张子和治高巡检之子，八岁病热。医者皆谓伤冷，以热药攻之，欲饮水禁而不与，内水涸竭，烦躁转生，
前后皆闭，口鼻俱干，寒热往来，咳嗽时作，遍身无汗。又欲灸之。张责其母曰∶重 浓被，暖炕红炉，儿已
不胜其热矣，尚可灸乎？先令服人参柴胡饮子，连进数服，下烂鱼肠之类，臭气异常，渴欲饮水，听其所欲，
而冰雪凉水，连进数杯。节次又下三四十行，大热方去。又与牛黄通隔丸，复下十余行，儿方大痊。前后约五
十余行，略无所困，冰雪水饮至一斛。倘灸之当何如哉？
吕东庄治吴尹明子十岁，患夜热二年余，颔下忽肿硬如石，面黄，时时鼻衄如注。脉之，沉郁之气，独见
阳关，曰∶病敦阜也。（右关主脾胃，沉郁乃实热症，敦阜字，狡示人以不易知也。）用石膏、藿香叶、栀子、
防风、黄连、甘草等，颌肿渐软，面黄复正。继用茯苓、枇杷叶、元参、枳壳、山栀、茵陈、石斛、天麦门冬、
生熟地黄饮，（甘露饮也。）重加黄连，而衄血夜热悉除。
陆养愚治李邑宰子，年十一，于六月夜间，忽发热微汗，头微痛。或谓伤暑，与香薷饮冷服，病更甚，且
喘嗽痰。又谓脉气浮数，火热上炎，以芩、连、知母、花粉清之，喘咳不绝，饮食不思，睡卧不安。脉之弦紧，
左倍于右，面赤戴阳。此风寒外束，宜发散之。或谓如此炎天，且身常有汗，何以宜表？曰∶正因风寒伤其卫
阳之气，令外之阳气，拒而不得入，故汗微微而不止，内之阳气伏而不得出，故身翕翕而壮热。若解散其邪，
则外者得入，内者得出，自汗止身凉矣。用干葛为君，苏叶、防风为臣，前胡、白芷、川芎为佐，桔梗、杏仁、
甘草为使。热服微覆，汗大泄。少顷，喘嗽吐热顿减，二剂全愈。
薛立斋治儒者薛衡甫子，年七岁，身弱羸，发热面黄。皆以为内伤瘀血，欲下之。谓乃脾脏受伤，投以六
君子汤加煨姜，两服，饮食顿进，数服诸证全愈。
万密斋治一儿发热，日晡犹甚。或作疟作潮热治，俱不效。曰∶此胃虚有宿食也。谓疟疾则寒热有发有止，
谓潮热则发有时，如水之潮过即退，次日根据时再发。此儿身常温，然至申酉时发，故知是宿食发热也。或曰∶
有所据乎？曰∶出仲景《伤寒·正理论》阳明病证云，潮热者实也，宜下之。以三化丸下之而愈。
一儿惊风，时热不退。有议用小柴胡汤者，有欲用竹叶汤者，有欲用凉惊丸者。曰∶大惊之后，脾胃已
虚，宜温补之，三方寒凉，不可用也。乃与理中汤，用炒干姜，一剂热除。
三府张公子，初冬三日发热，又二日热益甚，目上直视，口多妄言。或作风治无效。至二十七日，诊之曰∶
病势将退，但肺热未除耳。问何故？曰∶三关黄润，两目睛精明，此病当愈也。惟正面戴阳，喘气上息，此肺
虚热耳。与小阿胶散，咸阻之。幸不听，一剂喘止热退，欲食而安。
万密斋治黄学仪子，病热不退。其父治之，已八日不效。全叩之，（全，密斋名。）曰∶日夜发热，小便
赤，大便难。再叩药，曰∶先与胃苓丸，（庸手。）今与凉惊丸。全曰∶不效宜矣。其父曰∶汝能已此病乎？
全对曰∶此名风热，乃肝病，宜用泻青丸，热即退矣。黄氏相招，即令全往，如法治之，五日而愈。（然则今
之小儿宜养胃矣。羌活、大黄、芎 、山栀、胆草、当归、防风。）
余氏子病热，诸医汗之，下之，和解之，皆不效，以虚热也。用调元汤加炒干姜，未尽剂而热除。
密斋长男，幼多病。一日，病疟后潮热，日益瘦，先父母忧之。全曰∶此疳气也。用小柴胡加鳖甲、当归、
川芎、陈皮、青皮为丸，服之愈。
冯楚瞻治李氏儿，八岁，病热旬余。发散和解苦寒之剂，备尝无效，势日危笃。诊之，形肉枯槁，牙齿堆
垢，浓而色焦黑，唇舌燥烈，耳聋目盲，遍身疼痛，壮热无汗，谵语烦躁。脉之，沉微欲脱，阴寒之候也。此
釜底无火，锅盖干躁之象。上之假热，由于下之真寒也。乃重用人参、熟地，少加附子，壮水益火。服后，夜
半思食。次日其脉更虚，但神气小清爽，乃倍进前药三四剂，后渐瘳，不十剂全愈。
姜居安治一贵官，携家过沛，抵沙河，稚子病。居安告之曰∶请勿惊，但得沙一斗，病即愈。官如其指，
