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When infants and children suffer from fever due to illness, the clinical manifestations vary, and treatment methods differ accordingly. It is essential to distinguish between deficiency (Xu) and excess (Shi), and one must not blindly employ sweating or purgation therapies.

Fever caused by wind injury presents with symptoms such as sweating, body heat, yawning, red and gritty eyes, drowsiness, aversion to wind, and rapid breathing. This results from exposure to wind due to inadequate clothing. The appropriate approach is to disperse wind, relax the muscles, and reduce fever. Initially, Chai Ge Jie Ji Tang (Bupleurum and Pueraria Decoction to Release the Muscles) should be administered to expel wind pathogens. Once the fever subsides, Liang Jing Wan (Cooling Agitation Pill) should be taken to prevent internal heat.

Fever caused by cold injury presents with symptoms such as anhidrosis, body heat, yawning, restlessness, neck stiffness, facial redness, rapid breathing, aversion to cold, and hot breath. This results from exposure to cold due to inadequate clothing. The appropriate approach is to disperse cold pathogens, reduce fever, and calm agitation. Initially, Xing Xing San (Xingxing Powder) should be administered to expel cold pathogens, followed by Liang Jing Wan (Cooling Agitation Pill) to prevent internal heat.

For the above two conditions, if the child has a strong constitutional endowment, Liang Jing Wan (Cooling Agitation Pill) may be used. If the constitution is weak, it is better to use only Wei Ling Wan (Stomach Calming Pill), which is highly effective.

If fever is accompanied by wind-cold injury and also involves vomiting and diarrhea, dispersing therapy should not be used, as this indicates spleen and stomach weakness. Instead, Wu Ling San (Five-Ingredient Powder with Poria) should be used to swallow Li Zhong Wan (Regulate the Middle Pill), which is highly effective.

Fever caused by heat injury often occurs in summer. Symptoms include body heat, spontaneous sweating, thirst, lethargy, and heat in both hands and feet. This results from hot weather combined with excessive wrapping, leading to double exposure to heat. Initially, Bai Hu Tang (White Tiger Decoction) mixed with Yi Yuan San (Benefit Origin Powder) should be used to resolve the heat; subsequently, Tiao Yuan Sheng Mai San (Regulate Origin and Generate Pulse Powder) should be taken to tonify healthy qi.

Heat stroke-induced fever also commonly occurs in summer. Symptoms include body heat, spontaneous sweating, thirst, lethargy, and cold hands and feet. This results from excessive cooling in air-conditioned or shaded rooms. Tiao Yuan Sheng Mai San (Regulate Origin and Generate Pulse Powder) should be taken to tonify original qi, followed by Si Jun Zi Tang (Four Gentlemen Decoction) to prevent vomiting and diarrhea.

If sweating during summer exposes the body to wind, resulting in body heat and continuous spontaneous sweating throughout the body, this is termed "Summer Wind" (Shu Feng). Si Jun Zi Tang (Four Gentlemen Decoction) added with Mahuang Gen (Ephedrae Radix et Rhizoma) and Huang Qi (Astragali Radix) should be used to dispel wind, followed by Yi Yuan San (Benefit Origin Powder) to clear heat.

Fever caused by food stagnation presents with particular heat in the palms and abdomen, belching, regurgitation of milk, sour-smelling stools, abdominal pain with frequent crying, bloating, rapid breathing, and loss of appetite for milk and food. This results from overeating. Initially, laxatives should be used to remove accumulation, employing Ding Xiang Pi Ji Wan (Clove Spleen Accumulation Pill), followed by Ji Sheng Wan (Accumulation Sage Pill) for regulation.

If food stagnation persists for a long time, leading to gradual emaciation and yellowish complexion with intermittent fever, purgation should not be used. For mild cases, Bao He Wan (Preserve Harmony Pill) is used; for severe cases, Ji Sheng Wan (Accumulation Sage Pill) is used, with high efficacy.

Fever associated with smallpox and measles presents with dry face, red cheeks, red eyelids, yawning, restlessness, alternating hot and cold sensations, coughing, sneezing, cold fingers and toes, fright, and drowsiness. This results from contagious seasonal smallpox or measles. Clearing heat and detoxifying is appropriate. For smallpox, Shen Su Yin (Ginseng and Perilla Infusion) added with Mu Xiang (Aucklandiae Radix) is suitable; for measles, Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Detoxifying Powder) is used. Blindly applying sweating or purgation therapies should be avoided to prevent complications. If it is "transformation fever," this is a common pediatric condition requiring no medication (see relevant section).

Tidal fever should be divided into two types: one occurs at specific times, resolves after a while, and recurs daily at the same time, resembling malaria; this is Lung Heat. The other occurs morning and evening, twice daily, like the tide arriving on schedule; this is Stomach Heat. Generally, this arises from pathogenic factors causing blood vessel stagnation and impaired circulation. If untreated, it often transforms into convulsive malnutrition (Jing Gan). Lung Heat is treated primarily with Di Gu Pi San (Lycii Cortex Powder), and Stomach Heat is purged with San Huang Wan (Three Yellows Pill). Deficiency heat is regulated with Ji Sheng Wan (Accumulation Sage Pill).

