〔钱〕风温热，壮热，相似。潮热，时间发热，过时即止，来日根据时又热，此欲
发惊候也。壮热者，一向热而不已，甚则发惊痫也。风温者，身不热，而口中气
热又有风温证者，但温而不热。伤寒热，口热呵欠顿闷项急。（曾云∶伤寒热，十指稍冷，鼻
流清涕，发热无汗，面惨凌振，右腮有紫纹。）痘疮热，喷嚏，悸动，耳尖冷。（曾
云∶麻豆热、面赤足冷，身发壮热，呵欠、顿闷、咳嗽、腰疼，时或作惊，腹痛目痢、及中
指独冷者，是也。）变蒸热，唇上白泡珠起，耳冷。（曾云∶变蒸热、温温微热、气粗惊少，
乳泻黄，上唇尖有小泡、如水珠子，即变蒸也，不须用药攻治。）疳热，面黄，吃炭土，羸瘦，
鼻下赤烂。惊风热，发搐悸痫，脉数烦躁，颠 恍忽。（曾云∶惊风热、遍身发热，面光自汗，
心悸不宁，脉数烦躁，治法与急惊证同，所用药饵，必先解表。）〔杨〕小儿之
病，惟热居多，夫热有潮热，惊热，夜热，余热，食热，疳热，壮热，烦热，积热，
风热，虚热，客热，癖热，寒热，血热，疮疹热，十六者大同而小异。热之始发，
必有所因也，其潮热发歇有时，惊热颠叫恍忽，夜热夕发旦止，余热寒邪未尽，食
热肚腹先发，疳热骨蒸盗汗，壮热一向不止，烦热心躁不安，积热颊赤口疮，风热
汗出身热，虚热困倦少力，客热来去不定，痰热涎嗽饮水，寒热发如疟状，血热辰
巳发热，疮疹热耳鼻尖冷，诸证得之，各有所归。其间或有三两证交互者，宜随其
轻重而处治之。〔薛〕小儿之热，有肝心脾肺肾五脏之不同，虚实温壮四者之不一，
及表里血气，阴阳浮陷，与夫风湿痰食，各当详之。心热者，额上先赤，心烦心痛，
掌中热而哕，或壮热饮水，巳午时益甚。肝热者，左颊先赤，便难转筋，寻衣捻物，
多怒多惊，四肢困倦，寅卯时益甚。脾热者，鼻上先赤，怠惰嗜卧，身热饮水，遇
夜益甚。肺热者，在颊先赤，手掐眉目，喘咳，寒热饮水，日西热甚。肾热者，颏
下先赤，两足热甚，骨苏苏如虫蚀，热甚不能起于床，夜间益甚。仍当辨其虚实，
实则面赤气粗，口燥唇肿，作渴饮冷，大小便难，或掀衣露体，烦啼暴叫，伸体而
卧，睡不露睛，手足指热，宜用表下。虚则面色青白，恍忽神缓，口中虚冷，嘘气
软弱，喜热恶寒，泄泻多尿，或乍凉乍温，怫郁惊惕，上盛下泄，夜则虚汗，屈体
而卧，睡而露睛，手足指冷，宜用调补。壮热者肢体大热，热不已则发惊痫。温热
者肢体微热，热不已则发惊搐。阴虚则内热。阳盛则外热。以手轻扪之则热，重按
之不热，此皮毛血脉之热，热在表也。重按之筋骨之分则热，轻手则不热，此筋骨
之热，热在里也。不轻不重，按之而热，此肌肉之热，热在表里之间也。以虚实分
属表里而言之，壮热恶风寒，为元气不充，表之虚热也。壮热不恶风寒，为外邪所
客，表之实热也。壮热饮汤，为津液短少，里之虚热也。壮热饮水，为内火销烁，
里之实热也。若夫内外皆热，则喘而渴，齿干烦冤腹满，四肢热，逢风寒如炙于火，
能冬不能夏，是皆阳盛阴虚也。脉尺寸俱满为重实，尺寸俱弱为重虚。脉洪大，或
缓而滑，或数而鼓，此热盛拒阴，虽形证似寒，实非寒也。热而脉数按之不鼓，
此寒盛格阳，虽形证似热，实非热也。发热恶热，大渴不止，烦躁肌热，不欲近衣，
其脉洪大，按之无力，成兼目痛鼻干者，此血虚发躁也，当补其血。如不能食而热，
自汗者气虚也，当补其气。仲景论内外不足，发热自汗之证，禁不可发汗；如饮
食劳役，虽病发热，误发其汗，则表必虚也。身热而汗出者，风也。发热身疼而身
重黄者，湿也。憎寒发热，恶风自汗，脉浮胸痞者，痰也。发热头痛脉数者，食也。
寸口脉微，为阳不足，阴气上入阳中则恶寒，尺脉弱为阴不足，阳气下入阴中则发
热，阴阳不归其分，则寒热交争也。昼则安静，夜则发热烦躁，是阳气下陷入阴中
也，昼则发热烦躁，夜则安静，是重阳无阴也，当亟泻其阳，峻补其阴。至若身热
脉弦数，战栗而不恶寒者，瘅疟也。发热恶寒，脉浮数者，温病也。若四肢发热，
口舌咽干，是火热乘土位，湿热相合，故烦躁闷乱也。若身体沉重，走注疼痛，乃
湿热相搏，风热郁而不得伸也。
【钱乙】风温与热病，症状相似。潮热，指按时发热，过时即止，次日到点又发热，这是将要发生惊风的征兆。壮热，指持续高热不退，严重时会导致惊痫。风温病，身体不发热，但口中呼出的气热，且有风温证候的，只是温热而不炽热。伤寒发热，口中热，呵欠，头项强急。（曾世荣说：伤寒发热，十个手指稍冷，鼻流清涕，发热无汗，面色惨淡且战栗，右腮有紫色纹路。）痘疮发热，打喷嚏，悸动，耳尖冷。（曾世荣说：麻豆热，面赤足冷，全身发壮热，呵欠、头闷、咳嗽、腰痛，时而出现惊厥，腹痛目痢，以及中指独冷，就是这种情况。）变蒸热，嘴唇上起白色小水泡，耳朵冷。（曾世荣说：变蒸热，微微发热，呼吸粗重但惊悸少，乳汁排泄黄色，上唇尖有小泡像水珠子，这就是变蒸，不需要用药攻治。）疳积热，面色黄，吃炭土，消瘦，鼻子下方红肿溃烂。惊风热，发作抽搐惊痫，脉数烦躁，精神恍惚。（曾世荣说：惊风热，全身发热，面部光亮自汗，心悸不安，脉数烦躁，治疗方法与急惊证相同，所用药物，必须先解表。）【杨士瀛】小儿的疾病，以热证居多。热证有潮热、惊热、夜热、余热、食热、疳热、壮热、烦热、积热、风热、虚热、客热、癖热、寒热、血热、疮疹热，这十六种大体相同而略有差异。热证刚开始发作，必定有其原因。潮热发作和停止都有定时；惊热表现为尖叫恍惚；夜热傍晚发作早晨停止；余热是寒邪未尽；食热首先表现为肚腹不适；疳热表现为骨蒸盗汗；壮热持续不止；烦热表现为心躁不安；积热表现为脸颊红、口疮；风热表现为出汗后身热；虚热表现为困倦无力；客热表现为来去不定；痰热表现为涎多咳嗽饮水；寒热表现为像疟疾一样的症状；血热表现为辰时巳时（上午7-11点）发热；疮疹热表现为耳鼻尖冷。各种证候得到之后，各有其归属。其间如果有两三个证候交互出现的，应当根据病情的轻重来处置治疗。【薛己】小儿的热证，有肝、心、脾、肺、肾五脏的不同，虚、实、温、壮四者的不一，以及表里、气血、阴阳浮陷，还有风湿、痰、食等，都应当详细辨别。心热者，额头先红，心烦心痛，手掌心热且呃逆，或者壮热想喝水，巳午时（上午9点至下午1点）加重。肝热者，左颊先红，大便困难转筋，抓衣摸物，多怒多惊，四肢困倦，寅卯时（凌晨3点至7点）加重。