Pediatric fever refers to an abnormal increase in body temperature in children, accompanied by other symptoms. The body temperature of infants and young children may fluctuate within a certain range. If the overall condition is good and there are no other symptoms, it may not be considered pathological.

This condition has various names in classical medical texts. For example, Zhubing Yuanhou Lun．miscellaneous disease in pediatrics records "warm and strong syndrome," "high fever syndrome," "cold-damage disease syndrome," "warm disease syndrome," "alternating chills and fever syndrome," etc.; Shengji Zonglu．pediatrics section records "pediatric warm and strong," "pediatric high fever," "pediatric tidal fever," "pediatric wind-heat," "pediatric heat and thirst," etc. This article only differentiates common pediatric fever symptoms.

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1. External Contractionwind-cold︰Infants and young children tend to enjoy being held, showing aversion to wind and cold, disliking exposure of the head and face, with a pale complexion. Older children may exhibit aversion to cold with fever, absence of sweating, headache, body pain, spasm of the nape and back, cough, nasal congestion with runny nose, clear and smooth urination, thin white tongue coating, floating and tight pulse, and floating red finger veins. This is caused by wind-cold invading the exterior of the body. Cold, being a yin pathogen, has a congealing and blocking nature, which restrains the defensive yang, leading to aversion to cold with fever, absence of sweating, headache, and even soreness of the limbs or spasm of the nape and back. Wind-cold first damages the skin and hair, which are closely related to the lungs, resulting in dysfunction of lung qi. The treatment principle is to release the exterior with pungent-warm herbs. Representative formulas include Fistular Onion Stalk, Fermented Soybean Decoction and Apricot Kernel and Perilla Powder.
2. Wind-warm Syndrome︰Infants and young children often enjoy being held, show aversion to wind, have coarse breathing through the mouth and nose, warm mouth while nursing, and spontaneous sweating. Children commonly exhibit high fever, mild aversion to cold, aversion to wind, spontaneous sweating, headache, cough, dry mouth and thirst, nasal congestion with runny nose, a sensation of heat in the nostrils, difficulty expectorating phlegm, sore throat, yellow urine, thin yellow tongue coating, floating and rapid pulse, and superficial red-purple finger venules. This is caused by wind-warmth invading the body surface. Wind, being a yang pathogen, has a dispersing nature and easily damages yin fluids, hence manifesting symptoms such as fever, sweating, sore throat, dry mouth and thirst, and red-purple finger venules. The treatment principle is to release the exterior with pungent-cool herbs, with representative formulas being Mulberry Leaf and Chrysanthemum Decoction and Lonicera and Forsythia Powder.
3. Exogenous Summerheat Pathogen︰There are differences between "summerheat stroke" and "summerheat injury." Summerheat stroke fever is characterized by sudden high fever, sweating, headache heaviness of head, fatigue of the limbs, somnolence, excessive thirst and drinking, and in severe cases, neck stiffness, convulsion, unconsciousness, reversal cold of limbs, tongue coating thin blackend swallowwort root yellow, pulse flooding and slippery, and floating red-purple fingerprints reaching the qi pass. Summerheat injury fever is characterized by fever with mild aversion to wind and cold, without sweating, thirst, or thirst without desire to drink, bodily stiffness, aching pain in the limbs, fatigue and somnolence, tongue coating thin white, pulse floating and rapid, and floating red fingerprints. External contraction of summerheat is a common symptom and sign in children during summer. Summerheat stroke belongs to yang, while summerheat injury belongs to yin. The cause of summerheat stroke is that in winter, children's zang-fu organs are delicate, and their physical qi is not yet fully developed. In summer, exposure to summerheat leads to excessive sweating, causing yin fluids and yang qi to easily dissipate. Moreover, summerheat is a fiery pathogenic factor that most easily damages qi, so the disease often directly enters the Yangming stage at onset. Symptoms include sudden high fever, sweating, excessive thirst and drinking, headache heaviness of head, fatigue of the limbs, and in severe cases, neck stiffness, convulsion, unconsciousness, and cold limbs. The cause of summerheat injury is that during summer, sweat pores are open and the striae and interstice are not tightly closed. Additionally, children fear heat and crave coolness, leading to cold pathogens attacking the exterior. Symptoms include fever and chills, without sweating, bodily stiffness, and aching pain in the limbs. The key differences in symptoms are:
   1. Summerheat stroke presents with fever alone, without aversion to cold; summerheat injury presents with fever and chills.
   2. Summerheat stroke involves sweating and excessive thirst; summerheat injury involves no sweating, or thirst without desire to drink.
   For treatment: Summerheat stroke with fluid damage but not severe pathogenic heat should be treated by clearing summerheat and replenishing original qi. The representative formula is Wang's Summerheat-Clearing Qi-Replenishing Decoction. If stomach heat is particularly severe, clearing heat with pungent-cool medicinals is appropriate, using White Tiger Decoction or White Tiger plus Ginseng Decoction. Summerheat injury should be treated by dispelling summerheat and releasing the exterior. The representative formula is Newly Supplemented Mosla Decoction.
4. Exuberant Heat in Yangming︰The high fever persists, with flinging of hands and feet, uncovering clothes and kicking off quilts, and a thirst for cold water (infants continuously suckling milk is a sign of thirst). There is profuse sweating, a slippery and rapid pulse, and deep, stagnant fingerprints appearing red-purple. Clinical manifestations include high fever with sweating, thirst with a desire to drink, a thin yellow tongue coating, and a slippery-rapid or surging pulse. This indicates inward penetration of the exterior pathogen, with blazing pathogenic heat in the channel syndrome of fever. The fever pattern is characterized by a gradual rise in body temperature. Treatment should focus on clearing heat with pungent-cool medicinals, and the representative formula is White Tiger Decoction.
5. Yangming Fu-organ Excess︰午后潮热，大便不通，腹胀满而痛，手足濈然汗出，舌苔焦黄起刺，脉沉迟而滑，指纹郁滞，色红紫。胃中热盛，消耗津液，肠中糟粕与热搏结而成燥屎，则见大便秘结，此时热势蒸蒸，日晡更甚，严重者出现腹胀满而痛，手足濈然汗出，烦躁不安，神昏谵语，舌苔黄厚而糙，或生芒刺等，此为腑实热证，热盛衰有定时，一般在午后四时左右热势增高，故又称"日晡发热"。宜苦寒清降，代表方剂为大承气汤。
6. Pathogenic Factors Invading the Nutrient Phase︰The high fever persists unabated, worsening at night, with little thirst, heart dysphoria, sleeplessness, faint macula and papule, occasional delirious speech, a thin and rapid pulse, a crimson tongue texture, and purple-stagnant finger veins. As the pathogen resides in the qi aspect and its toxicity remains unresolved, the child's healthy qi is weak, body fluids are deficient, and pathogenic heat takes advantage of the deficiency to invade inward into the nutrient aspect. The consumption of nutrient yin leads to aggravated fever at night; the steaming of nutrient heat manifests as a crimson tongue, little thirst, or faint macula and papule. When pathogenic heat enters the nutrient aspect and disturbs the heart-mind, dysphoria, sleeplessness, or even occasional delirious speech may occur. This differs from the yangming fu-organ pattern, where excessive heat causes unconsciousness and delirious speech, which can be distinguished by assessing constipation, abdominal stuffiness and hardness, and the presence of tongue coating. The treatment should focus on clearing the nutrient aspect and discharging heat, with the representative formula being Nutrient-Clearing Decoction.
7. Evil Invading the Blood Phase︰High fever, unconsciousness, worse at night, restlessness and agitation, even mania, macula and papule eruption, hematemesis, epistaxis, or bloody stool, hematuria, pulse manifestation thready and rapid, tongue texture deep crimson, finger veins purple and stagnant extending through passes toward the nail. If the pathogenic factors in the nutrient aspect are not resolved, the pathogenic heat will inevitably penetrate deeper into the blood aspect. When pathogenic factors enter the blood aspect, in addition to symptoms such as irritability, insomnia, fever worsening at night, and mild thirst—which are characteristic of heat entering the nutrient aspect—there are generally also manifestations like hematemesis, epistaxis, or bloody stool, hematuria, as well as macula and papule eruptions, deep crimson tongue color, or restlessness and mania. The treatment should focus on {|###|}clearing heat and cooling blood{|###|}, with the representative formula being Rhinoceros Horn and Rehmannia Decoction.