Agitation fever presents with whole-body heat, bluish-green complexion, spontaneous sweating, palpitations, restlessness, rapid pulse, shouting, and trance-like states; this is Heart Heat. Liang Jing Wan (Cooling Agitation Pill) reduces fever, and An Shen Wan (Calming Spirit Pill) stabilizes the heart.

Night fever manifests only at night and subsides during the day; this is a Blood Deficiency syndrome. Ren Dang Gui San (Ginseng and Angelica Powder) treats it, supplemented with Bao Long Wan (Embracing Dragon Pill) to prevent convulsions.

Residual heat occurs when fever returns after sweating for cold damage, indicating deficiency in both exterior and interior, qi failing to return to its source, and yang floating externally. Cold-natured drugs should not be used again, as cautioned by ancient masters. Harmonizing stomach qi to allow yang to converge will naturally subside the heat. Ren Shen Cang Zhu San (Ginseng and Atractylodes Macrocephala Powder) is indicated. In severe cases, Si Jun Zi Tang (Four Gentlemen Decoction) added with fried Gan Jiang (Zingiberis Rhizoma) is effective.

Malnutrition fever presents with sallow and emaciated appearance, failure to gain weight despite eating, bone-stealing night sweats, irregular diarrhea, large abdomen, and small legs. This often follows serious illness with improper care, or irregular eating habits. Ji Sheng Wan (Accumulation Sage Pill) is used for regulation.

Robust fever is persistent and unremitting, caused by qi and blood congestion, heat generated in the five zang organs, and郁蒸 (stagnant steaming) internally. This leads to restless sleep and mental confusion; externally, it causes whole-body heat, dryness, irritability, and coarse breathing, potentially developing into convulsions. Dao Chi San (Guide Out Red Powder) and Xie Qing Wan (Drain Green Pill) treat the heat initially; Bao Long Wan (Embracing Dragon Pill) calms convulsions later. If there is excess heat with constipation of stool and urine, San Huang Wan (Three Yellows Pill) purges it.

Irritable heat presents with mental restlessness, heat in the five centers (palms, soles, chest), warm limbs, and dark red urine. Dao Chi San (Guide Out Red Powder) added with Mai Dong (Ophiopogonis Radix) and Shan Zhi Ren (Gardeniae Semen) treats it, followed by Liang Jing Wan (Cooling Agitation Pill) to eliminate residual pathogens.

Accumulated heat presents with red cheeks, oral ulcers, and dark, scanty urination and defecation, indicating excess in both exterior and interior. This can result from internal injury due to alcohol, wheat, heating herbs, or aggressive tonification, or external invasion by thick cotton and stove fires. This is accumulated heat from internal and external sources, not food stagnation. San Huang Wan (Three Yellows Pill) purges it initially, followed by Liang Jing Wan (Cooling Agitation Pill) for regulation.

Deficiency heat may result from excessive sweating or purgation consuming fluids, or from damaged original qi after serious illness. Symptoms include fatigue, weakness, bluish-white complexion, spontaneous sweating, sluggish spirit, weak respiration, and cold extremities. This indicates deficiency of both qi and blood; qi deficiency leads to collapse (Jue), while blood deficiency leads to fever. Si Jun Zi Tang (Four Gentlemen Decoction) added with fried Gan Jiang (Zingiberis Rhizoma) is used; in severe cases, one piece of Shu Fu Zi (Prepared Aconite Lateral Root) is added. Once the fever subsides slightly, Liang Jing Wan (Cooling Agitation Pill) regulates it.

Guest heat occurs when yang pathogens invade the heart. If the heart is affected, heat appears on the forehead, starting in the head and face with body heat, trance-like states, fright, and fear of sounds. This results from deficiency of the five qi allowing pathogens to prevail, leading to conflict. Fever is irregular, advancing and retreating like a guest. Dao Chi San (Guide Out Red Powder) dispels the pathogen initially, followed by Liang Jing Wan (Cooling Agitation Pill) for regulation.

Pi mass heat results from undigested milk and food stagnating internally, forming masses that generate internal heat, burning externally. Ji Sheng Wan (Accumulation Sage Pill) is indicated.

Malaria heat presents with alternating chills and fever. Symptoms may include headache with sweating, vomiting and anorexia, aversion to cold with robust fever and turbidity, generalized body pain, or vomiting and diarrhea. Given the variety of symptoms and causes, treatments vary: headache with sweating and generalized pain are treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Cang Zhu (Atractylodis Rhizoma) and Qiang Huo (Notopterygii Rhizoma); abdominal pain is purged with Pi Ji Wan (Spleen Accumulation Pill); thirst is treated with Bai Zhu San (Atractylodes Macrocephala Powder); vomiting and diarrhea are treated with Li Zhong Tang (Regulate the Middle Decoction). Ping Mie Yang Pi Wan (Stop Malaria and Nourish Spleen Pill) is used afterward for regulation.

Blood heat presents with fever during the Si and Wu hours (9 AM - 1 PM), cooling at night; this is Heart Heat. Mild cases are treated with Dao Chi San (Guide Out Red Powder); severe cases with Si Shun Yin (Four Smooth Infusion).