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Zhang Zhongjing stated: There is "xi xi" (feather-like) fever and "zheng zheng" (steaming) fever; this distinguishes the different applications of sweating (diaphoresis) and purging methods. "Xi xi" fever, resembling the warmth under a feather cover, indicates that the heat is in the exterior (biao), belonging to the first syndrome of Taiyang disease (Taiyang Exterior Syndrome), treated primarily with Guizhi Tang (Cinnamon Twig Decoction). "Zheng zheng" fever, intense like steaming, indicates that the heat is in the stomach (wei), belonging to the thirty-second syndrome of Yangming disease (Yangming Interior Syndrome), treated by purging with Tiaowei Chengqi Tang (Stomach-Regulating Purgative Decoction). This is Zhang Zhongjing's method.

Because pediatric febrile conditions appear similar but are actually different, superficially identical yet substantively distinct. There are cold damage fever (Shanghan re), bianzheng fever, accumulated heat fever, madou fever (fever resembling early-stage smallpox/measles), jingfeng fever (convulsive fever), tidal fever, bone-steaming fever; there is also fever due to simultaneous deficiency of the interior and exterior. Although the symptom of fever is the same, the names differ; must one not clearly distinguish the root and branch to apply treatment? One must verify the symptoms and medicate according to the syndrome; this is the accurate principle.

Cold damage fever presents with slightly cold fingertips, clear nasal discharge, fever without sweat, a pale and trembling facial expression, and purple markings on the right cheek. The treatment method is recorded in the Cold Damage chapters. Bianzheng fever presents with mild low-grade fever, coarse breathing but less fright, yellow loose stools, and small blisters on the tip of the upper lip like water beads; this is bianzheng fever, requiring no medicinal intervention. If accompanied by other syndromes, one should provide slight harmonization based on the contracted pathogen, without using heavy doses. "Bian" refers to changing appearance; "zheng" refers to steaming and growing muscles. Every 32 days constitutes one "bian"; every 64 days constitutes one "zheng". Furthermore, the three major "zhengs" accumulate over 512 days; upon completion of bianzheng, the form, qi, blood, pulse, sinews, and bones are fully developed. Regarding the theory of bianzheng, further examination of Chen Shi's book from the Ming Dynasty records five types of steaming within ten changes. Adding the three major steams, the total count is exactly 512 days, which is most clear.

Accumulated heat fever presents with swollen eyelids, sallow complexion, cold feet, fever intensifying from head to abdomen, nausea upon smelling food, abdominal pain, and vomiting. The treatment method is detailed in the Treatise on Food Stagnation. Madou fever presents with red face, cold feet, severe body heat, yawning and chest stuffiness, cough and lower back pain, occasional惊悸 (palpitations/fright), abdominal pain with spontaneous diarrhea, and isolated coldness of the middle finger. The treatment method is detailed in the Chapters on Eruptions. Jingfeng fever presents with generalized shiny fever, spontaneous sweating, palpitations and restlessness, rapid pulse, and irritability. The treatment is the same as for acute jingfeng (convulsion) syndromes. Medications used must first resolve the exterior.

Tidal fever presents with fever in the afternoon or during the You hour (5-7 PM), occurring regularly like the tide, unrelieved. First use Baijie San (Hundred-Resolution Powder) to release the exterior, then treat with Danggui San (Angelica Powder) and Sansanjie San (Three-Resolutions Powder). If the pulse is excess, purge it; Da Chaihu Tang (Major Bupleurum Decoction) is suitable. If the pulse is deficient, floating, and scattered, induce slight sweating with Baijie San. If fever is accompanied by vomiting, Xiao Chaihu Tang (Minor Bupleurum Decoction) is indicated.

Deficiency fever presents with irregular fever after illness, occurring three to five times a day; this is exogenous heat taking advantage of deficiency. First, administer Weiling Tang (Stomach-Lining Decoction) with added Huanglian (Coptis Rhizome) powder, mixed with warm rice water. Next, administer Qian Yi's Baizhu San (Atractylodes Macrocephala Powder) or Guzhen Tang (Solidify True Decoction), taken cool. Also, use warm salt water mixed with cool water to send down Heixi Dan (Black Tin Pill) to consolidate Yuan Qi (Primordial Qi).

Bone-steaming fever presents with emaciation and weakness, two episodes per evening, heat without chills, thirst and sweating only after waking. This is the residual toxin of Gan disease (malnutrition/parasitic disease) transmitting into bone-steaming, or abdominal masses (pi kuai) causing occasional mild pain. Use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) with ginger and jujube, mixed with Sanleng decoction (Sparganium decoction); or administer Huapi Wan (Mass-Resolving Pill). First treat spleen deficiency and retained stagnation, then treat with Chaihu Yin (Bupleurum Drink). Avoid toxic foods such as chicken, alcohol, mutton, and noodles.

Why does fever return after subsiding following the administration of interior-exterior resolving medicines in pediatric heat syndromes? Treatment at this stage cannot be summarized generally; whether re-resolving the exterior and purging the interior, or applying cooling agents, may cause the heat to worsen. One must differentiate using Yin and Yang theory to determine correctness. Tracing the origin, it is due to simultaneous deficiency of the interior and exterior, with Yang floating outward and Yin hiding inward, thus causing recurrent fever. It is appropriate to use warm and neutral medicines to harmonize the interior, so that body heat naturally eliminates. Administer Qian Yi's Baizhu San, removing Muxiang (Vladimiria Root) and adding Doukou (Amomum Fruit), decocted in water; along with Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) and Anshen San (Spirit-Calming Powder), leading to natural recovery. If prolonged sweating leads to irritability, thirst, reduced appetite, faint and slow pulse, and preference for hot drinks, Zhenwu Tang (True Warrior Decoction) can be taken. Although Fuzi (Prepared Aconite Root) is warm, it is used for its ability to consolidate Yang Qi; inside, Shaoyao (Peony Root) is cold. With one cold and one warm, balanced appropriately, its efficacy is invariably verified.