王肯堂曰。温热与壮热。相类而异。一向热不止。由气血壅实。五脏生热。蒸熨于内。则眠卧不安。精神恍惚。熏
发于外。则表里俱热。烦躁喘粗。甚则发惊痫也。轻则火府丹、金莲饮子。重则栀子仁汤。若但温温然不甚盛。是温热
也。大便臭而黄者。此腹内有伏热也。四顺饮子。粪白而酸臭。则挟宿食不消也。紫霜丸。轻者少服。重者多服。节哺
乳。当取微利。至五心热盛。烦躁不安。手足时欲露出。小便赤涩。谓之烦热。七宝散。若唇深红。饮水不止。竹叶石
膏汤。
阎孝忠曰。惊热者。遍身发热。或热而不甚。面青自汗。睡梦虚惊。颠叫恍惚。有因惊而生热者。有因热而生惊者。
钱氏导赤散、凉惊丸。皆其治也。
曾氏曰。积热者。腹中有癖而发热也。必眼胞浮肿。面黄足冷。发热。从头至肚愈甚。或闻饮食之气恶心。及肠疼
呕吐。治同伤积。
万全曰。按郑氏全婴方所云。血热者。巳午发热。夜则凉。指小儿血盛实而言也。盖谓巳午者。心火用事之时也。
心主血。血气行至巳午则阳气盛。阳气与正气相搏。故至期而发热。非其时者。非血热也。宜龙胆丸、地黄膏之类。海
藏云。夜热属阴。四顺饮之类。此言血热在夜也。脉经云。小儿有宿食。尝暮发热。明日复止。此言宿食夜热也。积热
者。久热也。疳热亦久。但兼面黄吃炭土。鼻下烂也。三因云。小儿积热者。表里俱热。遍身皆热。颊赤口干。小便赤。
大便焦黄。先以四顺饮利动脏腑。则热去。既去复热者。内热已解。而表热未解也。当用惺惺散。表热乃去。表热去后。
又发热者。此表里俱虚。气不归元。而阳浮于外。所以发热。非热极也。只用六神散入粳米煎。和其胃气。则阳收归内。
身体便凉。重者用银白散。临时发热者。或由感冒而得也。
Wang Kentang stated: Warm heat (Wen Re) and severe heat (Zhuang Re) are similar yet distinct. If fever persists continuously, it is due to the stagnation and excess of Qi and Blood, generating internal heat in the five Zang organs. This heat steams and scorches internally, causing restlessness in sleep and mental confusion; it steams outwardly, resulting in heat in both the interior and exterior, irritability, panting with coarse breathing, and in severe cases, convulsions and epilepsy. For mild cases, Huo Fu Dan (Fire Mansion Pill) or Jin Lian Yin Zi (Golden Lotus Decoction) are used; for severe cases, Zhi Zi Ren Tang (Gardenia Seed Decoction) is prescribed. If there is only a slight warmth without significant intensity, this is termed warm heat. If the stool is foul-smelling and yellow, it indicates latent heat within the abdomen, treated with Si Shun Yin Zi (Four Compliance Decoction). If the stool is white and sour-smelling, it indicates retained food not digesting, treated with Zi Shuang Wan (Purple Frost Pill). Administer a small dose for mild cases and a larger dose for severe cases, while regulating breastfeeding, aiming for a mild laxative effect. If the "five hearts" (both palms, both soles, and the epigastrium) are severely hot, accompanied by irritability, a desire to expose hands and feet from covers, red and scanty urine, this is called vexatious heat (Fan Re), treated with Qi Bao San (Seven Treasures Powder). If the lips are deep red and there is unquenchable thirst, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is used.
Yan Xiaozhong stated: Startled heat (Jing Re) presents as fever over the whole body, or fever that is not severe, with a bluish complexion, spontaneous sweating, fright in dreams, and startled crying with confusion. There are cases where heat arises from fright, and cases where fright arises from heat. Qian's Dao Chi San (Guide Out Redness Powder) and Liang Jing Wan (Cool Convulsion Pill) are treatments for this.
Zeng stated: Accumulated heat (Ji Re) refers to fever caused by masses (Pi) in the abdomen. It must be accompanied by swollen eyelids, sallow complexion, cold feet, and fever that intensifies from the head down to the belly. There may also be nausea upon smelling food, intestinal pain, and vomiting. The treatment is the same as for injury accumulation.
Wan Quan stated: According to Zheng's *Quan Ying Fang*, blood heat (Xue Re) manifests as fever during the Si and Wu hours (9 AM - 1 PM) and cools at night. This refers to the excess and fullness of blood in children. Specifically, Si and Wu hours are when Heart Fire is dominant. The Heart governs Blood, and when Qi and Blood circulate during these hours, Yang Qi is abundant. The struggle between Yang Qi and Healthy Qi causes fever at this specific time. Fever at other times is not blood heat. Drugs such as Long Dan Wan (Gentian Pill) and Di Huang Gao (Rehmannia Ointment) are suitable. Haizang (Zhang Yuansu) stated: Night fever belongs to Yin patterns, treated with Si Shun Yin and similar formulas. This refers to blood heat occurring at night. The *Mai Jing* states: Children with retained food often have evening fever that resolves by morning. This refers to night fever caused by retained food. Accumulated heat is prolonged fever. Gan heat (Malnutrition Heat) is also prolonged but is accompanied by a sallow complexion, pica for charcoal/earth, and erosion under the nose. The *San Yin Fang* states: In children with accumulated heat, both interior and exterior are hot, the whole body is hot, cheeks are red, mouth is dry, urine is red, and stool is dry and yellow. First, use Si Shun Yin to promote bowel movement and regulate the Zang-Fu, thereby eliminating the heat. If fever returns after subsiding, the interior heat has resolved but the exterior heat remains; Xing Xing San (Stunning Powder) should be used to resolve the exterior heat. After the exterior heat is resolved, if fever recurs, this indicates deficiency in both interior and exterior, Qi fails to return to its origin, and Yang floats outward, causing fever, which is not extreme heat. Use Liu Shen San (Six Spirits Powder) decocted with Jing Mi (Rice Grain) to harmonize Stomach Qi, allowing Yang to retract inward, cooling the body. For severe cases, Yin Bai San (Silver White Powder) is used. Sudden onset of fever may be due to exogenous contraction.