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Zi Hezi treated the son of Patrol Officer Gao, who was eight years old and suffering from fever. Physicians all believed it was caused by cold injury and used hot-natured drugs to attack it. They wanted him to drink water but prohibited giving it to him, causing internal fluids to dry up. This led to restlessness, convulsions, blockage of both anterior (urination) and posterior (defecation) orifices, dryness of the mouth and nose, alternating chills and fever, intermittent coughing, and absence of sweat over the whole body. They then intended to apply moxibustion. Zi Hezi reproached the mother, saying, "With heavy quilts, a heated kang bed, and red-hot stoves, the child can already no longer bear the heat; how can you still apply moxibustion?" First, he ordered the administration of *Renshen Chaihu Yinzi* (Ginseng and Bupleurum Decoction). After several doses, the child passed foul-smelling, rotten fish-intestine-like stool. Thirsty and desiring water, he was allowed to drink as much as he wished, consuming cups of ice-cold water repeatedly. Subsequently, he defecated thirty to forty times, and only then did the high fever subside. He was then given *Niuhuang Tongge Wan* (Calculus Bovis Intestinal Obstruction Pill), after which he defecated more than ten times, and the child fully recovered. In total, he defecated about fifty times without any sign of exhaustion, having consumed one hu (a unit of volume) of ice water. What would have happened if moxibustion had been applied?

Lu Dongzhuang treated the son of Wu Yinming, aged ten, who had suffered from night fevers for over two years. Suddenly, his submandibular region became swollen and hard as stone, his complexion turned yellow, and he experienced frequent profuse epistaxis. Upon palpating the pulse, a sunken and stagnant qi was found exclusively at the Yangguan position (Right Guan pulse). Lu stated, "This is 'Dunfu' syndrome" (The Right Guan pulse governs the Spleen and Stomach; sunken and stagnant indicates an excess-heat pattern; 'Dunfu' implies a deep-seated condition difficult to discern). He prescribed Shigao (Gypsum Fibrosum), Huoxiang Ye (Agastache Folium), Zhizi (Gardeniae Fructus), Fangfeng (Saposhnikoviae Radix), Huanglian (Coptidis Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma). The submandibular swelling gradually softened, and the yellow complexion returned to normal. Subsequently, he administered Fuling (Poria), Pipaye (Loquat Leaf), Yuanshen (Scrophulariae Radix), Zhike (Aurantii Fructus), Shanzhi (Gardeniae Fructus), Yichen (Capillaris Herba), Shihu (Dendrobii Caulis), Tianmendong (Asparagi Radix), Maidong (Ophiopogonis Radix), and Sheng/Dishu Dihuang (Rehmanniae Radix Preparata), known as *Ganlu Yin* (Sweet Dew Decoction), with added Huanglian (Coptidis Rhizoma). Consequently, the epistaxis and night fevers were completely eliminated.

Lu Yangyu treated the son of Magistrate Li, aged eleven. One night in June, he suddenly developed a slight fever with mild sweating and a mild headache. Some attributed it to summerheat injury and prescribed *Xiangru Yin* (Elsholtzia Decoction) taken cold, which worsened the condition, leading to wheezing, coughing, and phlegm. Others noted a floating and rapid pulse, indicating flaming-up fire, and prescribed Qingre (clearing heat) herbs such as Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Huafen (Trichosanthis Radix). However, the wheezing and coughing persisted, appetite was lost, and sleep was restless. Palpation revealed a wiry and tight pulse, stronger on the left than the right, with a flushed face resembling "floating yang." Lu diagnosed this as exterior constraint by wind-cold, requiring dispersal and release. Someone questioned, "In such hot weather, with constant sweating, how can we use diaphoretic methods?" Lu replied, "Precisely because wind-cold has injured the Wei-yang (Defensive Yang) qi, preventing external yang from entering, hence the persistent mild sweating. Internal yang is trapped and cannot exit, hence the continuous intense heat. If we resolve the pathogen, external yang will enter, and internal yang will emerge, stopping the spontaneous sweating and cooling the body." He used Gegen (Puerariae Lobatae Radix) as the sovereign herb, Suye (Perilla Folium) and Fangfeng (Saposhnikoviae Radix) as minister herbs, Qianhu (Peucedani Radix), Baizhi (Angelicae Dahuricae Radix), and Chuanxiong (Ligustici Chuanxiong Rhizoma) as assistant herbs, and Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), and Gancao (Glycyrrhizae Radix et Rhizoma) as envoy herbs. Taken hot with light covering to induce mild sweating, profuse sweating occurred. Shortly after, wheezing, coughing, and expulsion of hot phlegm decreased significantly, and full recovery was achieved in two doses.

Xue Lizhai treated the son of Scholar Xue Hengfu, aged seven, who was emaciated, feverish, and had a sallow complexion. All assumed it was internal injury with blood stasis and desired to purge. Xue identified it as Spleen injury and prescribed *Liujunzi Tang* (Six Gentlemen Decoction) with Weijiang (Roasted Ginger). After two doses, appetite improved drastically, and after several doses, all symptoms resolved.

