为纲领，其下的杂证为条目，有纲有目，如果不能辨别，是没有的事。
伤风发热，其症状是自汗身热，打哈欠，眼睛红赤多睡，恶风喘促急促。这是因为换洗襁褓衣裳时受风所致。治疗适宜解肌，用柴葛桂枝汤，热退之后，稍微宜用滋阴之法。
伤寒发热，其症状是无汗身热，打哈欠且突然感到闷乱，项部拘急面红，喘促急促恶寒，口中气息热。这是因为脱换衣物时受寒所致。治疗适宜用惺惺散。热退后，少量服用沆瀣丹，以防内热产生。
既伤了风寒导致发热，又兼有呕吐腹泻的，不可使用发散之法。这是脾胃虚弱怯懦。只用五苓散煎汤送服理中丸。
伤热发热，多在夏季发生。其症状是身热自汗，口渴昏睡，手足都热。这是因为天气过热，而包裹过厚，受到热气侵袭所致。用人参白虎汤来解其热，随后用调元生脉散补益。
伤暑发热，在夏季有这种情况。其症状是身热自汗，口渴昏睡，手足冷。这是因为住在高大宽敞的房屋里，阴冷太过，损伤了中气所致。先用调元生脉散补气，随后服用四君子汤以防呕吐腹泻。
心热证，浑身发热，面色青白，自汗，心悸不安，脉数烦躁，狂叫恍惚，这是心热证。用导赤散加黄连。
夜热证，夜间发热，早晨则退去，这是血虚证。用六味地黄汤加龟板、当归、白芍，以收敛纳藏阴气。
伤寒无汗，服用解表药后出汗，但热不退，又再次使用下法，热仍不退，这是表里俱虚，气不归元，阳气浮越于外，此为虚热，不可误用寒凉药物，应当调和胃气，帮助阳气收敛，热自然消退。用四君子汤加炮姜。
疳积发热，形色黄瘦，饮食不能长肌肉，骨蒸盗汗，泄泻无常，肚子大脚小。多起因于大病之后，失于调养，或者饥饱失调，脾气受伤。用六君子汤加当归、白芍。
壮热证，一直发热不停止。由气血壅滞实盛，五脏生热。郁蒸于内，则睡卧不安，精神恍惚；蒸发于外，则表里俱热，燥急喘粗，甚至抽搐。用导赤散煎汤送服泻青丸，大小便秘结的，用集成沆瀣丹。
烦热证，躁扰不安，五心烦热，四肢温壮，小便赤涩。这是心经有热，适宜用导赤散加麦冬、栀子仁。
积热证，面赤口疮，大小便黄赤。这是表里俱实。或者因内伤酒面、煎炒炙烤食物，或者误投峻补的药物；或者外因浓棉炉火，温暖过度，都能生热。这是人事因素所致，适宜用沆瀣丹清解。
虚热证，或者汗下太过，津液枯焦，或者大病之后，元气受伤，都能生热。其症状是困倦少力，面色青白，虚汗自出，神疲气怯，四肢软弱，手足厥冷。这是气虚发厥，血虚发热，属于大虚证。用四君子汤加炮姜，严重的加附子，热退后用平和的药剂调理。
客热证，忽有忽无。邪热干扰心脏，则热象表现在额头，所以先起于头面，而后身热，恍惚多恐，听到声音则惊惕。这是正气虚而热邪胜，所以邪正交争，发热不定，忽进忽退，像客人往来难以预测一样。用导赤散先祛除邪气，后用团参散保护正气。
The *Yellow Emperor's Inner Canon* states: When Yang is excessive, there is heat; when Yin is excessive, there is cold. Extreme cold generates heat, and extreme heat generates cold. Cold pathogenic factors damage the form (body structure), while heat pathogenic factors damage Qi. It is also said: Excess of Qi manifests as heat. In pediatric diseases, fever is common. However, syndrome differentiation in pediatrics is often too complex, dazzling to beginners and obscuring the key points. I believe that pediatric syndromes should be clear and concise, sufficient to aid treatment. Now, pediatric fever is divided into four major categories: one is Exterior Heat, two is Interior Heat, three is Deficiency Heat, and four is Excess Heat. Once Exterior, Interior, Deficiency, and Excess are clarified, the general principles are grasped, and subsequent syndrome differentiation will surely not escape the physician's discernment.