脾热者，鼻梁先红，怠惰嗜睡，身热想喝水，遇夜间加重。肺热者，在颊先红，手掐眉目，喘咳，寒热想喝水，日西（下午）热甚。肾热者，下巴先红，两脚热甚，骨头酸软如虫蚀，热甚不能起床，夜间加重。仍应当辨别虚实。实证表现为面赤气粗，口燥唇肿，口渴饮冷，大小便困难，或者掀衣露体，烦躁啼哭暴叫，伸体而卧，睡觉不露睛，手足指头热，宜用表法或下法。虚证表现为面色青白，神情恍惚迟缓，口中感觉虚冷，嘘气软弱，喜热恶寒，泄泻多尿，或者乍凉乍温，怫郁惊惕，上盛下泄，夜间虚汗，屈体而卧，睡觉露睛，手足指头冷，宜用调补法。壮热者肢体大热，热不已则发惊痫。温热者肢体微热，热不已则发惊搐。阴虚则内热。阳盛则外热。用手轻摸皮肤觉得热，重按却不热，这是皮毛血脉的热，热在表。重按筋骨部位觉得热，轻手摸却不热，这是筋骨的热，热在里。不轻不重，按之觉得热，这是肌肉的热，热在表里之间。以虚实分属表里来说，壮热且恶风寒，是元气不充，属于表的虚热。壮热且不恶风寒，是外邪所客，属于表的实热。壮热且喝热汤，是津液短少，属于里的虚热。壮热且喝冷水，是内火销烁，属于里的实热。如果内外皆热，则气喘口渴，牙齿干燥，烦冤腹满，四肢热，遇到风寒就像被火烧一样，能冬不能夏，这些都是阳盛阴虚。脉象尺寸俱满为重实，尺寸俱弱为重虚。脉洪大，或缓而滑，或数而鼓动，这是热盛拒阴，虽然形证似寒，实则不是寒。热而脉数，按之不鼓动，这是寒盛格阳，虽然形证似热，实则不是热。发热恶热，大渴不止，烦躁肌热，不欲近衣，脉洪大，按之无力，或者兼有目痛鼻干，这是血虚发躁，应当补血。如不能食而热，自汗，是气虚，应当补气。张仲景论述内外不足，发热自汗的证候，禁止不可发汗；如果是饮食劳役所致，虽然生病发热，误用发汗法，则表必虚。身热而汗出，是风邪。发热身疼且身重发黄，是湿邪。憎寒发热，恶风自汗，脉浮胸痞，是痰邪。发热头痛脉数，是食积。寸口脉微，为阳不足，阴气上入阳中则恶寒；尺脉弱为阴不足，阳气下入阴中则发热，阴阳不归其位，则寒热交争。白天安静，夜间发热烦躁，是阳气下陷入阴中；白天发热烦躁，夜间安静，是重阳无阴，应当紧急泻其阳，峻补其阴。至于身热脉弦数，战栗而不恶寒，是瘅疟。发热恶寒，脉浮数，是温病。如果四肢发热，口舌咽干，是火热乘土位，湿热相合，所以烦躁闷乱。如果身体沉重，走注疼痛，乃湿热相搏，风热郁结不得伸展。
[Qian] Wind-warmth and heat disease are similar. Tide fever (Chao Re) refers to fever occurring at specific times, subsiding when the time passes, and recurring at the same time the next day; this is a sign that wind-stroke or convulsion (Jing Hou) is about to occur. Vigorous fever (Zhuang Re) refers to persistent high fever without cessation; if severe, it may lead to wind-stroke and epilepsy (Jing Xian). Wind-warmth disease (Feng Wen), where the body does not feel hot, but the breath from the mouth is hot, and presents with wind-warmth symptoms, is merely warm rather than hot. Cold damage fever (Shang Han Re) presents with hot mouth, yawning, and stiffness of the neck. (Zeng said: In cold damage fever, the ten fingers are slightly cold, the nose runs clear fluid, there is fever without sweating, the face is pale and trembling, and there are purple lines on the right cheek.) Chickenpox/smallpox fever (Dou Chuang Re) presents with sneezing, palpitations, and cold ear tips. (Zeng said: Mahou fever [fever associated with chickenpox/smallpox eruption], with red face and cold feet, vigorous whole-body fever, yawning, chest stuffiness, cough, lower back pain, occasional convulsions, abdominal pain, dysentery, and isolated coldness in the middle finger, is this condition.] Bianzheng fever (Bian Zheng Re) presents with white blisters appearing on the lips and cold ears. (Zeng said: Bianzheng fever involves slight warmth, coarse breathing but few惊 (fright), yellow milk discharge, small blisters on the tip of the upper lip like water beads; this