Wan Muzhai treated a child with fever that intensified in the late afternoon. Treatments for malaria or tidal fever were ineffective. Wan stated, "This is stomach deficiency with retained food." He explained that malaria presents with alternating chills and fever with intervals, while tidal fever occurs at specific times like the tide. This child was usually normal but febrile during Shen and You hours (3 PM–7 PM), indicating retained food fever. When asked for evidence, he cited Zhang Zhongjing's *Shanghan Lun*: "Tidal fever indicates excess; purgation is indicated." He used *Sanhua Wan* (Three Transformations Pill) to purge, resulting in recovery.

Another child suffered from convulsions with persistent fever. Suggestions included *Xiaochaihu Tang* (Minor Bupleurum Decoction), *Zhuye Tang* (Bamboo Leaf Decoction), or *Liangjing Wan* (Cooling Convulsion Pill). Wan argued, "After severe fright, the Spleen and Stomach are deficient; warming and tonification are needed. These three formulas are cold and cooling and should not be used." He prescribed *Lizhong Tang* (Regulate the Middle Decoction) with fried Ganjiang (Zingiberis Rhizoma). One dose eliminated the fever.

The young master of the Zhang family in Sanfu suffered from fever for three days in early winter, worsening over the next two days, with upward staring eyes and delirious speech. Wind treatments failed. On the 27th day, upon examination, Wan said, "The disease trend is receding, but Lung heat remains." Asked why, he replied, "The three pulses are yellow and moist, and the pupils are bright, indicating recovery. Only the facial flushing (floating yang) and asthmatic breathing indicate Lung deficiency heat." He prescribed *Xiao Ejiao San* (Small Donkey-Hide Gelatin Powder). Despite opposition, one dose stopped the asthma and fever, restored appetite, and brought calm.

Wan Muzhai treated the son of Scholar Huang, whose fever persisted despite eight days of treatment by his father. Detailed inquiry revealed day-and-night fever, dark urine, and difficult defecation. Medications used previously were *Weiling Wan* (Stomach-Lining Pill) and *Liangjing Wan*. Wan remarked, "No wonder they failed." The father asked if he could cure it. Wan diagnosed "Wind-Heat" affecting the Liver and prescribed *Xieqing Wan* (Draining Green Pill). Following this regimen, the child recovered in five days. (Note: Pediatricians today should nourish the Stomach Qi. Ingredients: Qianghuo, Dahuang, Chuanxiong, Shanzhi, Dancao, Danggui, Fangfeng.)

The son of Mr. Yu suffered from fever. Sweating, purging, and harmonizing methods failed; it was deemed deficiency heat. *Tianyuan Tang* (Origin-Regulating Decoction) with fried Ganjiang (Zingiberis Rhizoma) was used, and the fever subsided before the course was finished.

Wan Muzhai’s eldest son, often ill in childhood, developed tidal fever after malaria, becoming increasingly emaciated. Parents were worried. Wan diagnosed "Gan Qi" (Malnutrition Syndrome) and prescribed pills made from *Xiaochaihu Tang* plus Biejia (Testudinis Carapax et Plastrum), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Qingpi (Citri Reticulatae Pericarpium Viride). Recovery followed.

Feng Chuzhan treated Li’s son, aged eight, with fever for over ten days. Diaphoretics, harmonizers, and bitter-cold agents had failed, and the condition deteriorated. Examination showed emaciation, dirty black teeth, dry/cracked lips and tongue, deafness, blindness, body pain, high fever without sweat, delirium, and restlessness. The pulse was deep, minute, and nearly imperceptible, indicating Yin-cold. Feng described this as "fireless stove, dry lid": false heat above due to true cold below. He heavily used Renshen (Ginseng Radix et Rhizoma) and Shudi (Rehmanniae Radix Preparata), with a little Fuzi (Aconiti Lateralis Radix Preparata) to strengthen Water and benefit Fire. By midnight, the child desired food. The next day, the pulse was weaker but spirit slightly clearer. Doubling the previous prescription for three to four doses led to gradual improvement, and full recovery in less than ten doses.

Jiu Jian’an treated a noble official’s child who fell ill upon arriving at Shahe. Jiu advised, "Do not panic. Obtain one dou of sand, spread it in the boat, and let the child lie on it." After some time, the child moved limbs, and the illness resolved quickly. Explaining, Jiu said, "Children are pure Yang. In spring, wearing cotton makes them too hot; cooling air resolves it." (*Jiangsu General Gazette*).