One: Fever without apparent cause in children is mostly due to external contraction of Wind-Cold. The symptoms include a preference for being held, shrinking from cold, aversion to wind and cold, reluctance to expose the head and face, a pale and dull complexion, absence of thirst, normal urination and defecation, coolness of the mouth during breastfeeding, or nasal congestion with runny nose, or sneezing, and generalized stiffness and tension. This is Exterior Heat. At the onset, it can be resolved by inducing sweating. Use Guizhi Tang (Cinnamon Twig Decoction) added with Chaihu (Bupleurum Root) and Fengegen (Kudzu Root). Take it hot to induce slight sweating for efficacy. If the Yuan Qi (Original Qi) is weak and timid, use Sijunzi Tang (Four Gentlemen Decoction) added with Fangfeng (Saposhnikovia Root), Chaihu, and Fengegen.
Two: During fever, if the child prefers to expose the head and face, lies supine, throws hands and feet about, removes clothes and blankets, feels thirsty and desires water, continues breastfeeding incessantly (due to thirst), has a hot mouth during breastfeeding, dark red urine, and constipation, this is Interior Heat. It is suitable to resolve and clear using Daodi San (Guide Out the Red Powder) decocted to administer Xieqing Wan (Drain the Green Pill).
Three: Deficiency Heat often occurs after severe illness, presenting as either warm fever or tidal fever (regular like the tides), with variable thirst, and normal urination and defecation. It is suitable to tonify using Zhuye Tiaoyuan Tang (Bamboo Leaf Regulating Origin Decoction).
Four: Excess Heat presents with red cheeks and dry malar area, dry and scorched nostrils, a desire for cold environments, lying prone or supine, exposing limbs, removing clothes and blankets, unquenchable thirst, and constipation of both stool and urine. It is suitable to mildly purge using Jicheng Hangxie Dan (Jicheng Hangxie Pill).
These four fevers serve as the outline, while miscellaneous syndromes below serve as the details. With outline and details established, failure to differentiate would be unprecedented.
Wind-Strike Fever presents with spontaneous sweating, body heat, yawning, red eyes, drowsiness, aversion to wind, and rapid breathing. This is caused by exposure to wind during changing swaddling clothes. Treatment should focus on releasing the muscle layer using Chaige Guizhi Tang (Bupleurum, Kudzu, and Cinnamon Twig Decoction). After the fever subsides, slight yin-nourishing measures are appropriate.
Cold Damage Fever presents with no sweating, body heat, yawning accompanied by sudden oppression, stiff neck, red face, rapid breathing, aversion to cold, and hot breath from the mouth. This is caused by exposure to cold during undressing. Treatment should use Xingxing San (Wonderful Powder). After the fever subsides, take a small amount of Hangxie Dan to prevent internal heat accumulation.
If Wind-Cold injury causes fever accompanied by vomiting and diarrhea, dispersing methods are contraindicated. This indicates Spleen-Stomach deficiency and timidity. Use Wuling San (Five-Ingredient Poria Powder) decocted to administer Lizhong Wan (Regulate the Middle Pill).
Heat-Injury Fever mostly occurs in summer. Symptoms include body heat, spontaneous sweating, thirst, drowsiness, and heat in both hands and feet. This is due to excessive ambient heat combined with thick wrapping, leading to heat retention. Use Renshen Baibu Tang (Ginseng and White Tiger Decoction) to resolve the heat, followed by Tiaoyuan Shengmai San (Regulating Origin and Generating Pulse Powder) to tonify.