is Bianzheng, and no medicinal treatment is needed.) Gan accumulation fever (Gan Re) presents with sallow complexion, pica for charcoal or earth, emaciation, and redness/ulceration under the nose. Convulsive fever (Jing Feng Re) presents with convulsions, palpitations, epilepsy, rapid pulse, irritability, and mental confusion. (Zeng said: Convulsive fever involves whole-body fever, shiny face with spontaneous sweating, palpitations and restlessness, rapid pulse, and irritability. The treatment method is the same as acute wind-stroke; the medicines used must first release the exterior.) [Yang] Children's diseases are mostly heat syndromes. Heat syndromes include tide fever, fright fever, night fever, residual fever, food fever, Gan fever, vigorous fever, vexatious fever, accumulation fever, wind fever, deficiency fever, guest fever, mass fever, chills-and-fever fever, blood fever, and rash fever. These sixteen types are largely similar but slightly different. When heat syndrome first appears, it must have a cause. Tide fever has regular onset and cessation; fright fever manifests as screaming and confusion; night fever starts in the evening and stops in the morning; residual fever indicates incomplete elimination of pathogenic cold; food fever initially manifests in the abdomen; Gan fever manifests as bone-steaming and nocturnal sweating; vigorous fever persists continuously; vexatious fever manifests as mental restlessness; accumulation fever manifests as red cheeks and mouth ulcers; wind fever manifests as body heat after sweating; deficiency fever manifests as fatigue and weakness; guest fever comes and goes unpredictably; phlegm-heat manifests as excessive saliva, cough, and thirst; chills-and-fever fever resembles malaria; blood fever occurs during Chen and Si hours (7 AM–11 AM); rash fever manifests as cold ear and nose tips. Each syndrome has its own location. If two or three syndromes interact, treatment should be adjusted according to their severity. [Xue] Children's heat syndromes differ among the five Zang organs (Liver, Heart, Spleen, Lung, Kidney), vary in deficiency, excess, mildness, and vigor, and involve exterior-interior, Qi-blood, Yin-Yang floating/sinking, as well as wind-dampness, phlegm, and food stagnation, all of which require detailed differentiation. Heart heat manifests as redness starting on the forehead, heart vexation and pain, hot palms, hiccups, or vigorous fever with thirst, worsening during Si-Wu hours (9 AM–1 PM). Liver heat manifests as redness starting