Library

*Quan Ying Fang Lun* states: The so-called tidal fever (Chao Re) refers to fever and defervescence occurring at fixed intervals. This is either due to flourishing blood and qi with internal heat generated in the zang-fu organs, or due to contracting pathogenic factors from wind-cold (Shang Han) or seasonal epidemics, resulting in an imbalance between yin and yang.

Startled fever (Jing Re) manifests as startled cries, mental confusion, fever at night, and cessation by morning.

Residual heat (Yu Re) refers to cold pathogenic factors that have not yet been fully cleared, or residual heat left over from the transmission of disease through the meridians.

Food stagnation heat (Shi Re) presents with initial heat in the abdomen and back.

Gan malnutrition heat (Gan Re) manifests as bone-steaming fever (a sensation of heat emanating from the bones) and night sweats.

High fever (Zhuang Re) refers to persistent high fever without abatement. Qian Yi stated: If high fever persists, it may severe enough to trigger convulsions and epilepsy (Jing Xian).

Vexatious heart (Fan Xin) presents with mental restlessness, agitation, rapid and coarse breathing; if severe, it may also trigger epilepsy.

Accumulated heat (Ji Re) manifests as red cheeks and mouth ulcers; if accumulated heat is lower, it leads to carbuncles and swelling in the waist and legs; if both exterior and interior are excess, there is body fever and scanty, painful urination; if it is a deficiency pattern, fever persists after sweating or purging therapies.

Wind-heat (Feng Re) presents with fever after sweating, yawning, and flushed face.

Deficiency heat (Xu Re) manifests as fatigue, weakness, and lack of energy.

Fever resulting from chronic cough, chronic diarrhea, chronic dysentery, chronic hematochezia, or chronic malaria—all conditions arising after these diseases—belong to deficiency heat.

Guest heat (Ke Re) comes and goes irregularly; this is caused by yang pathogenic factors invading the Heart. When the Heart is affected, heat manifests on the forehead, so fever usually starts from the head and face and is often accompanied by palpitations/startle, due to deficiency of true qi and excess of pathogenic factors.

Pi mass heat (Pi Re) manifests as salivation, cough, and thirst for water. This is caused by undigested milk and food stagnating and knotting in the middle jiao, forming pi masses. Some present with phlegm-cough accompanied by startle, others with irregular vomiting and regurgitation, occurring during the day and crying at night, alternating hot and cold like tidal fever.

Chills and fever (Han Re) resemble malaria and result from yin-yang imbalance. Chills preceding fever indicates insufficient yang; fever preceding chills indicates insufficient yin. More chills than fever indicates yin excess and yang deficiency; more fever than chills indicates yang excess and yin deficiency. Equal amounts of chills and fever indicate yin-yang conflict.

Blood heat (Xue Re) manifests as fever specifically between the hours of Ji and Wu (9 AM to 3 PM), cooling down after nightfall.

Rash heat (Zhen Re) manifests as coldness at the tips of the ears and nose.

Qian Yi stated: Fetal heat (Tai Re) occurs when an infant has agitated blood and qi at birth, crying loudly, with body fever, complexion resembling pale tea color, red eyes, dark yellow and thick stool, and an urgent desire to nurse. Treatment is primarily via bathing methods.

Commentary: The above differentiation of various syndromes can be considered detailed and thorough. However, regarding blood heat, Li Dongyuan argued that fever at night with clear consciousness during the day constitutes blood heat, because day belongs to yang and night to yin. As for food stagnation heat, symptoms such as heat in the palms, belching, spitting up milk, and vomiting are common; one should deduce the syndrome based on specific manifestations and carefully study the original text.

*Quan Ying Fang Lun* further states: The so-called Bian Zheng (maturation process) serves to grow blood and qi. "Bian" refers to changes in upper qi, and "Zheng" refers to body heat. Bian Zheng varies in severity: mild cases present with slight body heat, minor startle, cool ears, slight sweating, and white blisters on the lips resembling beads; severe cases present with alternating chills and fever, chaotic pulse, abdominal pain, incessant crying, inability to feed, and frequent vomiting. Mild cases resolve in three days, severe cases in five days. Ancient methods used Hei San Zi (Black Pill) and Zi Wan Zi (Purple Pill) for treatment. However, many infants undergo "hidden maturation" (An Bian) without fever, startle, or obvious symptoms, due to robust prenatal constitution.

Commentary: The annotation in this treatise notes: I have examined the differing accounts of Bian Zheng in Qian Yi's works versus *Xiao Er Yao Zheng Zhi Jie*. Qian Yi stated: First change Kidney, second change Bladder, third change Heart, fourth change Small Intestine, fifth change Liver, sixth change Gallbladder, seventh change Lung, eighth change Large Intestine, ninth change Spleen, tenth change Stomach. Thus, water number one changes first. *Xiao Er Yao Zheng Zhi Jie* stated: First change Liver, second change Lung, third change Heart, fourth change Spleen, fifth change Kidney. Both theories describe the Five Elements progressing sequentially, following Sheng (generation) and Ke (restriction). Where generation meets restriction, and where restriction meets generation. Generally, in yin-yang creation, generation is smooth/forward, while restriction is reverse. Bian Zheng is the method of generating blood, nourishing qi, and enriching the five zang organs through generation; this principle is evident. Generation follows the mother-child relationship; restriction follows the husband-wife relationship. Generation ensures continuity; restriction ensures regulation. Originally, fetal formation results from the intersection of water and fire, yin-yang creation, and mutual regulation of the five elements, starting with the initial generation of Kidney qi. Pediatric Bian Zheng should follow yin-yang ascension and descent, succeeding through the five zang organs to form a human, thus starting with the initial change of the Liver. Although both theories have merits, generally, children's prenatal constitution varies in robustness or frailty, and the manifested syndromes differ. The two ancient formulas mentioned are not universal treatments for all conditions, and thus are not recorded here.