布沙舟中，令儿卧其上。久之，儿手足能动，不数时而病良已。贵官问故，曰∶小儿纯阳，当春月而衣被皆湖
棉，过于热，故得凉气而解。（《江南通志》。）
冯楚瞻治洪氏儿，未及一周，时当暑热，壮热多日，神气困倦，唇舌焦燥，饮乳作吐，五心亦热如烙，脉
洪数而弦。医与发散消导数剂，复疑麻疹，更为托表。冯曰∶久热伤阴，阴已竭矣，复加托表，阳外越矣。若
不急为敛纳，何以续阴阳于垂绝哉？乃用熟地四钱，麦冬一钱五分，牛膝一钱二分，五味子一分，制附子四分，
一剂热退。次日加炒黄白术一钱六分，另煎人参冲服愈。
张景岳仲男，生于五月，于本年初秋，忽感寒发热，脉微紧数，知其脏气属阴，不敢清解，遂与芎、苏、
羌、芷、细辛、生姜之属，冀散其寒。一剂热不退，反大泻二日不止，继之以喘，愈泻则愈喘。见其表里俱剧，
乃用人参二钱，生姜五片，煎汁半盏，未敢骤进，恐加喘也。与二三茶匙，呼吸仍旧。乃与三四匙，息稍舒。
遂与半小钟，觉有应。遂自午及酉，完此一剂。适一医至，曰∶误矣，焉有大喘可用参者？速宜抱龙丸解之。
张但唯唯，仍用人参二钱五分，如前煎汤，自酉至子尽其剂，气息已平，酣睡泻止，而热亦退矣。所以知其然
者，观其因泻反喘，岂非中虚。设有实邪，自当喘随泻减。向使易以清利，中气脱而死矣，必反咎用参之误也。
孰是孰非，何从辨哉？（此医之所以难为而易为也。）因纪此，见温中散寒之功，其妙有如此者。
按∶是症或者小儿变蒸之热误用峻表，伤其元气，以致喘利。幸服独参挽回，后之所云，亦过后详载
耳。叶天士曰∶五月至新秋，仅两月耳。婴儿不能言语，六脉难凭。初秋暑邪尚炽，感而发热，当用清暑之药。
乃孟浪投以辛温发表，纯阳柔嫩之躯，当暑伤元气之时，肺气焉得不耗散乎？肺与大肠相表里，肺气虚，注其
大肠而作泻，肺气耗散则喘作，此辛温发表之误也，故用参补其肺气而愈。乃不省其药误，反云治病之妙，何
愦愦若此？竟云人参可以冶发热，恐误后人，故不得不为之辨白。
一儿感冷，恶寒大热，用发药则汗出热退，过一二日复热，大便秘，必里未解也。服四顺清凉饮，利一行，
热退，隔日又热，小便赤。服导赤饮热退，过三日又热。庸劣者几无措手矣。诊其脉，脉已和。既发汗又利小
便，其气已虚，阳气无所归，皆见于表，所以热。以六神散和其胃气，加乌梅一枚，令微有酸味，收其阳气归
内，服此全愈。（无名氏。）
又一儿有积热，表里俱热，颊赤口干，小便赤，大便焦黄。用四顺饮利动脏腑，热乃去，既而复热，里解
而表未解也。发散微汗，热乃去，隔日又热。此无他，表里俱虚，气不归元，而阳浮于外，所以再热，实非热
症也。只以六神散入粳米煎，和其胃气，则寒气归内，身体自凉。（同上。二案表里变化。）
潮热者，时间发热，过时即退，日根据时而发，此欲发惊也。壮热者，常热不已，甚则发痫也。风热者，身
热而口中气热，乃风邪外感也。温热者，肢体微热也。发热而不欲饮水者，胃气虚热也。发热而饮水作渴，喜
冷冻饮料食者，胃气实热也。
张子和治疗高巡检的儿子，八岁患热病。医生们都认为是受寒所致，用热性药物攻伐治疗，想让他喝水却禁止不给，导致体内津液枯竭，烦躁不安，大小便闭塞不通，口鼻干燥，寒热往来，咳嗽不时发作，全身无汗。又打算给他施灸。张子和责备孩子的母亲说：“盖上厚重的被子，烧暖炕头，点上红炉火，孩子已经承受不了这种热气了，还可以再施灸吗？”先让服用人参柴胡饮子，连续服下几剂后，排出像烂鱼肠一样的秽物，气味异常恶臭，口渴想喝水，听任他想要什么就喝什么，冰雪凉水连喝几杯。接着又排便三四十次，大热症状才消退。又给予牛黄通隔丸，再次排便十多次，孩子才完全康复。前后大约排泄五十多次，身体毫无困倦之感，冰雪水喝了一斛之多。如果当时施灸会怎么样呢？
