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Whenever a child falls ill, fever is invariably present. The clinical manifestations vary; they are listed and explained below.

If a child develops fever at a specific time of day and the fever subsides after that time, only to recur at the same time the next day (regardless of whether it is day or night), this is termed tidal fever (Chao Re). It indicates an impending onset of convulsions (Jing Feng).

If a child has a fever that persists continuously with high intensity without abating, this is termed robust fever (Zhuang Re). In severe cases, it may lead to convulsions.

If a child has a fever that is warm but not intensely high, this is termed mild heat (Wen Re).

If a child has a fever, hot breath from the mouth, frequent crying and wailing, yawning with lethargy, cyanosis of the face and eyes, this is termed wind-heat (Feng Re). In severe cases, it may also trigger convulsions.

If a child has a fever, exhibits fearfulness when drinking water, tremors of the hands and feet, upward deviation of the eyes, tongue protrusion, visible blue veins in the glabella (Yin Tang), red palms, aversion to objects, and salivation, this is termed fright-heat (Jing Re).

If a child has a fever, persistent facial redness, waking up with startled cries, rapid breathing, thirst, chest distension with phlegm obstruction, this is termed accumulated heat (Ji Re). This resembles robust fever, but differs by chest distension and phlegm stagnation. It arises from heat toxins accumulating within the Zang-Fu organs, causing stagnation in the San Jiao (Triple Burner) and diaphragm. Cases involving head shaking and nuchal rigidity also indicate San Jiao and diaphragmatic stagnation. Severe cases of the above may result in spasms/twitching (Chu Tou). (Treatment is detailed in the section on Fright Epilepsy).

If a child has a fever, shortness of breath, nasal congestion, clear rhinorrhea, sneezing, piloerection, lacrimation, or expectoration of phlegm-water, this is termed cold damage (Shang Han). (Treatment is detailed in the section on Cold Damage).

If a child has a fever that comes and goes, with residual abdominal heat upon subsidence, or nocturnal fever accompanied by sallow complexion, abdominal distension, vomiting, diarrhea, indigestion of milk and food, and unusually sour-smelling feces, this is termed food injury (Shang Shi). (Treatment is detailed in the section on Food Injury).

If a child has fever at night which resolves by morning, accompanied by excessive saliva and somnolence, this is lung deficiency fever (Fei Xu Fa Re). This resembles nocturnal fever due to food injury and must be distinguished. The accompanying symptoms differ: food injury can be treated with purgatives, whereas lung deficiency cannot. Purgation in lung deficiency damages body fluids, leading to thirst and excessive drinking. For instance, Qian Yi treated the five-year-old son of Supervisor Zhu, who had nocturnal fever resolving by morning. Other physicians treated it as excess heat with cooling herbs without success. The symptoms included excessive saliva and somnolence; another physician attempted to purge phlegm, worsening the condition. By the fifth or sixth day, the child drank excessively. Qian Yi advised against purgation, prescribing Baizhu San (Atractylodes Macrocephala Decoction) decocted in three sheng of water for free consumption. When asked if excessive drinking would cause diarrhea, Qian Yi replied that without raw water, diarrhea cannot occur, and even dysentery would not be surprising, but purgation is contraindicated. When asked what disease to treat first, Qian Yi stated that stopping diarrhea, resolving phlegm, reducing fever, and calming the spirit are all achieved by this medicine. After completing the course, two more doses were given, resulting in cessation of thirst and phlegm. Finally, Ejiao San (Donkey-Hide Gelatin Decoction) was administered twice, leading to recovery. This case is recorded in Qian Yi's collection.

If a child develops fever every morning after eating, which cools down by night, this is termed blood heat (Xue Re). (Treatment follows later).

If a child has a fever, emaciation, excessive thirst, and poor muscle gain despite adequate intake, this is termed gan heat (Gan Re). (Treatment is detailed in the section on Gan Syndrome).

If a child has vigorous qi and blood, thirst with excessive drinking, dry yellow stools, scanty dark urine, and sudden warmth of the limbs and body, this is termed stomach excess heat (Wei Shi Re). (Treatment should involve purgation).

If a child has a fever with slight fright, cold ears and extremities, white blisters on the upper lip resembling fish eggs, with or without sweating, this is termed bian zheng (Bian Zheng / Physiological Fever). (Treatment is detailed in the section on Bian Zheng).

If a child has a fever, deep sleep with palpitations, frequent sneezing, and cold ears and extremities, this is a sign of exanthema (Chuang Zhen Hou). (Treatment is detailed in the section on Exanthema). This resembles food injury and bian zheng. In cold damage, ears and extremities are hot; in bian zheng, white wart-like blisters appear on the lips.

Regarding fever in children, there is internal and external differentiation. Internal causes often relate to improper fluid intake, while external causes relate to wind-cold invasion. Qian stated: "Fever with thirst indicates internal heat; fever without thirst indicates external heat." This is a general rule. Internal heat is suitable for purgation; external heat is suitable for dispersion. If a child has internal accumulation and external contraction, presenting with generalized fever, flushed cheeks, dry mouth, dark urine, and scanty dark yellow stools, first administer Sishun Qingliang Yinzi (Four-Obedience Clearing and Cooling Drink) to unblock the fu organs, which will reduce the fever. If fever recurs, it indicates resolved interior heat but lingering exterior heat. Administer Xingxing San (Xingxing Powder) or Hongmian San (Red Cotton Powder) with Ephedrae Herba (Mahuang) to induce slight sweating, thereby removing exterior heat. If fever recurs again after resolution, contemporary physicians often fail to understand this. Repeated purgation or dispersion is incorrect and harmful. This recurrence is due to deficiency of both exterior and interior, failure of qi to return to its origin, and floating yang. Administer Liushen San (Six-Spirit Powder) to harmonize stomach qi, allowing yang to return inward, thus cooling the body.

Yan Xiaozhong discussed robust fever in children, noting that wind-warmth epidemic, wind-cold wind-heat, and exanthema with food injury often present similarly. Until clearly differentiated, administering Shengma Gegen Tang (Bupleurum and Pueraria Decoction), Xingxing San, or Xiaochaihu Tang (Minor Bupleurum Decoction) is effective, as these are broad-spectrum remedies that minimize error. However, for food injury, characterized by sour-smelling stools, undigested milk/food, anorexia, or vomiting, mild purgation is appropriate.

Sun Simiao discussed vigorous qi and blood in children, slight fright during sleep, minor wind-cold or food injury, or suspected bian zheng fever. He recommended Ziwu (Purple Pill) or Longdan Tang (Gentiana Decoction). These two formulas are universally applicable; although they cause mild purgation to reduce excess qi, they do not damage healthy qi. Yellow, foul-smelling stools indicate latent heat in the abdomen, suitable for Longdan Tang. White, sour-smelling stools indicate cold-induced indigestion, suitable for Ziwu. Dosage should be small to achieve mild bowel movement; increase slightly for severe cases to achieve loose stools. Milk and food intake should be restricted for one to two days to stabilize stomach qi. Failure to restrict diet leads to relapse. Relapse followed by purgation damages stomach qi, causing abdominal distension. Repeated purgation causes excessive damage.