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[Qian] Wind-warmth and heat disease are similar. Tide fever (Chao Re) refers to fever occurring at specific times, subsiding when the time passes, and recurring at the same time the next day; this is a sign that wind-stroke or convulsion (Jing Hou) is about to occur. Vigorous fever (Zhuang Re) refers to persistent high fever without cessation; if severe, it may lead to wind-stroke and epilepsy (Jing Xian). Wind-warmth disease (Feng Wen), where the body does not feel hot, but the breath from the mouth is hot, and presents with wind-warmth symptoms, is merely warm rather than hot. Cold damage fever (Shang Han Re) presents with hot mouth, yawning, and stiffness of the neck. (Zeng said: In cold damage fever, the ten fingers are slightly cold, the nose runs clear fluid, there is fever without sweating, the face is pale and trembling, and there are purple lines on the right cheek.) Chickenpox/smallpox fever (Dou Chuang Re) presents with sneezing, palpitations, and cold ear tips. (Zeng said: Mahou fever [fever associated with chickenpox/smallpox eruption], with red face and cold feet, vigorous whole-body fever, yawning, chest stuffiness, cough, lower back pain, occasional convulsions, abdominal pain, dysentery, and isolated coldness in the middle finger, is this condition.] Bianzheng fever (Bian Zheng Re) presents with white blisters appearing on the lips and cold ears. (Zeng said: Bianzheng fever involves slight warmth, coarse breathing but few惊 (fright), yellow milk discharge, small blisters on the tip of the upper lip like water beads; this is Bianzheng, and no medicinal treatment is needed.) Gan accumulation fever (Gan Re) presents with sallow complexion, pica for charcoal or earth, emaciation, and redness/ulceration under the nose. Convulsive fever (Jing Feng Re) presents with convulsions, palpitations, epilepsy, rapid pulse, irritability, and mental confusion. (Zeng said: Convulsive fever involves whole-body fever, shiny face with spontaneous sweating, palpitations and restlessness, rapid pulse, and irritability. The treatment method is the same as acute wind-stroke; the medicines used must first release the exterior.) [Yang] Children's diseases are mostly heat syndromes. Heat syndromes include tide fever, fright fever, night fever, residual fever, food fever, Gan fever, vigorous fever, vexatious fever, accumulation fever, wind fever, deficiency fever, guest fever, mass fever, chills-and-fever fever, blood fever, and rash fever. These sixteen types are largely similar but slightly different. When heat syndrome first appears, it must have a cause. Tide fever has regular onset and cessation; fright fever manifests as screaming and confusion; night fever starts in the evening and stops in the morning; residual fever indicates incomplete elimination of pathogenic cold; food fever initially manifests in the abdomen; Gan fever manifests as bone-steaming and nocturnal sweating; vigorous fever persists continuously; vexatious fever manifests as mental restlessness; accumulation fever manifests as red cheeks and mouth ulcers; wind fever manifests as body heat after sweating; deficiency fever manifests as fatigue and weakness; guest fever comes and goes unpredictably; phlegm-heat manifests as excessive saliva, cough, and thirst; chills-and-fever fever resembles malaria; blood fever occurs during Chen and Si hours (7 AM–11 AM); rash fever manifests as cold ear and nose tips. Each syndrome has its own location. If two or three syndromes interact, treatment should be adjusted according to their severity. [Xue] Children's heat syndromes differ among the five Zang organs (Liver, Heart, Spleen, Lung, Kidney), vary in deficiency, excess, mildness, and vigor, and involve exterior-interior, Qi-blood, Yin-Yang floating/sinking, as well as wind-dampness, phlegm, and food stagnation, all of which require detailed differentiation. Heart heat manifests as redness starting on the forehead, heart vexation and pain, hot palms, hiccups, or vigorous fever with thirst, worsening during Si-Wu hours (9 AM–1 PM). Liver heat manifests as redness starting on the left cheek, difficult defecation and tendon twitching, grasping clothes and rubbing objects, anger and fright, limb fatigue, worsening during Yin-Mao hours (3 AM–7 AM). Spleen heat manifests as redness starting on the nose bridge, lethargy and desire to sleep, body heat and thirst, worsening at night. Lung heat manifests as redness on the cheeks, scratching eyebrows and eyes, wheezing and cough, chills/fever and thirst, worsening in the late afternoon. Kidney