吕东庄治疗吴尹明的儿子，十岁，夜间发热两年多，下巴突然肿胀坚硬如石头，面色发黄，时常流鼻血如注。诊脉发现，沉郁之气独见于阳关（右关脉），说：“这是脾土敦阜之症。”（右关脉主脾胃，沉郁表示实热证，“敦阜”一词暗示病情深重不易察觉。）使用石膏、藿香叶、栀子、防风、黄连、甘草等药，颌下肿块逐渐变软，面色恢复正常。继而又用茯苓、枇杷叶、元参、枳壳、山栀、茵陈、石斛、天冬、麦冬、生地黄、熟地黄煎服（即甘露饮），并重加黄连，于是鼻出血和夜间发热全部消除。
陆养愚治疗李邑宰的儿子，十一岁，在六月夜间，忽然发热微汗，头部轻微疼痛。有人说是伤暑，给予香薷饮冷服，病情反而加重，且出现气喘咳嗽痰多。又有人说脉象浮数，是火热上炎，用黄芩、黄连、知母、花粉清热，但喘咳不止，不想饮食，睡卧不安。诊脉弦紧，左侧比右侧明显，面色赤红如戴阳状。这是风寒外束，应当发散解表。有人说：“正值炎热夏天，且身上常有汗，怎么适宜用发汗解表法？”回答说：“正因为风寒损伤了卫阳之气，使体表的阳气被拒而不能入内，所以微微出汗不止；体内的阳气伏郁而不能外出，所以身体感到持续壮热。如果解散了邪气，那么外部的阳气得以进入，内部的阳气得以发出，自汗停止，身体自然凉爽。”用干葛为君药，苏叶、防风为臣药，前胡、白芷、川芎为佐药，桔梗、杏仁、甘草为使药。热服后覆盖被子取微汗，大汗一出，片刻之间，气喘咳嗽吐出热痰的症状立刻减轻，两剂药后完全痊愈。
薛立斋治疗儒生薛衡甫的儿子，七岁，身体瘦弱羸乏，发热面色发黄。大家都认为是内伤瘀血，想要用泻下法。薛立斋认为这是脾脏受伤，投以六君子汤加煨姜，服两剂后，饮食立刻增加，服几剂后所有症状全部痊愈。
万密斋治疗一个儿童发热，傍晚时分更加严重。有人按疟疾或潮热治疗，都不见效。万密斋说：“这是胃虚有宿食。”他说如果是疟疾，则寒热有发作和停止的时候；如果是潮热，则有固定的发作时间，像潮水一样退去后，第二天按时再发。这个孩子平时体温正常，但到了申时、酉时（下午3-7点）发热，所以知道是宿食引起的发热。有人说：“有什么依据吗？”回答说：“出自张仲景《伤寒论·正理论》阳明病证中说：‘潮热者实也，宜下之。’”于是用三化丸泻下而痊愈。
另一个孩子患惊风，时时发热不退。有人建议用小柴胡汤，有人想用竹叶汤，有人想用凉惊丸。万密斋说：“大惊之后，脾胃已经虚弱，应当温补，这三方都是寒凉的，不可使用。”于是给予理中汤，用炒干姜，一剂药后热除。
三府张家的公子，初冬三天发热，又两天热度更甚，眼睛向上直视，口中多说胡话。有人按风邪治疗无效。到第二十七日，诊察说：“病势将要消退，只是肺热未清除罢了。”问为什么这么说？回答说：“三关指纹黄润，两眼瞳孔精明，这说明病当愈。只有正面戴阳，喘息气逆，这是肺虚热。”给予小阿胶散，众人极力阻止。幸好没听他们的，一剂药后喘息停止，热退，想吃东西且安静下来。
万密斋治疗黄学仪的儿子，病热不退。他的父亲治疗，已经八天无效。详细询问病情，回答说：“日夜发热，小便赤，大便难。”再问用药情况，回答说：“先用胃苓丸，现在用凉惊丸。”万密斋说：“不效是应该的。”他父亲说：“你能治好这病吗？”万密斋回答说：“这叫风热，属于肝病，应当用泻青丸，热就会退。”黄家相邀，立即让万密斋前往，照此法治，五天痊愈。（然而现在的儿科医生宜养胃气。方药组成：羌活、大黄、川芎、山栀、胆草、当归、防风。）
余氏的儿子患热病，各位医生用发汗、泻下、和解的方法，都不见效，认为是虚热。用调元汤加炒干姜，药还没吃完热就退了。
万密斋的大儿子，小时候多病。一天，患疟疾后出现潮热，日益消瘦，父母很担忧。万密斋说：“这是疳气。”用小柴胡汤加鳖甲、当归、川芎、陈皮、青皮制成丸药，服用后痊愈。
