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Infants and young children are endowed with pure Yang constitution and abundant, stagnant Qi and Blood. Therefore, when the Zang-Fu organs experience slight disharmony or changes in Yin-Yang Qi, it leads to internal stagnation and external steaming, resulting in fever. This is because Yin cannot coordinate with Yang, and Blood cannot coordinate with Qi. Consequently, most disease manifestations belong to Fire syndromes. Liver Heat manifests as red cheeks, staring eyes, hands grasping at clothing collars, limb stiffness, susceptibility to fright, and red, painful eyes. Heart Heat manifests as irritability, crying, bright red lips, upward rushing movements, teeth grinding, confusion due to deficiency pain, oral ulcers, and red, swollen urine. Lung Heat manifests as incessant rapid breathing, constipation, hands rubbing the eyebrows and mouth, nasal congestion, and dry, brittle hair. Spleen Heat manifests as drooling, yellow eyes, abdominal distension, restless teeth, and irritability. Combined Heart-Spleen Heat manifests as double tongue (Chong She) or wooden tongue (Mu She). Stomach Heat manifests as foul breath. Kidney Heat manifests as excessive pus in the ears, continuous foul discharge, downward rushing movements, and photophobia. When the five Zang organs accumulate Wind-Heat and toxic factors, the face becomes red like cinnabar, there is heat in the five centers (palms, soles, and chest), limbs feel warm and hot, eyes are dry, and there is excessive thirst. If the heat rushes upward to the throat, it contends with Qi and Blood, forming stagnation and swelling, leading to throat closure (Hou Bi) and mumps-like swelling of the cheeks. If stagnant heat does not dissipate and remains in the chest and diaphragm, extreme heat generates Wind and palpitations.

However, fevers vary in severity. There is "Xi Xi Fever" (fever felt like being covered by feathers), indicating heat on the exterior and belonging to Exterior Syndromes, caused by Wind-Cold lodging in the skin and obstructing Yang Qi; this should be treated with sweating methods to disperse it. There is "Zheng Zheng Fever" (feeling like steaming), indicating heat in the interior and belonging to Interior Syndromes, caused by Yang Qi sinking into the Yin; this should be treated with purgative methods to clear it. If fever persists after sweating and purging, it indicates deficiency in both exterior and interior, Qi failing to return to its source, and Yang floating externally. Cool medicines should not be used, nor further sweating or purging; instead, harmonize the Stomach Qi to allow Yang Qi to converge internally, and the fever will cease. If exterior symptoms persist and pathogens re-aggregate, it is called "Liang Gan" (Double Contraction), presenting with full pulse upon lifting and pressing, yellowish complexion with red cheeks, dry lips and mouth, hot breath from nose and mouth, dark scanty urine, and hard stool, indicating heat in both exterior and interior. Thus, fever with aversion to cold indicates onset in Yang channels; absence of fever but with aversion to cold indicates onset in Yin channels. Fever with exterior signs is called Exterior Heat; fever without exterior signs is called Interior Heat.

Generally, all heat syndromes belong to the Heart, representing the image of Fire. For mild heat, use cool herbs to harmonize; for severe heat, use cold herbs to subdue; for extreme heat, use sweating methods. If sweating fails, use counter-treatment methods; if that fails, seek the root cause to weaken it. Bitter herbs treat the five Zang organs; pungent herbs treat the six Fu organs. Treatments for internal conditions involve purging, while those for external conditions involve sweating. Subsequently, nourishing Blood and benefiting Yin can resolve the heat. Although ancient texts classify eighty types, they cannot all be listed here. In summary, almost all diseases involve heat, which is essentially the manifestation of one's own internal fire. One must investigate the cause to regulate it, avoiding mere use of cold/cool substances that might damage the body's Yang Qi.