Both Yangming heat exuberance and Yangming fu-organ excess belong to the "interior heat excess pattern," caused by the inward transmission of pathogenic heat from external contraction that is unresolved, leading to intense heat in Yangming. The main distinguishing point between the channel pattern and the fu-organ pattern lies in whether there is dry stool in the intestines.

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1. Xiao'er Yaozheng Zhijue．wind-warmth tidal fever high fever Similar: "Tidal fever refers to a fever that occurs at specific times and subsides after a certain period, coming from a fever that follows a schedule, indicating an impending fright. High fever refers to a persistent heat that does not cease, and in severe cases, it can lead to fright epilepsy. Wind-heat refers to body heat with heat in the middle qi of the mouth, accompanied by wind pattern. Warmth and fullness refer to warmth without heat."
2. Youke Fahui．Various Fevers: "Liver heat is characterized by a greenish color in the eyes, hands searching for the collar, and randomly grasping objects. It is treated with Green-Blue-Draining Pill and Angelica, Gentian and Aloe Pill. Heart heat is characterized by redness in the eyes, observing the sleep, warmth in the middle qi of the mouth, sleeping face down or on the back, upward movement, and teeth grinding. It is treated with Redness-Removing Powder and Coptis Rhizome Calming Spirit Pill. Spleen heat is characterized by a yellowish color in the eyes and a wagging tongue. It is treated with Yellow-Draining Powder and Powder of Capillaris and Five Ingredients with Poria. Lung heat is characterized by a turbid white color in the eyes and hands picking at the eyebrows, eyes, face, and nose. It is treated with Licorice and Platycodon Decoction and Akebia Stem Powder. Kidney heat is characterized by a lack of brightness in the eyes, fear of light, heaviness in the spine, and a lot of white in the eyes, with the skull appearing to separate. It is treated with Rehmannia Pill."