冯楚瞻治疗李氏的儿子，八岁，患热病十多天。发散、和解、苦寒的药物都试过了，无效，病情日益危重。诊察发现，形体肌肉枯槁，牙齿堆积污垢，厚且色焦黑，嘴唇舌头干燥烈痛，耳聋目盲，全身疼痛，壮热无汗，谵语烦躁。诊脉沉微欲脱，是阴寒的征候。这是釜底无火，锅盖干燥的现象。上面的假热，是由于下面的真寒造成的。于是重用的人参、熟地，少加附子，壮水益火。服药后，半夜想吃东西。第二天脉象更虚，但神气稍微清爽，于是加倍进服前药三四剂，后来逐渐好转，不到十剂完全痊愈。
姜居安治疗一位高官，带着家人经过沛县，到达沙河，幼子生病。姜居安告诉他说：“请不要惊慌，只要弄得一斗沙，病就会好。”官员照着他的指示，把沙铺在船中，让孩子躺在上面。很久之后，孩子手脚能动，不一会儿病就好了。高官问原因，回答说：“小儿纯阳之体，在春月穿衣盖被都是湖棉，过于热，所以得到凉气就解除了。”（出自《江南通志》。）
冯楚瞻治疗洪氏的儿子，不满一周岁，正值暑热天气，壮热多天，神气困倦，嘴唇舌头焦燥，吃奶呕吐，五心（两手心、两足心及心口）也热得像烙铁，脉象洪数而弦。医生给发散消导几剂，又怀疑是麻疹，改为托表透疹。冯楚瞻说：“久热伤阴，阴已竭尽，再加托表透发，阳气就要外越了。如果不赶紧收敛纳气，凭什么在阴阳垂绝之时延续生机呢？”于是用熟地四钱，麦冬一钱五分，牛膝一钱二分，五味子一分，制附子四分，一剂药后热退。第二天加炒黄白术一钱六分，另煎人参冲服而愈。
张景岳的二儿子，生于五月，在本年初秋，忽然感受寒冷发热，脉微紧数，知道他脏腑之气属阴，不敢用清解法，于是用川芎、苏叶、羌活、白芷、细辛、生姜之类，希望散去寒气。一剂药后热不退，反而大泻两天不止，继之以气喘，泻得越多喘得越厉害。见其表里症状都剧烈，于是用人参二钱，生姜五片，煎汁半盏，不敢一下子进服，怕加重气喘。先给二三茶匙，呼吸依旧。再给三四匙，气息稍舒。于是给半小钟，觉得有效。从午时到酉时，喝完这一剂。恰好有一位医生到来，说：“错了，哪有喘证用人参的？快用抱龙丸来解。”张景岳只是答应着，仍然用人参二钱五分，像之前那样煎汤，从酉时到子时喝完，气息已平，酣睡泻止，热也退了。之所以知道这样做是对的，观察他因为腹泻反而气喘，难道不是中气虚吗？如果有实邪，自然会随着腹泻而喘减。假如换成清利之法，中气脱失而死，一定会反过来责怪用人参的错误。谁是谁非，从何辨别呢？（这就是医生之所以难做也容易做错的原因。）记录此事，可见温中散寒的功效，奇妙竟达到如此地步。
按语：这个症状或许是小儿变蒸之热误用峻猛发汗药，损伤元气，以致气喘腹泻。幸亏服用独参汤挽回，后面的说法，也是事后详细记载罢了。叶天士说：“五月到新秋，仅仅两个月。婴儿不能言语，六脉难以凭信。初秋暑邪尚炽盛，感而发热，应当用清暑的药。竟然鲁莽地投以辛温发表药，对于纯阳柔嫩的躯体，在暑邪损伤元气的时候，肺气怎么能不耗散呢？肺与大肠相表里，肺气虚，注于大肠而作泻，肺气耗散则喘作，这是辛温发表的错误，所以用人参补肺气而愈。却不明白是药误，反而说治病的神妙，为何糊涂到这种地步？竟说人参可以治发热，恐怕误导后人，所以不得不为之辩白。”
一个孩子感受寒冷，恶寒大热，用发汗药则汗出热退，过一两天又发热，大便秘结，必定是里邪未解。服用四顺清凉饮，利下一行，热退，隔日又发热，小便赤。服用导赤饮热退，过三天又发热。庸医几乎无计可施。诊其脉，脉已调和。既然发汗又利小便，其气已虚，阳气无所归依，都显现于体表，所以发热。用六神散调和胃气，加乌梅一枚，令其微有酸味，收敛阳气归于内，服用此方全愈。（无名氏著）
又一个孩子有积热，表里俱热，脸颊红赤口干，小便赤，大便焦黄。用四顺饮利动脏腑，热乃去除，过后又发热，里邪已解而表邪未解。发散微汗，热乃去除，隔日又发热。这没有别的原因，是表里俱虚，气不归元，而阳浮于外，所以再次发热，其实并非热症。只用六神散加入粳米煎煮，调和胃气，则寒气归内，身体自然凉爽。（同上。两个案例关于表里的变化。）