Fever occurring twice daily (morning and evening) is often called Tidal Fever (Chao Re) in cases of fright-heat, caused by stagnation of Ying and Wei Qi and heat generation in the five Zang organs steaming outward. Fever appearing at dusk (Shen hour) indicates Yangming Excess Heat. Excess requires promoting bowel movements. However, chronic cases become deficient, requiring tonification of Earth (Spleen) to store Yang or nourishing Yin to retreat fire. Causes include residual heat after Shang Han (Cold Damage), masses from Pi Qi (stagnation), irregular Yin injury, Jia masses (abdominal lumps) combined with cold food stagnation causing Spleen-Stomach disharmony, deficiency of Zang-Fu with Yin-Yang imbalance, stomach summer-heat dampness, or spleen malnutrition syndrome. It may also result from un erupted rash/toxins. Fever due to food accumulation presents with a belly hot as fire and cold feet, requiring urgent purging. Emaciation with excessive thirst, bone-stealing night sweats, scalp eruptions, eating non-food items, persistent heat in five centers, and failure to gain muscle mass defines Malnutrition Heat (Gan Re). Fever due to heart-heat exposed to wind results in wind-pathogen invading skin and organs, causing dry eyes, dizziness, chest oppression, aversion to wind, high fever with sweat, defined as Wind-Heat. Face redness, headache, cracked lips, sore throat, swollen tongue, red eyes, hardness below cheeks, oral ulcers, difficult phlegm, thick sputum, restlessness, delirium, and madness define Diaphragm Heat. Fetal Heat (Tai Re) occurs if the mother consumed hot drugs, alcohol, or fried foods during pregnancy, transmitting heat-toxin to the fetus, resulting in yellow-red skin, closed eyes with groaning, facial redness, body heat, scalding mouth temperature, or skin sores after birth. Night fever starts in evening and stops in morning; Guest Fever comes and goes unpredictably; Cold-Heat alternates resembling Malaria; Blood Heat occurs during Chen-Si hours (7-11 AM); Fright Heat involves convulsions and trance; Food Heat starts in abdomen/back; Accumulation Heat involves red cheeks, oral ulcers, frequent thirst, irritability, and crying; Deficiency Heat involves fatigue and weakness; Pi Heat involves drooling, coughing, and drinking water.

Excess Heat presents with red face, coarse breathing, mouth heat, irritability, swollen lips, difficulty defecating, kicking off covers, and frantic crying. Deficiency Heat presents with blue-white complexion, slight body heat, cold breath, normal urination/defecation, cold palms/soles, trance, lethargy, weak sighing, and spontaneous cold sweat. Deficiency heat should not be aggressively attacked, as removing heat may invite cold; nor overly tonified, as tonics may retain residual heat. One must address the root. Pathogenic heat in the Heart (Fire element) causes inflammation, crying with sweat, red face/stool, hot breath, arching back, irritability, and fear of light, resembling measles/varicella. Pre-rash fever features cold middle finger, nose tip, and ears, poor feeding, dry/red eyes, sleepiness, alternating chills/fever, restlessness, and red threads behind ears. Unlike Shang Han which moves from exterior to interior, rashes emerge from interior to exterior. Fright-Wind Heat involves biting nipples, drooling, upward gaze, and frightful crying. Epidemic Toxic Heat resembles Shang Han but affects everyone similarly during outbreaks.

Night fever has three types: Blood Heat, retained food, and Gan-Lao (malnutrition consumption). Warm-Zhuang Fever arises from organ disharmony, latent heat, or retained cold clashing with Stomach Qi, causing Qi-Blood stagnation and body heat retention. Yellow smelly stool indicates latent heat; white sour-smelly stool indicates retained cold. Maternal consumption of ginger during pregnancy (highly heating) can transmit heat through meridians to the fetus, causing generalized erysipelas, sores, or head nodules; severe cases cause large abscesses and tissue necrosis, termed Ying Heat. Maternal emotional disturbance or labor can move True Qi, allowing empty pathogens to disturb Shen and enter the womb, causing postnatal lethargy, abdominal urgency, coarse breathing, restlessness, crying, poor growth, and sores, termed Wei Heat.