on the left cheek, difficult defecation and tendon twitching, grasping clothes and rubbing objects, anger and fright, limb fatigue, worsening during Yin-Mao hours (3 AM–7 AM). Spleen heat manifests as redness starting on the nose bridge, lethargy and desire to sleep, body heat and thirst, worsening at night. Lung heat manifests as redness on the cheeks, scratching eyebrows and eyes, wheezing and cough, chills/fever and thirst, worsening in the late afternoon. Kidney heat manifests as redness starting below the chin, intense heat in both feet, bone soreness like insect erosion, inability to rise from bed due to severe heat, worsening at night. One must still differentiate deficiency and excess. Excess patterns present with red face, coarse breath, dry mouth, swollen lips, thirst for cold drinks, difficulty in urination and defecation, throwing off clothes, irritability, crying out violently, lying stretched out, sleeping with eyes closed, and hot fingertips; treat with exterior-releasing or purgative methods. Deficiency patterns present with blue-white complexion, confused/sluggish spirit, feeling of cold in the mouth, weak sighing, preference for warmth and aversion to cold, diarrhea, frequent urination, alternating cold and warmth, depression and startle, upper excess and lower leakage, nocturnal deficiency sweating, lying curled up, sleeping with eyes open, and cold fingertips; treat with regulation and tonification. Vigorous fever involves large heat in the limbs; if unceasing, it leads to convulsions and epilepsy. Warmth fever involves slight heat in the limbs; if unceasing, it leads to convulsions. Yin deficiency leads to internal heat. Yang excess leads to external heat. Light palpation reveals heat, but heavy pressure does not; this is heat in skin and vessels, located in the exterior. Heavy pressure on sinews and bones reveals heat, but light touch does not; this is heat in sinews and bones, located in the interior. Moderate pressure reveals heat; this is heat in muscles, located between exterior and interior. Regarding exterior-interior based on deficiency/excess: Vigorous fever with aversion to wind and cold indicates insufficient Yuan Qi, representing deficiency heat in the exterior. Vigorous fever without aversion to wind and cold indicates invasion by external pathogens, representing excess heat in the exterior. Vigorous fever with desire for hot drinks indicates shortness of Jin-Ye (body fluids), representing deficiency heat in the interior. Vigorous fever with desire for cold