潮热，是指定时发热，过时即退，每天按时发作，这是将要发惊风的征兆。壮热，是指常热不已，严重时发痫病。风热，是指身体热而口中呼气热，是风邪外感所致。温热，是指肢体轻微发热。发热而不想喝水的，是胃气虚热。发热而饮水作渴，喜欢冷冻饮料食物的，是胃气实热。
Zi Hezi treated the son of Patrol Officer Gao, who was eight years old and suffering from fever. Physicians all believed it was caused by cold injury and used hot-natured drugs to attack it. They wanted him to drink water but prohibited giving it to him, causing internal fluids to dry up. This led to restlessness, convulsions, blockage of both anterior (urination) and posterior (defecation) orifices, dryness of the mouth and nose, alternating chills and fever, intermittent coughing, and absence of sweat over the whole body. They then intended to apply moxibustion. Zi Hezi reproached the mother, saying, "With heavy quilts, a heated kang bed, and red-hot stoves, the child can already no longer bear the heat; how can you still apply moxibustion?" First, he ordered the administration of *Renshen Chaihu Yinzi* (Ginseng and Bupleurum Decoction). After several doses, the child passed foul-smelling, rotten fish-intestine-like stool. Thirsty and desiring water, he was allowed to drink as much as he wished, consuming cups of ice-cold water repeatedly. Subsequently, he defecated thirty to forty times, and only then did the high fever subside. He was then given *Niuhuang Tongge Wan* (Calculus Bovis Intestinal Obstruction Pill), after which he defecated more than ten times, and the child fully recovered. In total, he defecated about fifty times without any sign of exhaustion, having consumed one hu (a unit of volume) of ice water. What would have happened if moxibustion had been applied?
