小儿之热。有五脏之不同。虚实之各异。实则面赤气粗。口燥唇肿。作渴饮冷。大小便难。
或掀衣露体。烦啼暴叫。伸体而卧。睡不露睛。手足指热。宜用汗下。虚则面色青白。恍惚神缓。
口中虚冷。嘘气软弱。喜热恶寒。泄泻多尿。或乍凉乍温。怫郁惊惕。上热下泄。夜则虚汗。屈
体而卧。睡而露睛。手足指冷。宜用调补。壮热者。肢体大热。热不已则发惊痫。若身热而口中
气热。乃风寒外感也。轻则惺惺散。重则羌活之类。发热而搐搦上窜。拗哭昏睡者。惊热也。实
则泻青丸、抱龙丸。虚则钩藤散。肝火内热者。龙胆泻肝汤。阴盛格阳而热者。理中汤。发热而
不欲饮水者。胃气虚热也。白术散。发热而饮水作渴喜冷冻饮料食者。胃气实热也。泻黄散。小儿诸
热。其因外证而作者。当从外证治之。或乳母七情浓味。饮食停积。遗热于儿。或儿嗜食甘肥。
衣裳过暖。或频浴热汤。积热于内为患者。当详其因而治之。潮热者。时间发热即退。来日根据时
而至。有风寒疳积食癖之分。表里阴阳虚实之异。如汗出身热。呵欠面赤。风热也。伤寒时疫。阴
阳相胜。外感热也。肌瘦口干。骨蒸盗汗。疳热也。大小便秘涩。汗下不解。积热也。腹背先热。
夜发旦止。食热也。涎嗽饮水。乳食不消。癖积也。又有烦热者。气粗喘促。心烦不安。颊赤口
疮。兼发痫证。疮疹热者。耳鼻尖冷。心热者。巳午间发。至夜则凉。虚热者。困倦少力。大凡
壮热饮水。大便秘结。属实热。泻黄散加黄 、犀角。热渴饮汤。大便如常。属阴虚。六味丸。
若见惊搐等证。肝经血虚生风也。四物加天麻、钩藤钩。颊赤口干。小便赤色。大便焦黄。表里
俱实热也。清凉饮。如大便已利。或热未止。表邪未解也。惺惺散微汗之。阳气下溜于阴中而发
热者。补中益气。若食乳婴儿。当兼治其母。小儿潮热。或壮热不退。多是变蒸及五脏相胜。不
必用药。又多食积郁热。由中发外。见于肌表。只理其中。清阳明之热而表热自除。不可认作外
感。用解表攻里等药重伤其内。又潮热不退。恐是出痘。亦当审察。勿便下药。大抵发热饮水者。
热在内。不饮水者。热在外。宜详辨之。
小儿的发热，有五脏性质的不同，虚实证候的各异。实证表现为面色红赤、气息粗重、口燥唇肿、口渴喜饮冷水、大小便困难；或者掀开衣服露出身体、烦躁啼哭暴叫、伸展身体而卧、睡眠时眼睛不闭合（睡不露睛）、手足指尖发热，适宜采用发汗或攻下的治法。虚证表现为面色青白、神志恍惚精神萎靡、口中感觉虚冷、呼吸气弱声低、喜欢温热厌恶寒冷、腹泻多尿、或者忽冷忽热、抑郁惊悸、上部发热下部泄泻、夜间盗汗、蜷缩身体而卧、睡眠时眼睛半睁（睡而露睛）、手足指尖发冷，适宜采用调和补益的治法。
壮热者，肢体大热，热势不退则引发惊痫。如果身体发热且口中呼出的气也热，这是风寒外感所致。轻症用惺惺散，重症用羌活类药物。发热并伴有抽搐上窜、拗颈哭闹昏睡症状的，是惊热。实证用泻青丸、抱龙丸；虚证用钩藤散。肝火内热者，用龙胆泻肝汤。阴寒内盛格拒阳气于外而发热的，用理中汤。发热但不想喝水的，是胃气虚热，用白术散。发热且饮水作渴、喜欢冷冻饮料和食物的，是胃气实热，用泻黄散。
小儿各种发热，如果是因外证引起的，应当从外证治疗。或者是乳母七情过激、食用浓味食物，饮食停积，将余热遗留给婴儿；或者是婴儿嗜好甘肥食物、穿衣过暖、频繁洗热水澡，导致积热于内为患者，应当详细查明原因进行治疗。
潮热者，到一定时间发热随即退去，第二天按时而至。有风寒、疳积、食癖的区别，以及表里、阴阳、虚实的差异。如出汗后身热、打哈欠面赤，是风热。伤寒时疫，阴阳相争，是外感热。肌肉消瘦口干、骨蒸盗汗，是疳热。大小便秘涩，汗下法不解，是积热。腹背先热，夜间发作早晨停止，是食热。流涎咳嗽饮水、乳食不消化，是癖积。
又有烦热者，气息粗重喘促，心烦不安，两颊红赤口舌生疮，兼发惊痫证。疮疹热者，耳鼻尖冷。心热者，在巳午时（上午9点至下午3点）发作，到了夜晚则凉爽。虚热者，困倦少力。
大凡壮热饮水、大便秘结的，属实热，用泻黄散加黄芩、犀角。热渴饮汤、大便如常的，属阴虚，用六味地黄丸。如果见到惊搐等证，是肝经血虚生风，用四物汤加天麻、钩藤。两颊红赤口干、小便赤色、大便焦黄的，是表里俱实热，用清凉饮。如果大便已经通畅，但热未止，说明表邪未解，用惺惺散微发其汗。阳气下陷于阴中而发热的，用补中益气汤。若是吃奶的婴儿，应当同时治疗其母亲。
小儿潮热，或者壮热不退，多是变蒸（婴幼儿生长发育过程中的生理现象）及五脏相胜所致，不必用药。又多是饮食积滞郁而化热，由中焦发于体表，见于肌表，只需调理中焦，清阳明之热而表热自然消除。不可误认为外感，使用解表攻里等药物重伤其内脏。另外，若潮热不退，恐怕是出痘疹，也应当审慎观察，不要轻易下药。大体而言，发热饮水的，热在内；不饮水的，热在外，应当详细辨别。
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.