drinks indicates consumption by internal fire, representing excess heat in the interior. If both interior and exterior are hot, there is wheezing, thirst, dry teeth, vexation, abdominal fullness, limb heat, sensitivity to wind-cold as if burned, tolerance for winter but not summer; these are all Yang excess and Yin deficiency. Pulse full at both Cun and Chi positions indicates severe excess; pulse weak at both positions indicates severe deficiency. Pulse surging and large, or slow and slippery, or rapid and drumming, indicates heat excess rejecting Yin; although symptoms resemble cold, it is not cold. Heat with rapid pulse that does not drum upon pressure indicates cold excess repelling Yang; although symptoms resemble heat, it is not heat. Fever with aversion to heat, incessant great thirst, irritability, hot skin, reluctance to wear clothes, surging pulse, empty upon pressure, or accompanied by eye pain and dry nose, indicates blood deficiency causing agitation; tonify the blood. Inability to eat with fever and spontaneous sweating indicates Qi deficiency; tonify the Qi. Zhang Zhongjing stated that for insufficiency of interior/exterior with fever and spontaneous sweating, sweating methods are prohibited. If caused by diet and overwork, even if fever exists, mistaken sweating will cause exterior deficiency. Body heat with sweating indicates Wind. Fever with body ache, heaviness, and yellowing indicates Dampness. Aversion to cold with fever, aversion to wind, spontaneous sweating, floating pulse, and chest oppression indicates Phlegm. Fever with headache and rapid pulse indicates Food Stagnation. Cun pulse micro indicates Yang insufficiency; Yin Qi enters Yang causing aversion to cold. Chi pulse weak indicates Yin insufficiency; Yang Qi sinks into Yin causing fever. When Yin and Yang do not remain in their proper places, cold and heat contend. Quiet during the day, fever and irritability at night, indicates Yang Qi sinking into Yin. Fever and irritability during the day, quiet at night, indicates excessive Yang and lack of Yin; urgently drain Yang and strongly tonify Yin. Body heat with wiry-rapid pulse, shivering but no aversion to cold, is Dan Malaria (Dang Nue). Fever with aversion to cold, floating-rapid pulse, is Warm Disease (Wen Bing). If limbs are hot, mouth/tongue/throat dry, it is Fire-Heat attacking the Earth position, combined with Damp-Heat, causing vexation and confusion. If body is heavy, wandering pain, it is Damp-Heat clashing, with Wind-Heat constrained and unable to extend.