Lu Dongzhuang treated the son of Wu Yinming, aged ten, who had suffered from night fevers for over two years. Suddenly, his submandibular region became swollen and hard as stone, his complexion turned yellow, and he experienced frequent profuse epistaxis. Upon palpating the pulse, a sunken and stagnant qi was found exclusively at the Yangguan position (Right Guan pulse). Lu stated, "This is 'Dunfu' syndrome" (The Right Guan pulse governs the Spleen and Stomach; sunken and stagnant indicates an excess-heat pattern; 'Dunfu' implies a deep-seated condition difficult to discern). He prescribed Shigao (Gypsum Fibrosum), Huoxiang Ye (Agastache Folium), Zhizi (Gardeniae Fructus), Fangfeng (Saposhnikoviae Radix), Huanglian (Coptidis Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma). The submandibular swelling gradually softened, and the yellow complexion returned to normal. Subsequently, he administered Fuling (Poria), Pipaye (Loquat Leaf), Yuanshen (Scrophulariae Radix), Zhike (Aurantii Fructus), Shanzhi (Gardeniae Fructus), Yichen (Capillaris Herba), Shihu (Dendrobii Caulis), Tianmendong (Asparagi Radix), Maidong (Ophiopogonis Radix), and Sheng/Dishu Dihuang (Rehmanniae Radix Preparata), known as *Ganlu Yin* (Sweet Dew Decoction), with added Huanglian (Coptidis Rhizoma). Consequently, the epistaxis and night fevers were completely eliminated.
Lu Yangyu treated the son of Magistrate Li, aged eleven. One night in June, he suddenly developed a slight fever with mild sweating and a mild headache. Some attributed it to summerheat injury and prescribed *Xiangru Yin* (Elsholtzia Decoction) taken cold, which worsened the condition, leading to wheezing, coughing, and phlegm. Others noted a floating and rapid pulse, indicating flaming-up fire, and prescribed Qingre (clearing heat) herbs such as Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Huafen (Trichosanthis Radix). However, the wheezing and coughing persisted, appetite was lost, and sleep was restless. Palpation revealed a wiry and tight pulse, stronger on the left than the right, with a flushed face resembling "floating yang." Lu diagnosed this as exterior constraint by wind-cold, requiring dispersal and release. Someone questioned, "In such hot weather, with constant sweating, how can we use diaphoretic methods?" Lu replied, "Precisely because wind-cold has injured the Wei-yang (Defensive Yang) qi, preventing external yang from entering, hence the persistent mild sweating. Internal yang is trapped and cannot exit, hence the continuous intense heat. If we resolve the pathogen, external yang will enter, and internal yang will emerge, stopping the spontaneous sweating and cooling the body." He used Gegen (Puerariae Lobatae Radix) as the sovereign herb, Suye (Perilla Folium) and Fangfeng (Saposhnikoviae Radix) as minister herbs, Qianhu (Peucedani Radix), Baizhi (Angelicae Dahuricae Radix), and Chuanxiong (Ligustici Chuanxiong Rhizoma) as assistant herbs, and Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), and Gancao (Glycyrrhizae Radix et Rhizoma) as envoy herbs. Taken hot with light covering to induce mild sweating, profuse sweating occurred. Shortly after, wheezing, coughing, and expulsion of hot phlegm decreased significantly, and full recovery was achieved in two doses.
Xue Lizhai treated the son of Scholar Xue Hengfu, aged seven, who was emaciated, feverish, and had a sallow complexion. All assumed it was internal injury with blood stasis and desired to purge. Xue identified it as Spleen injury and prescribed *Liujunzi Tang* (Six Gentlemen Decoction) with Weijiang (Roasted Ginger). After two doses, appetite improved drastically, and after several doses, all symptoms resolved.
Wan Muzhai treated a child with fever that intensified in the late afternoon. Treatments for malaria or tidal fever were ineffective. Wan stated, "This is stomach deficiency with retained food." He explained that malaria presents with alternating chills and fever with intervals, while tidal fever occurs at specific times like the tide. This child was usually normal but febrile during Shen and You hours (3 PM–7 PM), indicating retained food fever. When asked for evidence, he cited Zhang Zhongjing's *Shanghan Lun*: "Tidal fever indicates excess; purgation is indicated." He used *Sanhua Wan* (Three Transformations Pill) to purge, resulting in recovery.
