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The fever in infants and children varies according to the five zang organs and differs in deficiency and excess patterns. In excess patterns, symptoms include a red face, coarse breathing, dry mouth with swollen lips, thirst for cold drinks, and difficulty in urination and defecation. The child may throw off clothes, cry out violently, lie with body extended, sleep with eyes open (sleep without closing eyes), and have hot fingertips. Sweating or purging methods are appropriate. In deficiency patterns, symptoms include a blue-white complexion, vague spirit with sluggishness, a feeling of coldness in the mouth, weak breath and low voice, preference for warmth and aversion to cold, diarrhea with frequent urination, alternating chills and fever, depression with fright, upper heat with lower diarrhea, night sweats, lying curled up, sleeping with eyes half-open (sleep showing eyes), and cold fingertips. Harmonizing and tonifying methods are appropriate.

Zhuang re (Intense fever) is characterized by intense heat in the limbs; if the heat persists, it may trigger jing xian (convulsions and epilepsy). If the body is hot and the breath from the mouth is also hot, this indicates an external contraction of wind-cold. For mild cases, Xingxing San (Awakening Powder) is used; for severe cases, herbs such as Qianghuo (Notopterygii Rhizoma et Radix) are used. Fever accompanied by convulsions, upward staring, neck stiffness, crying, and drowsiness indicates jing re (fright-heat). For excess patterns, Xieqing Wan (Draining Green Pill) and Baolong Wan (Embracing Dragon Pill) are used; for deficiency patterns, Gouteng San (Uncaria Decoction) is used. For internal heat due to liver fire, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) is used. For heat caused by yin excess repelling yang, Lizhong Tang (Regulate the Middle Decoction) is used. Fever without desire to drink water indicates stomach qi deficiency heat, treated with Baizhu San (Atractylodes Macrocephala Powder). Fever with thirst, desire for cold drinks and food, indicates stomach qi excess heat, treated with Xiehuang San (Drain Spleen Powder).

For various fevers in children caused by external manifestations, treatment should follow the external pattern. Alternatively, if the cause lies in the wet nurse's excessive emotions or rich diet causing food stagnation that transmits residual heat to the infant, or if the infant indulges in sweet and fatty foods, wears too many clothes, or frequently takes hot baths leading to accumulated internal heat, the specific cause must be identified and treated accordingly.

Chao re (Tidal fever) refers to fever that occurs at specific times and subsides, recurring at the same time the next day. It can be attributed to wind-cold, gan ji (malnutrition due to parasites/diet), or shi pi (food accumulation). There are differences in exterior-interior, yin-yang, and deficiency-excess. For example, fever after sweating with yawning and red face indicates wind-heat. Shanghan shiyi (Cold damage and epidemic diseases) involving the struggle between yin and yang indicates external heat. Emaciation, dry mouth, bone-steaming night sweats indicate gan re (malnutrition heat). Constipation unrelieved by sweating or purging indicates accumulated heat. Heat starting in the abdomen and back, occurring at night and stopping in the morning, indicates food heat. Salivation, coughing, drinking water, and indigestion indicate pi ji (accumulation due to stagnation).

Fan re (Vexatious heat) involves coarse breathing, panting, mental restlessness, red cheeks, mouth sores, and may be accompanied by epilepsy. Chuangzhen re (Rash fever) presents with cold nose and ear tips. Xin re (Heart heat) occurs during the Si-Wu hours (9 AM - 3 PM) and cools down at night. Xu re (Deficiency heat) presents with fatigue and weakness.

Generally, intense fever with thirst and constipation belongs to excess heat, treated with Xiehuang San added with Huangqin (Scutellariae Radix) and Xijiao (Rhinocerotis Cornu). Heat with thirst preferring warm drinks and normal stool belongs to yin deficiency, treated with Liuwei Wan (Six-Ingredient Rehmannia Pill). If convulsions are seen, it indicates liver blood deficiency generating wind, treated with Siwu Tang (Four Substance Decoction) added with Tianma (Gastrodiae Rhizoma) and Goutenggou (Uncariae Ramulus cum Uncis). Red cheeks, dry mouth, dark urine, and scorched yellow stool indicate exterior and interior excess heat, treated with Qingliang Yin (Cooling Drink). If stool has passed but fever persists, the exterior pathogen remains unresolved; treat with Xingxing San to induce slight sweating. Heat caused by yang qi sinking into the yin is treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For nursing infants, the mother should also be treated.

Tidal fever or persistent intense fever in children is often due to bianzheng (physiological growth changes) or mutual overacting among the five zang organs, and medication is not always necessary. Often, it is due to food stagnation transforming into heat, emanating from the middle jiao to the surface. Treatment should focus on regulating the middle jiao and clearing yangming heat, which will resolve the surface heat. Do not mistake this for an external contraction and use exterior-releasing or interior-purging drugs that could severely damage the interior. Furthermore, if tidal fever persists, consider the possibility of smallpox/variolae vaccination reaction, and examine carefully before administering purgatives. Generally, fever with thirst indicates heat inside; fever without thirst indicates heat outside. Careful differentiation is required.