(a) Identification characteristics: heat is the main evidence, the spread of rapid. Fever in children with external sensation belongs to the category of warm diseases. Children are prone to fever due to the physiological and pathological characteristics of children, as stated in the Treatise on the Origin of Diseases: “Children are not yet full of qi and blood, the skin is fragile, if the nourishment is inappropriate, the cold and temperature is out of proportion, and the coup is deficient, that is, the wind is in”. It means that children are easily invaded by external evil. The external evil is wind, cold, summer, moisture, dryness, fire six evil, children due to external wind and cold is not a minority, but the wind and cold evidence only in the initial stage of the disease, children for the body of the less Yang, “easy to deficiency easy to real”, “easy to cold easy to heat”, so the disease is rapid transmission, the wind and cold of the evil quickly The evil of wind and cold will soon enter the body and turn into heat. In addition, children do not complain of discomfort, making it difficult for parents to detect abnormalities at an early stage, so they only come to the clinic when they have a fever. At the same time, children have a surplus of yang, and all the evils can easily turn into heat, as Ye Tianshi said in “The Essentials of Infant Medicine”: “The six evils are all from the fire, and the food stays and becomes heat.” Therefore, clinical evidence of Yang and heat is the most common. The onset of the disease in children is easy and spreads rapidly, so the symptoms of the same disease in the body, the qi, the ying and even the blood are manifested soon after the onset of the disease. (2) Features of treatment: truncation and reversal, and the same treatment of Wei-Qi-Ying-Blood. Because of the easy onset and rapid spread in children, the treatment cannot be based on “sweating in the body can be; to the gas can only clear the gas; into the camp can still penetrate the heat to turn the gas, such as rhinoceros horn, yuan ginseng, antelope horn and other things; into the blood is afraid of blood depletion and blood, it is necessary to cool the blood to disperse the blood. It is proposed that in the treatment of fever in children with external sensation, the approach of “truncation and reversal” should be adopted. In other words, in the early stage of fever, while using the symptoms to clear the heat, we should take good care of the Qi-Ying to prevent the evil from further penetrating, which better reflects the characteristics of Chinese medicine of “treating the disease before it occurs”. Mr. An often said, “If you can keep one point of Yin, you can have one point of vitality”. Children are often deficient in yin, and heat is a yang evil that can easily injure the body’s yin and fluids, so when children suffer from febrile diseases, they are more likely to have a deficiency of yin and fluids. Therefore, in the treatment of febrile diseases in children, attention should be paid to the protection of Yin and nourishment of Yin at an early stage. (3): Characteristics of the formula: Pungent-cooling is the main ingredient, accompanied by sweet-cold, to protect yin and fluid. When treating pediatric exogenous fever, clinical experience has been summarized in the formula. The drugs are: silver flower, forsythia, scutellaria, Zhi Mu, xuan Shen, gypsum, mustard, peppermint, artemisia, tannin, ground bark, rehmannia root and antelope horn. Among them, Yin Qiao San with addition can clear the heat of the Wei division, and Huang Qin can enter the six meridians to clear heat and detoxify dampness. A lot of modern medical research has confirmed that the heat-clearing and detoxifying drugs in Chinese medicine have antiviral and antibacterial effects. The two medicines of gypsum and Zhi Mu are the rulers and subjects of Bai Hu Tang, a famous formula in the Treatise on Typhoid Fever, which has been proven by numerous doctors and patients for thousands of years to be a good formula for reducing fever, mainly for clearing heat in the qi division. Artemisia annua is mostly used to clear deficiency fever and is used at the early stage of fever. It is believed that this medicine clears heat and penetrates the ligaments and can draw out the evil that is deep-lying. Antelope horn powder clears heat and detoxifies, calms the liver and quenches the wind, especially suitable for children with fever and high fever convulsions. In particular, mustard spike is the only pungent and warm medicine in the formula, and Mr. An believes that this medicine disperses superficial evil, is sweet, slow and not harsh, and in combination with many pungent and cool medicines, generates sweat without harming yin. On the basis of the commonly used formula, attention is also paid to adding and subtracting with the evidence. If you have sore throat or swollen tonsils, add fried burdock to clear heat and relieve pharynx; if the stool is dry, add hedgehog shell to clear the internal organs and eliminate stagnation; if you have abdominal pain without vomiting and diarrhea, add raw white peony and roasted licorice, sour and sweet to dissolve yin and ease the pain. If the spleen is deficient and loose, add raw yam and white lentil to strengthen the spleen and stomach. (D) Typical medical cases: Case 1 The child Li, female, 5 years and 10 months old, was seen on April 10, 2009. The day before the visit, she had a fever with a temperature of 39.3 and a vicious chill. Physical examination: red throat, red tongue with white coating. Cardiopulmonary (-) laboratory examination: normal blood count. Western medical diagnosis: upper respiratory tract infection. TCM diagnosis: external fever. Dialectical evidence: wind-cold attacking the surface and entering the interior to turn into heat, with the lung and stomach in the same disease. Treatment: Drain wind and clear heat, treating both the exterior and interior. Herbs: Yinhua 10g, forsythia 10g, scutellaria 10g, ZhiMu 6g, XuanShen 6g, gypsum 24g, mustard 6g, peppermint 6g, dandruff 10g, ground bark 10g, artemisia 10g, almond 10g, QianHu 10g, antelope horn powder. Four doses, decoction in water, one dose daily. 