Another child suffered from convulsions with persistent fever. Suggestions included *Xiaochaihu Tang* (Minor Bupleurum Decoction), *Zhuye Tang* (Bamboo Leaf Decoction), or *Liangjing Wan* (Cooling Convulsion Pill). Wan argued, "After severe fright, the Spleen and Stomach are deficient; warming and tonification are needed. These three formulas are cold and cooling and should not be used." He prescribed *Lizhong Tang* (Regulate the Middle Decoction) with fried Ganjiang (Zingiberis Rhizoma). One dose eliminated the fever.
The young master of the Zhang family in Sanfu suffered from fever for three days in early winter, worsening over the next two days, with upward staring eyes and delirious speech. Wind treatments failed. On the 27th day, upon examination, Wan said, "The disease trend is receding, but Lung heat remains." Asked why, he replied, "The three pulses are yellow and moist, and the pupils are bright, indicating recovery. Only the facial flushing (floating yang) and asthmatic breathing indicate Lung deficiency heat." He prescribed *Xiao Ejiao San* (Small Donkey-Hide Gelatin Powder). Despite opposition, one dose stopped the asthma and fever, restored appetite, and brought calm.
Wan Muzhai treated the son of Scholar Huang, whose fever persisted despite eight days of treatment by his father. Detailed inquiry revealed day-and-night fever, dark urine, and difficult defecation. Medications used previously were *Weiling Wan* (Stomach-Lining Pill) and *Liangjing Wan*. Wan remarked, "No wonder they failed." The father asked if he could cure it. Wan diagnosed "Wind-Heat" affecting the Liver and prescribed *Xieqing Wan* (Draining Green Pill). Following this regimen, the child recovered in five days. (Note: Pediatricians today should nourish the Stomach Qi. Ingredients: Qianghuo, Dahuang, Chuanxiong, Shanzhi, Dancao, Danggui, Fangfeng.)
The son of Mr. Yu suffered from fever. Sweating, purging, and harmonizing methods failed; it was deemed deficiency heat. *Tianyuan Tang* (Origin-Regulating Decoction) with fried Ganjiang (Zingiberis Rhizoma) was used, and the fever subsided before the course was finished.
Wan Muzhai’s eldest son, often ill in childhood, developed tidal fever after malaria, becoming increasingly emaciated. Parents were worried. Wan diagnosed "Gan Qi" (Malnutrition Syndrome) and prescribed pills made from *Xiaochaihu Tang* plus Biejia (Testudinis Carapax et Plastrum), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Qingpi (Citri Reticulatae Pericarpium Viride). Recovery followed.
Feng Chuzhan treated Li’s son, aged eight, with fever for over ten days. Diaphoretics, harmonizers, and bitter-cold agents had failed, and the condition deteriorated. Examination showed emaciation, dirty black teeth, dry/cracked lips and tongue, deafness, blindness, body pain, high fever without sweat, delirium, and restlessness. The pulse was deep, minute, and nearly imperceptible, indicating Yin-cold. Feng described this as "fireless stove, dry lid": false heat above due to true cold below. He heavily used Renshen (Ginseng Radix et Rhizoma) and Shudi (Rehmanniae Radix Preparata), with a little Fuzi (Aconiti Lateralis Radix Preparata) to strengthen Water and benefit Fire. By midnight, the child desired food. The next day, the pulse was weaker but spirit slightly clearer. Doubling the previous prescription for three to four doses led to gradual improvement, and full recovery in less than ten doses.
Jiu Jian’an treated a noble official’s child who fell ill upon arriving at Shahe. Jiu advised, "Do not panic. Obtain one dou of sand, spread it in the boat, and let the child lie on it." After some time, the child moved limbs, and the illness resolved quickly. Explaining, Jiu said, "Children are pure Yang. In spring, wearing cotton makes them too hot; cooling air resolves it." (*Jiangsu General Gazette*).
Feng Chuzhan treated Hong’s infant, under one week old, during summer heat. High fever for days, lethargy, dry/cracked lips and tongue, vomiting milk, hot palms/soles/chest, and a flooding, rapid, wiry pulse. Previous doctors used diaphoretics, digestion aids, and measles-resolving methods. Feng stated, "Prolonged heat injures Yin; Yin is exhausted. Adding dispersing/resolving methods causes Yang to escape. Without urgent astringency and gathering, how can Yin and Yang be sustained near collapse?" He prescribed Shudi (4 qian), Maidong (1.5 qian), Niuxi (1.2 qian), Wuweizi (0.1 fen), and Zhifuzi (0.4 fen). Fever subsided after one dose. Next day, Bai Zhu (1.6 qian) was added, and Renshen (Ginseng Radix et Rhizoma) decocted separately and mixed in. Recovery ensued.
