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The heat syndromes in children have several simple methods for differentiation as follows. If the entire face or both cheeks are red, the stool is dry and constipated, the urine is short and yellow or crimson, or there is no discharge at all, with extreme thirst and excessive water intake, coarse and rapid breathing, hot breath from the mouth and nose, particularly hot palms and soles, red and congested sclera, or soreness and distension of the upper and lower eyelids. These are all heat diseases caused by excess heat. It is most taboo to use warming and tonifying medicines, for fear that the cloying and sticky nature of the drugs will solidify the interior, making the qi transformation of the whole body even less able to circulate smoothly. Moreover, since the syndrome is excess heat, sweet-cold natured medicines should be applied to clear the heat. To treat a heat disease with warm medicines is like carrying firewood to put out a fire; the disease cannot be removed but will instead increase. Precious body fluids will become withered and dried up immediately. Once body fluids are lost, spasms and convulsions will arrive instantly, and life may be lost in an instant; how can one hope for a cure?

Cold syndromes in children also have several concise phenomena that can provide reference for examination, assisting treatment during clinical practice. Such as a sallow and pale complexion, emaciation without luster, lack of blood color, dark greenish-black or loose pale stools with a fishy, rotten odor, abdominal distension due to deficiency, frequent borborygmus, bean-green colored sclera, or spiritless pupils, vomiting undigested milk and food, watery diarrhea, cold calves, fingers colder than the palms, sleeping with eyes partially open (exposed eyes), and spontaneous leakage of cool sweat. Whenever these pathological signs appear, it indicates a deficiency-cold syndrome. The major contraindication in treatment is the use of cold-natured drugs. At this time, warming and tonifying agents should be applied to resolve condensed cold and restore yang qi, supporting the spleen and warming the kidneys to save the depletion of qi and blood. Only when qi and blood do not become deficient and weak can the natural resistance overcome the pathogenic excess. If one only sees the false heat signs on the exterior, believing the body is not very weak, and dares to use cooling and resolving drugs, thinking that after the disease is gone, qi-tonifying and blood-nourishing drugs can be used for follow-up care, they do not realize that treating a cold syndrome with cold drugs will fail to resolve the disease first, and how can the deficient qi and blood be nourished? Furthermore, if the syndrome is cold and the drug nature is also cold, yin deficiency leads to coagulation, which becomes stuck and cannot be resolved. The result is that the spleen and stomach fail first, followed by the exhaustion of kidney qi, leading almost inevitably to extreme cold and collapse. This is the general method for differentiating cold, heat, excess, and deficiency in children.

There are also common diseases that children easily contract, such as food stagnation and milk retention, as well as symptoms of external wind-pathogen invasion, which must be carefully differentiated and medical attention sought. Although these symptoms are subtle, if fever persists, it will damage yin over time; if exterior pathogens are not treated properly, they can turn inward and attack internally. The onset of severe diseases likely begins here. How can pediatricians ignore them? If a child has no external contraction, only milk retention and food injury, the symptoms and pathology are very simple, merely fever, vomiting milk, restlessness in sleep, excessive crying, and irritability. Medication is not needed. One should simply reduce milk and food intake, be cautious against wind and cold, allowing the tender spleen and stomach to recover their natural tension and relaxation capabilities, so that digestion of food and drink will naturally resume and recovery will occur.

Or if a child has already contracted an external pathogen, experiencing dizziness or headache (manifested by the child preferring to lean their head and face into the mother's arms, or frequently lowering the head with dry, gritty eyes), high fever with tight pores, frequent sneezing, runny clear nasal discharge, and yellow sticky discharge in the corners of the eyes. The pathological form and intensity seem slightly severe, but the stomach is clear and free of food stagnation. Without internal fullness and qi stagnation, the external pathogen cannot surge and amplify the pathology. Applying heat-clearing and muscle-releasing methods will relax the skin and muscles, causing the external pathogen to dissipate naturally.

If a child has already suffered from food stagnation and fluid retention, impairing the transportation and transformation of stomach qi, there is already a possibility of illness developing. If, coincidentally, an external pathogen is also contracted, the pathological form and intensity become extremely tense, and the treatment procedure becomes complicated. Symptoms include heavy dizziness and pain, high fever, limb fatigue, vomiting milk and sour fluid, irritability and insomnia, and coarse breathing. All these phenomena indicate internal injury combined with external contraction, involving both interior and exterior. During clinical consultation, purgative and digestive-promoting drugs should not be used, lest the external pathogen sink inward, and the heat pathogen advance internally, scorching the nervous system, leading to critical signs such as tension, spasms, and convulsions. Even with skilled physicians, it would be difficult to manage.

Alternatively, knowing to use purgatives to clean up residual harm in the intestines and stomach but hesitating to use them, and instead exclusively using stagnation-resolving and wind-dispersing drugs seems somewhat reasonable but is incorrect. My opinion is that only heat-clearing and muscle-releasing drugs are sufficient. Once the muscle layer is released and wind disperses, although the stomach is full and stagnant, lacking a basis for amplification, it cannot brew a pathology that is hard to treat. Associated symptoms will naturally subside invisibly. Moreover, if stagnation-resolving drugs are used among wind-dispersing drugs, the wind pathogen will rise with the stomach qi. The lung, located in the upper jiao, bears the brunt. The trachea and bronchi will inevitably become inflamed and swollen due to wind pathogen accumulation. Externally manifested symptoms include tight throat, itching trachea, rebellious qi with choking cough, and profuse phlegm-saliva. At this time, lung syndromes must also be treated simultaneously: opening the lungs to drive out pathogens, descending phlegm to calm coughs, adding another step to the procedure. Not realizing that exclusively using clearing and resolving methods allows the external wind pathogen to be resolved from the exterior, bringing body temperature back to normal, and then using stagnation-resolving drugs to remove stomach fullness for follow-up care, is the safest treatment method.

However, after a child recovers, milk and food should still be reduced to prevent new stagnation, sluggish transformation, and obstruction of natural growth functions. Over time, the hair may become brittle and the body thin, gradually developing into infantile malnutrition (Gan syndrome). Because the stagnation has just been cleared, the injured spleen and stomach have not yet recovered, and upon initial recovery, righteous qi still needs cultivation. Therefore, parents must be more cautious in caring for the child after the new recovery from illness.