2 months later again because of its disease to the clinic when complained of taking the above 2 doses of body temperature completely normal. Note: Modern medicine believes that 90% of pediatric upper respiratory tract infections are caused by viral infections, antibiotic treatment is ineffective. Treatment of external fever using “cut off and reverse” method, that is, in the early stage of external fever to cut off the transmission of Wei Qi and Ying Blood, while emphasizing that “retain a point of Yin liquid, there will be a point of life”. In this case, while using Yin Qiao Bai Hu Tang to clear the fever in the Wei and Qi divisions, a large number of sweet and cold medicines such as Xuan Shen, Artemisia annua, Dan Pi, Di Bone Bark and Antelope Horn Powder were used to nourish Yin and clear the fever to protect the child’s Yin and fluid. It is believed that this can better reflect the characteristics of “treating the disease before it happens” in TCM. Case 2: Liu, male, 2 years and 8 months old. He was seen on June 23, 2009, and his parents complained of fever for 3 days, with a maximum temperature of 39.3℃, blistered tongue, salivation, no food for 3 days, and dry stools. Examination: pharynx congestion, herpes visible in oral mucosa, red rash visible on the soles of the feet, heart and lungs (-). Diagnosis: Hand, foot and mouth disease. Evidence: wind-heat with dampness, lung and stomach with the same disease. Treatment: Clearing heat and detoxifying toxins, draining wind and resolving dampness. Prescription: Yinhua 10g, forsythia 10g, scutellaria 10g, ZhiMu 6g, XuanShen 6g, raw gypsum 20g, Artemisia 10g, peppermint 6g, fried coix seed 10g, citrus aurantium 6g, dandruff 10g, ground bark 10g. 4 doses, antelope capsule. The rash disappeared completely after taking 2 doses and the body temperature was normal. Note: Hand, foot and mouth disease is a common infectious disease in pediatrics. It is common in summer and can be caused by a variety of intestinal viral infections. Infants and young children are the high-risk group. The clinical manifestations are fever and rash or herpes on the hands, feet, mouth, anus and other parts of the body. Severe cases can be complicated by aseptic meningitis, encephalitis, acute flaccid paralysis, respiratory tract infection and myocarditis, and even death. According to Chinese medicine, this disease belongs to the category of “warm disease”. Heat, toxicity and dampness are the main pathological aspects. Therefore, the treatment mainly adopts the method of clearing heat and detoxifying dampness. The treatment is based on clearing heat from the Wei and Qi divisions with Yin Qiao Bai Hu Tang, and reversing the disease with products that clear the Ying and cool the Blood. Stir-fried Coix seeds to clear heat and dampness, and Citrus aurantium to clear heat from the internal organs. Case 3 Liu, female, 9 years old. She was seen on February 12, 2010 with fever for 6 days, cough, runny nose, sneezing, sputum, nocturnal cough, thin stools, and 2 daily rows. Blood count: WBC2×109/L, CRP<1. Chest X-ray: peribronchitis. Western medical diagnosis: peribronchitis. TCM diagnosis: pneumonia and wheezing. Dialectical evidence: wind-heat offending the lung, clearing and purging malfunction. Treatment: Promote heat in the lung and clear heat, resolve phlegm and stop cough. Prescription: 5g of roasted ephedra, 10g of almonds, 6g of Zhi Mu, 24g of raw gypsum, 10g of Scutellaria, 10g of Mulberry Bark, 10g of Ground Bark, 10g of Dang Pi, 10g of Artemisia, 10g of Bai Wei, 6g of Scrophularia, 6g of Su Zi, 10g of raw yam, 6g of Chen Pi, 10g of Xian He Cao, 10g of Bai Bai. 4 doses. On February 20, 2010, the patient returned to the clinic after taking 2 doses of the medicine. The fever subsided, the cough was relieved, with runny nose, sputum, no cough at night, dry stool, and little food. Physical examination: slightly red pharynx, red tongue with floral coating, no abnormalities in the heart, lungs and abdomen. Treatment: Subsequent formulation to clear the lung and resolve phlegm. Herbs: 10g of white chrysanthemum, 10g of rehmannia root, 10g of scutellaria baicalensis, 6g of Zhi Mu, 10g of mulberry bark, 10g of ground bark, 6g of scape hebecarpa, 6g of soursop, 6g of green diaphanous clam powder, 10g of white fruit, 10g of senghuo grass, 10g of Bai Bu, 4 doses. Note: The child in this case had fever for 6 days with unresolved temperature, accompanied by cough and loose stools. Peripheral blood picture with low leukocytes and chest X-ray suggesting peribronchitis were considered to be due to viral infection. The patient was considered to be suffering from a viral infection. In traditional Chinese medicine, this is a case of wind-heat attacking the lung and loss of lung purification. We use hemp apricot, stone and sweet soup with diarrhea and white powder plus reduction to promote heat in the lung, lower the Qi and resolve phlegm. The use of Zhi Mu, Dan Pi, Di Bone Bark, Artemisia annua and Bai Wei can not only clear the heat but also prevent the prolonged heat from injuring Yin. At the same time, to protect the child's spleen and stomach, Shan Yao Chen Pi was added to strengthen the spleen and stop diarrhea. The next day of consultation coincided with the Spring Festival holiday, and when he visited the clinic after the holiday, he complained that his fever had subsided after taking 2 doses of medicine, and his cough was predominant, while he still had symptoms such as sneezing and runny nose, so he used Mao Ju Tang to clear the wind and heat, and added Di Bai San to clear the lung heat.