Zhang Jingyue’s second son, born in May, caught cold and fever in early autumn. Pulse was micro-tight and rapid. Knowing his organ qi was Yin-deficient, Zhang avoided clearing/cold methods and used Xiong (Chuanxiong), Su (Perillae Folium), Qiang (Qianghuo), Zhi (Baizhi), Xixin (Asari Radix et Rhizoma), and Shengjiang (Zingiberis Rhizoma Recens) to disperse cold. Fever persisted, followed by severe diarrhea for two days and subsequent wheezing; worse diarrhea meant worse wheezing. Seeing severe exterior-interior symptoms, Zhang used Renshen (2 qian) and Shengjiang (5 slices) decocted in half a cup. Fearful of worsening wheezing, he gave 2-3 tea spoons first; breathing remained unchanged. Then 3-4 spoons; breathing eased. Finally, half a small cup was given. From Wu to You hours, the dose was completed. Another physician arrived, criticizing, "Mistake! Who uses Ginseng for wheezing? Use Baolong Wan immediately." Zhang persisted, using Renshen (2.5 qian) decocted similarly until Zi hour. Breathing normalized, sleep deepened, diarrhea stopped, and fever subsided. Reasoning: Diarrhea-induced wheezing indicates Middle Deficiency. With excess pathogens, wheezing would decrease with diarrhea. Had clearing/drainage been used, Middle Qi collapse and death would have occurred, likely blaming Ginseng. Who is right? This illustrates the difficulty of medicine. Recording this shows the miracle of warming the middle and dispersing cold.
Commentary: This case might involve misdiagnosed infant metabolic fever ("Bianzheng") treated with harsh diaphoretics, damaging Yuan Qi, causing wheezing and diarrhea. Fortunately, Dushen Tang (Single Ginseng Decoction) saved him. Ye Tianshi commented: "From May to early autumn is only two months. Infants cannot speak, making pulse diagnosis difficult. Early autumn summerheat is strong; fever should be treated with summerheat-clearing herbs. Recklessly using acrid-warm diaphoretics on pure-Yang tender bodies during summerheat-induced Qi damage causes Lung Qi dispersion. Lung and Large Intestine are interior-exterior partners; Lung Qi deficiency leads to diarrhea, and dispersion causes wheezing. This was an error of acrid-warm diaphoretics; Ginseng replenished Lung Qi for cure. Not realizing the medication error, claiming therapeutic miracles is ignorant. Saying Ginseng cures fever may mislead future generations, necessitating this clarification."
One child felt cold, with aversion to cold and high fever. Diaphoretics induced sweating and fever resolution, but recurrence after 1-2 days with constipation indicated unresolved interior pathology. *Sishun Qingliang Yin* (Four-Obedience Cooling Clearing Decoction) relieved one bowel movement, fever subsided, but recurred after two days with dark urine. *Daochi Yin* (Guide Out Red Decoction) worked temporarily, but fever returned after three days. Physicians were baffled. Pulse was harmonious. Post-sweating and diuresis indicated Qi deficiency; unanchored Yang manifested on the surface, causing fever. *Liushen San* (Six Spirits Powder) harmonized Stomach Qi, adding one Wumei (Myrabolana Fructus) for sour taste to anchor Yang internally. Full recovery resulted. (Anonymous)
Another child had accumulated heat, presenting with exterior-interior heat, red cheeks, dry mouth, dark urine, and dry yellow stool. *Sishun Yin* moved the bowels, resolving heat, but recurrence indicated resolved interior but unresolved exterior. Mild diaphoresis resolved heat, but recurrence after two days indicated exterior-interior deficiency, Qi failing to return to its source, with Yang floating externally—false heat. *Liushen San* with Jingmi (Oryza Sativa Germ) harmonized Stomach Qi, returning cold internally and cooling the body. (Same source. Two cases on exterior-interior changes.)
Tidal fever: Fever at specific times, resolving afterwards, recurring daily at the same time; indicates impending convulsions. Intense fever: Continuous fever, potentially leading to epilepsy. Wind-heat: Body heat with hot breath; external wind pathogen. Warm-heat: Mild limb heat. Fever without thirst: Stomach Qi deficiency heat. Fever with thirst, preferring cold drinks/food: Stomach Qi excess heat.