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[Qian] Wind-warmth and heat disease are similar in symptoms. Tide fever (Chao Re) refers to fever occurring at specific times, ceasing when the time passes, and recurring at the same time the next day; this is a sign that wind-stroke convulsions (Jing Feng) are about to occur. Vigorous heat (Zhuang Re) refers to persistent high fever without cessation; if severe, it may lead to wind-stroke epilepsy (Jing Xian). Wind-warmth syndrome (Feng Wen Zheng), the body does not feel hot, but breath from the mouth is hot, and there are manifestations of wind-warmth, yet it is merely warm rather than intensely hot. Cold damage heat (Shang Han Re), the mouth is hot, yawning, sudden dizziness and stuffiness, neck stiffness. (Zeng said: In cold damage heat, the ten fingers are slightly cold, nasal discharge is clear, fever with no sweat, facial expression is pale and trembling, and there are purple markings on the right cheek.) Smallpox/Chickenpox heat (Dou Chuang Re), sneezing, palpitations, cold ear tips. (Zeng said: Mahou heat [heat associated with smallpox/chickenpox eruption], red face with cold feet, whole body vigorous heat, yawning, dizziness, cough, back pain, occasional convulsions, abdominal pain, dysentery, and isolated coldness of the middle finger, these are the signs.) Bianzheng heat (Bian Zheng Re), white blisters appear on the lips, cold ears. (Zeng said: Bianzheng heat involves slight warmth, coarse breathing but few convulsions, yellowish milk excretion, small blisters like water beads on the tip of the upper lip; this is Bianzheng, requiring no medicinal treatment.) Gan accumulation heat (Gan Re), yellow complexion, pica for charcoal or soil, emaciation, redness and ulceration under the nose. Convulsive heat (Jing Feng Re), onset of spasms and convulsions, rapid pulse, irritability, mental confusion. (Zeng said: Convulsive heat presents as whole-body fever, shiny face with spontaneous sweating, palpitations and restlessness, rapid pulse and irritability; the treatment method is the same as acute wind-stroke, but the medication must first release the exterior.)

[Yang] Pediatric diseases are predominantly heat syndromes. Heat syndromes include tide fever, convulsive heat, night fever, residual heat, food heat, gan accumulation heat, vigorous heat, vexatious heat, accumulated heat, wind heat, deficiency heat, guest heat, mass heat, cold-heat alternating, blood heat, and rash heat. These sixteen types are largely similar but have minor differences. When heat initially arises, it must have a cause. Tide fever has regular intervals of onset and cessation; convulsive heat manifests as screaming and confusion; night fever begins in the evening and stops in the morning; residual heat indicates incomplete elimination of cold pathogens; food heat originates in the abdomen; gan accumulation heat involves bone-steaming and night sweats; vigorous heat persists continuously; vexatious heat involves heart agitation and restlessness; accumulated heat presents with red cheeks and oral ulcers; wind heat follows sweating with body heat; deficiency heat causes fatigue and weakness; guest heat comes and goes unpredictably; phlegm heat involves salivation, coughing, and thirst; cold-heat alternating resembles malaria; blood heat occurs during Chen and Si hours (7 AM–11 AM); rash heat presents with cold ear and nose tips. Each syndrome has its specific attribution. If two or three syndromes interact, treatment should be adjusted according to severity.