Prolonged illness depletes Qi and Blood. Qi deficiency leads to syncope; Blood deficiency leads to fever. Combined deficiency causes cold extremities with body fever. Redness location indicates affected organ: Left cheek = Liver; Right cheek = Lung; Forehead = Heart; Chin = Kidney; Nose = Spleen. Fever with sour regurgitation, bad breath, head tilt, upper heat/lower cold, forehead sweat, chest distension, air reflux, crying, hot palms, full Renying pulse, headache, and rapid pulse indicates Food Injury. Fever with heaviness, pain, and jaundice indicates Dampness. Fever with increased chills, aversion to wind, spontaneous sweat, floating pulse, and chest stuffiness indicates Phlegm. Microcun Kou pulse indicates Yang deficiency with Yin rising causing chills. Weak Chi pulse indicates Yin deficiency with Yang sinking causing fever. Untreated, Yin-Yang fail to separate, causing alternating chills/fever. Yang excess causes heat, deficiency causes cold; Yin excess causes cold, deficiency causes heat. This is mutual overcoming of Yin-Yang. Cold/Yin/Interior vs Heat/Yang/Exterior. Exterior pathogens contend with Yang causing chills; Interior pathogens contend with Yin causing heat; Half-exterior/half-interior pathogens contend with both. Quiet day/fever night indicates Yang sinking into Yin; Hot day/quiet night indicates Yang flourishing in Yang divisions; Constant day/night heat indicates Double Yang without Yin, requiring draining Yang and tonifying Yin. Day illness relates to Qi; Night illness relates to Blood.

Hot body with wiry-rapid pulse, tremors without chills indicates Dan Malaria. Fever with chills and floating-rapid pulse indicates Warm Disease. Hot limbs, bitter taste, dry throat, irritability indicates Fire attacking Earth position with Damp-Heat combination. Heavy body, migrating pain indicates Damp-Heat clashing with constrained Wind-Heat. Fever with chills, extreme thirst, irritability, desire to discard clothes, surging-but-empty pulse, dry nose, painful eyes indicates Yin-Blood deficiency causing dry heat; treat by nourishing Blood. Inability to eat, fever, spontaneous sweat indicates Qi deficiency; treat by tonifying Qi. Frequent loose stools, dry lips/throat indicate Floating Empty Yang. Full Cun-Chi pulses indicate Severe Excess; Weak Cun-Chi pulses indicate Severe Deficiency. Surging, slow-slippery, or rapid-beating pulses indicate Heat rejecting Yin (appearing cold but is heat). Rapid pulse not beating strongly under pressure indicates Cold rejecting Yang (appearing hot but is cold). Deep pressure revealing less heat indicates superficial/exterior heat; deep pressure revealing more heat indicates deep/interior heat; moderate pressure revealing heat indicates half-exterior/half-interior heat. High fever with aversion to wind/cold indicates Yuan Qi deficiency (Exterior Deficiency Heat). High fever without aversion indicates external pathogen invasion (Exterior Excess Heat). High fever desiring hot drinks indicates short fluids (Interior Deficiency Heat). High fever desiring cold water indicates internal fire consuming fluids (Interior Excess Heat).

Palmar heat indicates abdominal heat; palmar cold indicates abdominal cold. Upper body heat corresponds to waist-up; lower body heat to waist-down. Elbow front heat corresponds to chest; elbow back heat to shoulders/back. Arm heat corresponds to waist/abdomen. Heat 3-4 cun below elbow back indicates intestinal worms. Stomach heat (above navel) causes above-navel heat; Intestine heat (below navel) causes below-navel heat. Liver/Gallbladder heat (flanks) causes flank heat. Chest/Back heat (chest area) causes chest/back heat. Kidney heat (waist) causes waist heat. These can be inferred analogously.

Extreme Yang transforms to Yin; Extreme Yin transforms to Yang. Yang governs heat; Yin governs cold. Extreme cold generates heat; extreme heat generates cold. Thus, treating cold requires guarding against heat, and treating heat requires guarding against cold. Alcohol is contraindicated in all heat syndromes, as it is like adding fuel to fire. Fatal signs include persistent fever despite Yin-Yang deficiency, dysentery with fever, fever unrelieved by sweating, recurrence after sweating, rapid pulse, delirium, and inability to eat.