Feng Chuzhan treated Hong’s infant, under one week old, during summer heat. High fever for days, lethargy, dry/cracked lips and tongue, vomiting milk, hot palms/soles/chest, and a flooding, rapid, wiry pulse. Previous doctors used diaphoretics, digestion aids, and measles-resolving methods. Feng stated, "Prolonged heat injures Yin; Yin is exhausted. Adding dispersing/resolving methods causes Yang to escape. Without urgent astringency and gathering, how can Yin and Yang be sustained near collapse?" He prescribed Shudi (4 qian), Maidong (1.5 qian), Niuxi (1.2 qian), Wuweizi (0.1 fen), and Zhifuzi (0.4 fen). Fever subsided after one dose. Next day, Bai Zhu (1.6 qian) was added, and Renshen (Ginseng Radix et Rhizoma) decocted separately and mixed in. Recovery ensued.

Zhang Jingyue’s second son, born in May, caught cold and fever in early autumn. Pulse was micro-tight and rapid. Knowing his organ qi was Yin-deficient, Zhang avoided clearing/cold methods and used Xiong (Chuanxiong), Su (Perillae Folium), Qiang (Qianghuo), Zhi (Baizhi), Xixin (Asari Radix et Rhizoma), and Shengjiang (Zingiberis Rhizoma Recens) to disperse cold. Fever persisted, followed by severe diarrhea for two days and subsequent wheezing; worse diarrhea meant worse wheezing. Seeing severe exterior-interior symptoms, Zhang used Renshen (2 qian) and Shengjiang (5 slices) decocted in half a cup. Fearful of worsening wheezing, he gave 2-3 tea spoons first; breathing remained unchanged. Then 3-4 spoons; breathing eased. Finally, half a small cup was given. From Wu to You hours, the dose was completed. Another physician arrived, criticizing, "Mistake! Who uses Ginseng for wheezing? Use Baolong Wan immediately." Zhang persisted, using Renshen (2.5 qian) decocted similarly until Zi hour. Breathing normalized, sleep deepened, diarrhea stopped, and fever subsided. Reasoning: Diarrhea-induced wheezing indicates Middle Deficiency. With excess pathogens, wheezing would decrease with diarrhea. Had clearing/drainage been used, Middle Qi collapse and death would have occurred, likely blaming Ginseng. Who is right? This illustrates the difficulty of medicine. Recording this shows the miracle of warming the middle and dispersing cold.

Commentary: This case might involve misdiagnosed infant metabolic fever ("Bianzheng") treated with harsh diaphoretics, damaging Yuan Qi, causing wheezing and diarrhea. Fortunately, Dushen Tang (Single Ginseng Decoction) saved him. Ye Tianshi commented: "From May to early autumn is only two months. Infants cannot speak, making pulse diagnosis difficult. Early autumn summerheat is strong; fever should be treated with summerheat-clearing herbs. Recklessly using acrid-warm diaphoretics on pure-Yang tender bodies during summerheat-induced Qi damage causes Lung Qi dispersion. Lung and Large Intestine are interior-exterior partners; Lung Qi deficiency leads to diarrhea, and dispersion causes wheezing. This was an error of acrid-warm diaphoretics; Ginseng replenished Lung Qi for cure. Not realizing the medication error, claiming therapeutic miracles is ignorant. Saying Ginseng cures fever may mislead future generations, necessitating this clarification."

One child felt cold, with aversion to cold and high fever. Diaphoretics induced sweating and fever resolution, but recurrence after 1-2 days with constipation indicated unresolved interior pathology. *Sishun Qingliang Yin* (Four-Obedience Cooling Clearing Decoction) relieved one bowel movement, fever subsided, but recurred after two days with dark urine. *Daochi Yin* (Guide Out Red Decoction) worked temporarily, but fever returned after three days. Physicians were baffled. Pulse was harmonious. Post-sweating and diuresis indicated Qi deficiency; unanchored Yang manifested on the surface, causing fever. *Liushen San* (Six Spirits Powder) harmonized Stomach Qi, adding one Wumei (Myrabolana Fructus) for sour taste to anchor Yang internally. Full recovery resulted. (Anonymous)

Another child had accumulated heat, presenting with exterior-interior heat, red cheeks, dry mouth, dark urine, and dry yellow stool. *Sishun Yin* moved the bowels, resolving heat, but recurrence indicated resolved interior but unresolved exterior. Mild diaphoresis resolved heat, but recurrence after two days indicated exterior-interior deficiency, Qi failing to return to its source, with Yang floating externally—false heat. *Liushen San* with Jingmi (Oryza Sativa Germ) harmonized Stomach Qi, returning cold internally and cooling the body. (Same source. Two cases on exterior-interior changes.)

Tidal fever: Fever at specific times, resolving afterwards, recurring daily at the same time; indicates impending convulsions. Intense fever: Continuous fever, potentially leading to epilepsy. Wind-heat: Body heat with hot breath; external wind pathogen. Warm-heat: Mild limb heat. Fever without thirst: Stomach Qi deficiency heat. Fever with thirst, preferring cold drinks/food: Stomach Qi excess heat.