Summerheat Injury Fever occurs in summer. Symptoms include body heat, spontaneous sweating, thirst, drowsiness, and cold hands and feet. This is caused by staying in large, spacious houses where the cold is excessive, damaging the Middle Qi. First, use Tiaoyuan Shengmai San to tonify Qi, then take Sijunzi Tang to prevent vomiting and diarrhea.
Heart Heat presents with generalized fever, blue-green facial hue, spontaneous sweating, palpitations and restlessness, rapid pulse, irritability, screaming, and mental confusion. This is Heart Heat. Use Daodi San added with Huanglian (Coptis Rhizome).
Night Fever presents with fever at night that subsides in the morning. This is Blood Deficiency. Use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Guiban (Tortoise Shell), Danggui (Angelica Sinensis Root), and Baishao (White Peony Root) to gather and store Yin Qi.
In Cold Damage with no sweating, if sweating occurs after taking exterior-releasing medicines but the fever persists, and purgatives are subsequently used with no reduction in fever, this indicates simultaneous deficiency of Exterior and Interior, Qi failing to return to its origin, and Yang floating externally. This is Deficiency Heat. Do not mistakenly use cold-cooling herbs. Instead, harmonize Stomach Qi to assist Yang convergence, and the fever will recede naturally. Use Sijunzi Tang added with Paojiang (Fried Ginger).
Gan Accumulation Heat presents with sallow and emaciated appearance, inability to gain weight from food, bone-steaming night sweats, irregular diarrhea, distended abdomen, and thin legs. It often arises after severe illness due to lack of recuperation, or irregular eating habits injuring Spleen Qi. Use Liujunzi Tang (Six-Gentleman Decoction) added with Danggui and Baishao.
Zhuang Re (Violent Heat) refers to persistent, unremitting fever. It results from stagnation and excess of Qi and Blood, generating heat in the Five Zang Organs. Internal stagnation leads to restless sleep and mental confusion; external evaporation leads to simultaneous exterior and interior heat, dryness, agitation, coarse breathing, and even convulsions. Use Daodi San decocted to administer Xieqing Wan. For those with constipation, use Jicheng Hangxie Dan.
Fan Re (Vexatious Heat) presents with restlessness, vexation in the five centers (palms, soles, and chest), warm and robust limbs, and dark, scanty urine. This indicates Heat in the Heart Meridian. Use Daodi San added with Maidong (Ophiopogon Tuber) and Zhiren (Gardenia Seed).
Ji Re (Accumulated Heat) presents with red face, oral ulcers, and yellow-red urine and stool. This indicates simultaneous Excess in Exterior and Interior. It may result from internal injury due to alcohol, flour products, fried foods, or mistaken use of strong tonics; or external injury from excessive warmth due to thick cotton or stoves. These are caused by human behavior and should be cleared and resolved using Hangxie Dan.
Deficiency Heat may result from excessive sweating or purging leading to dried-up fluids, or from Qi injury after severe illness. Symptoms include fatigue, weakness, blue-white complexion, spontaneous virtual sweating, lethargy, timid Qi, weak limbs, and cold extremities. This is Qi Deficiency causing collapse and Blood Deficiency causing fever, representing a severe deficiency syndrome. Use Sijunzi Tang added with Paojiang. In severe cases, add Fuzi (Aconite Lateral Root). After the fever subsides, regulate with mild formulas.
Ke Re (Guest Heat) comes and goes intermittently. When pathogenic heat interferes with the Heart, heat manifests on the forehead, starting at the head and face before spreading to the body, accompanied by mental confusion, fear, and startle at sounds. This is because Zheng Qi (Upright Qi) is deficient while pathogenic heat is dominant, leading to struggle between pathogen and righteousness, resulting in fluctuating fever like an unpredictable guest. Use Daodi San first to eliminate the pathogen, then Tuanshen San (Round Ginseng Powder) to protect Zheng Qi.
Blood Heat presents with fever specifically during Si and Wu hours (9 AM to 1 PM), cooling down overnight. This is Blood Heat in the Heart Meridian. For mild cases, use Daodi San; for severe cases, use Sishun San (Four-Obstruction-Free Powder).