[Xue] Pediatric heat varies by the five zang organs (Liver, Heart, Spleen, Lung, Kidney), differs in deficiency/excess, warmth/vigorous states, and involves superficial/deep, qi/blood, yin/yang floating/sinking, as well as wind-dampness, phlegm, and food stagnation, all of which require detailed differentiation. Heart heat: redness appears first on the forehead, heart vexation and pain, heat in palms and hiccups, or vigorous heat with thirst, worsening during Wu hours (11 AM–1 PM). Liver heat: redness appears first on the left cheek, difficult defecation and tendon conversion, grasping at clothes and objects, anger and fright, limb fatigue, worsening during Mao hours (5 AM–7 AM). Spleen heat: redness appears first on the nose bridge, lethargy and desire to sleep, body heat and thirst, worsening at night. Lung heat: redness appears on the cheeks, scratching eyebrows and eyes, wheezing and coughing, cold-heat alternating and thirst, worsening in the late afternoon (You hours, 5 PM–7 PM). Kidney heat: redness appears first under the chin, intense heat in both feet, bone soreness as if bitten by insects, inability to rise from bed due to severe heat, worsening at night. One must also distinguish deficiency and excess. Excess patterns present with red face and coarse breathing, dry mouth and swollen lips, thirst for cold drinks, difficulty in urination and defecation, throwing off clothes, irritability and screaming, lying stretched out, eyes closed during sleep, and hot fingertips; treat with exterior-releasing or purgative methods. Deficiency patterns present with blue-white complexion, confused and slow spirit, feeling of cold in the mouth, weak sighing, preference for warmth and aversion to cold, diarrhea and frequent urination, alternating chills and fever, depression and startle, upper excess and lower leakage, night sweats, lying curled up, eyes open during sleep, and cold fingertips; treat with regulation and tonification. Vigorous heat involves large-scale body heat; if prolonged, it leads to convulsions. Warmth involves slight body heat; if prolonged, it leads to convulsive tremors. Yin deficiency leads to internal heat. Yang excess leads to external heat. Light palpation reveals heat, but deep pressure does not; this is heat in skin and vessels, located in the exterior. Deep pressure reveals heat in bones and sinews, but light touch does not; this is heat in bones and sinews, located in the interior. Moderate pressure reveals heat in muscles; this is heat between exterior and interior. Regarding exterior/interior based on deficiency/excess: Vigorous heat with aversion to wind and cold indicates insufficient primal qi, representing exterior deficiency heat. Vigorous heat without aversion to wind and cold indicates invasion by external pathogens, representing exterior excess heat. Vigorous heat with desire for hot soup indicates shortness of body fluids, representing interior deficiency heat. Vigorous heat with desire for water indicates consumption by internal fire, representing interior excess heat. If both interior and exterior are hot, there is wheezing and thirst, dry teeth, vexation and abdominal fullness, limb heat, sensitivity to wind-cold feeling like burning, tolerance of winter but not summer; these are all cases of yang excess and yin deficiency. Pulse full at both cun and chi positions indicates heavy excess; pulse weak at both positions indicates heavy deficiency. Pulse surging and large, or slow and slippery, or rapid and drumming, indicates heat excess rejecting yin; although symptoms resemble cold, it is not cold. Heat with rapid pulse that does not drum upon pressure indicates cold excess repelling yang; although symptoms resemble heat, it is not heat. Fever with aversion to heat, unquenchable thirst, irritability, hot skin, reluctance to wear clothes, surging pulse that is forceless upon pressure, or accompanied by eye pain and dry nose, indicates blood deficiency causing agitation; tonify blood. Inability to eat with fever and spontaneous sweating indicates qi deficiency; tonify qi. Zhang Zhongjing stated that for insufficiency of interior/exterior with fever and spontaneous sweating, sweating methods are contraindicated; if caused by diet and overwork, mistaken sweating will further weaken the exterior. Body heat with sweating indicates wind. Fever, body ache, heaviness, and yellowing indicate dampness. Aversion to cold with fever, aversion to wind, spontaneous sweating, floating pulse, and chest oppression indicate phlegm. Fever, headache, and rapid pulse indicate food stagnation. Microcun pulse indicates yang insufficiency, where yin qi enters yang causing aversion to cold; weak chi pulse indicates yin insufficiency, where yang qi sinks into yin causing fever; when yin and yang do not remain in their proper divisions, cold and heat contend. Quiet during the day and fever/agitation at night indicates yang qi sinking into yin; fever/agitation during the day and quiet at night indicates excessive yang and lack of yin; urgently drain yang and strongly tonify yin. Body heat with wiry-rapid pulse, shivering but no aversion to cold, indicates Dan Malaria (Dan Nue). Fever with aversion to cold and floating-rapid pulse indicates Warm Disease (Wen Bing). Heat in four limbs, dry mouth/tongue/throat indicates fire-heat attacking the Earth position, combined with damp-heat, causing vexation and confusion. Heaviness of body and wandering pain indicates damp-heat clashing, with wind-heat constrained and unable to extend.