小儿表症。谓外感风寒。其见证必先发热。然发热之证有三。最宜详辨。不可一概混同
也。其在冬月感于寒者。头痛。身痛。项背强。恶寒。壮热无汗。脉浮而紧。此太阳表证。
药得法。一汗即解。详见实论。其感于风者。头痛鼻塞。流涕。发热。或有汗恶风。或无汗
恶寒。或咳嗽干呕。脉浮而数。或紧。此四时之感冒是也。治法不可大发散。微表之即已
如易简参苏饮。惺惺散之类主之。大抵近日人情。爱护小儿者众。富贵之家。重衣浓褥。贫
贱之子亦皆衣絮。以致汗液不断。腠理疏泄。偶触微风。即成感冒。是以迩来小儿。冬月
感寒之症。百无一二。而伤风发热之症恒多也。至若内因于虚。发热之症极多。最为疑似。
人殊不知。更宜详辨。如阳虚生寒。阴虚发热。血虚发躁而热。气虚自汗不能食而热。气虚
注夏而热。暑湿合病而热。汗后阴虚。阳无所附而热。汗后阳虚。阴无所附而热。阳气下入
阴中。昼安静。夜烦躁而热。重阳无阴。夜安静。昼烦躁而热。以上诸症。同一发热也。若
误表之必死。其次则又有变蒸之热。将发痘疹之热。亦同一发热也。而援守各异。每见庸
医。一遇发热。动皆表散。殊不知病有微甚。热有虚实。虽同一发热。而治法殊途。攻补迥
。业幼科者。于临症之际。务宜细心体认。必先问其病之新久。曾未服药。以及一切爱恶
状。然后再察其热之温壮。形之强弱。脉之虚实。色之夭泽。合四者以决之。庶无误人于夭
札也。盖外感为暴病。其发热也骤。必手背热。脉浮。身热无汗。仍须分别虚实以治之。详
见虚实门。若无手背热脉浮身热无汗等症。或发热已久。则非外感证矣。治者审焉。
Pediatric exterior syndromes refer to exogenous contraction of Wind-Cold. The clinical manifestations invariably begin with fever. However, there are three types of febrile conditions that require careful differentiation; they must not be treated indiscriminately as a single entity.
If contracted in winter due to Cold pathogen, symptoms include headache, body pain, stiffness and rigidity of the neck and back, aversion to cold, high fever without sweating, and a floating and tight pulse. This is an Exterior Syndrome of the Taiyang (Greater Yang) Channel. If the medication is appropriate, the condition can be resolved through diaphoresis (sweating). For detailed information, see the "Excess Syndromes" chapter.
If contracted due to Wind pathogen, symptoms include headache, nasal congestion, rhinorrhea, fever, possibly accompanied by sweating and aversion to wind, or no sweating but aversion to cold, or cough and dry retching. The pulse may be floating and rapid, or tight. These are common colds occurring in all four seasons. The treatment method should not involve excessive dispersion; mild release of the exterior is sufficient. Formulas such as Yijian Rensu Yin (Easy-to-Use Ginseng and Perilla Decoction) and Xingxing San (Stirring Up Powder) are primarily used.
Generally speaking, recent trends show that people are overly protective of children. Wealthy families dress children in heavy clothes and thick bedding, while even poor children wear cotton-padded garments. This leads to continuous sweating and laxity of the Cou Li (pores and interstices). Consequently, slight exposure to wind easily results in a common cold. Therefore, among contemporary children, cases of Winter Cold contraction account for only one or two out of a hundred, whereas cases of Wind-Injury with fever are very common.
Regarding fevers caused by internal deficiency, there are numerous variations, making them highly prone to misdiagnosis. People often fail to recognize this, necessitating careful differentiation. Examples include: Cold generated from Yang deficiency; Fever generated from Yin deficiency; Irritability and heat from Blood deficiency; Spontaneous sweating, inability to eat, and heat from Qi deficiency; Summerheat exacerbation and heat from Qi deficiency; Heat from combined Summerheat-Dampness disease; Heat after sweating due to Yin deficiency where Yang has no attachment; Heat after sweating due to Yang deficiency where Yin has no attachment; Heat with daytime calmness and nighttime irritability due to Yang Qi sinking into Yin; Heat with daytime calmness and nighttime irritability due to Excess Yang and absence of Yin. Although all these present as fever, misusing exterior-releasing methods will inevitably lead to death.
Secondly, there is heat from Bian Zheng (physiological growth-related fever in infants), and heat preceding the eruption of smallpox/variolae. These also present as fever but have distinct etiologies and treatments. It is frequently observed that incompetent physicians, upon encountering fever, indiscriminately use dispersing methods. They fail to realize that diseases vary in severity and fevers differ in excess and deficiency. Although presenting as fever, the treatment approaches diverge significantly, with attacking and tonifying strategies being entirely different. Practitioners of pediatrics must carefully observe and comprehend during clinical practice. One must first inquire about the duration of the illness, prior medication history, and the child’s preferences and aversions. Then, assess the degree of fever, physical strength, pulse quality (excess or deficiency), and complexion luster. Integrating these four aspects allows for accurate diagnosis, thereby preventing fatal medical errors.
Generally, exogenous pathogens cause acute illnesses characterized by sudden onset of fever, typically manifesting as heat in the dorsal hands, floating pulse, and body heat without sweating. Differentiation between excess and deficiency remains necessary. For details, see the "Excess and Deficiency" section. If symptoms such as heat in the dorsal hands, floating pulse, or body heat without sweating are absent, or if the fever has persisted for a long time, it is not an exogenous exterior syndrome. Physicians must exercise prudent judgment.