heat manifests as redness starting below the chin, intense heat in both feet, bone soreness like insect erosion, inability to rise from bed due to severe heat, worsening at night. One must still differentiate deficiency and excess. Excess patterns present with red face, coarse breath, dry mouth, swollen lips, thirst for cold drinks, difficulty in urination and defecation, throwing off clothes, irritability, crying out violently, lying stretched out, sleeping with eyes closed, and hot fingertips; treat with exterior-releasing or purgative methods. Deficiency patterns present with blue-white complexion, confused/sluggish spirit, feeling of cold in the mouth, weak sighing, preference for warmth and aversion to cold, diarrhea, frequent urination, alternating cold and warmth, depression and startle, upper excess and lower leakage, nocturnal deficiency sweating, lying curled up, sleeping with eyes open, and cold fingertips; treat with regulation and tonification. Vigorous fever involves large heat in the limbs; if unceasing, it leads to convulsions and epilepsy. Warmth fever involves slight heat in the limbs; if unceasing, it leads to convulsions. Yin deficiency leads to internal heat. Yang excess leads to external heat. Light palpation reveals heat, but heavy pressure does not; this is heat in skin and vessels, located in the exterior. Heavy pressure on sinews and bones reveals heat, but light touch does not; this is heat in sinews and bones, located in the interior. Moderate pressure reveals heat; this is heat in muscles, located between exterior and interior. Regarding exterior-interior based on deficiency/excess: Vigorous fever with aversion to wind and cold indicates insufficient Yuan Qi, representing deficiency heat in the exterior. Vigorous fever without aversion to wind and cold indicates invasion by external pathogens, representing excess heat in the exterior. Vigorous fever with desire for hot drinks indicates shortness of Jin-Ye (body fluids), representing deficiency heat in the interior. Vigorous fever with desire for cold drinks indicates consumption by internal fire, representing excess heat in the interior. If both interior and exterior are hot, there is wheezing, thirst, dry teeth, vexation, abdominal fullness, limb heat, sensitivity to wind-cold as if burned, tolerance for winter but not summer; these are all Yang excess and Yin deficiency. Pulse full at both Cun and Chi positions indicates severe excess; pulse weak at both positions indicates severe deficiency. Pulse surging and large, or slow and slippery, or rapid and drumming, indicates heat excess rejecting Yin; although symptoms resemble cold, it is not cold. Heat with rapid pulse that does not drum upon pressure indicates cold excess repelling Yang; although symptoms resemble heat, it is not heat. Fever with aversion to heat, incessant great thirst, irritability, hot skin, reluctance to wear clothes, surging pulse, empty upon pressure, or accompanied by eye pain and dry nose, indicates blood deficiency causing agitation; tonify the blood. Inability to eat with fever and spontaneous sweating indicates Qi deficiency; tonify the Qi. Zhang Zhongjing stated that for insufficiency of interior/exterior with fever and spontaneous sweating, sweating methods are prohibited. If caused by diet and overwork, even if fever exists, mistaken sweating will cause exterior deficiency. Body heat with sweating indicates Wind. Fever with body ache, heaviness, and yellowing indicates Dampness. Aversion to cold with fever, aversion to wind, spontaneous sweating, floating pulse, and chest oppression indicates Phlegm. Fever with headache and rapid pulse indicates Food Stagnation. Cun pulse micro indicates Yang insufficiency; Yin Qi enters Yang causing aversion to cold. Chi pulse weak indicates Yin insufficiency; Yang Qi sinks into Yin causing fever. When Yin and Yang do not remain in their proper places, cold and heat contend. Quiet during the day, fever and irritability at night, indicates Yang Qi sinking into Yin. Fever and irritability during the day, quiet at night, indicates excessive Yang and lack of Yin; urgently drain Yang and strongly tonify Yin. Body heat with wiry-rapid pulse, shivering but no aversion to cold, is Dan Malaria (Dang Nue). Fever with aversion to cold, floating-rapid pulse, is Warm Disease (Wen Bing). If limbs are hot, mouth/tongue/throat dry, it is Fire-Heat attacking the Earth position, combined with Damp-Heat, causing vexation and confusion. If body is heavy, wandering pain, it is Damp-Heat clashing, with Wind-Heat constrained and unable to extend.