{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:11:20Z","timestamp":1784182280939,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically analyze the clinical manifestations, dynamic changes in hematological parameters, traditional Chinese medicine (TCM) tongue characteristics, and syndrome differentiation patterns in children with influenza A during spring, so as to provide clinical evidence for the integrated Chinese and Western medicine diagnosis and treatment of pediatric influenza A in spring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center retrospective study design was adopted. A total of 143 children who visited the Department of Traditional Chinese Medicine of our hospital in the spring of 2024 and 2025 and were initially diagnosed with influenza A were included. General information, initial symptoms, and symptom combinations were collected. Hematological parameters were measured, including white blood cell count (WBC), absolute neutrophil count (NEU), absolute lymphocyte count (LYM), neutrophil-to-lymphocyte ratio (NLR), procalc itonin (PCT), and C-reactive protein (CRP). According to disease duration, patients were divided into three stages: &amp;lt;1 d, &amp;gt;1\u2013\u22643 d, and &amp;gt;3\u201314 d, and trends of change were compared. Tongue characteristics including tongue color, coating texture, and coating color were recorded, and TCM syndrome differentiation types were statistically analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      (1) General data and symptom characteristics: Among the 143 children, 78 were male (54.55%) and 65 were female (45.45%), with a mean age of (6.48\u2009\u00b1\u20093.61) years. The main age group was &amp;gt;5\u2013\u226410 years (64 cases, 44.76%). The mean disease duration was (1.82\u2009\u00b1\u20091.69) d, and 100 cases (69.93%) sought medical care within \u22641 d. Fever was the most common initial symptom (132 cases, 92.31%). The most frequent symptom combination was \u201c fever\u2009+\u2009cough\u201d (116 cases, 81.12%), followed by \u201cfever\u2009+\u2009constipation\u201d (85 cases, 59.44%). (2) Changes in hematological parameters: At the initial visit, 129 cases (90.21%) had LYM below the normal reference range, and 84 cases (58.74%) had elevated PCT. With disease progression, WBC showed a s light downward trend without statistical significance (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05); NEU gradually decreased, and was lower in the &amp;gt;3\u201314 d stage than in the &amp;lt;1 d stage (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05); LYM gradually increased, and was higher in the &amp;gt;1\u2013\u22643 d and &amp;gt;3\u201314 d stages than in the &amp;lt;1 d stage (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05); NLR gradually decreased, and was lower in the &amp;gt;3\u201314 d stage than in the &amp;lt;1 d stage (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). PCT and CRP increased in the &amp;gt;1\u2013\u22643 d stage and decreased in the &amp;gt;3\u201314 d stage; PCT in the &amp;gt;3\u201314 d stage was lower than that in the &amp;gt;1\u2013\u22643 d stage (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), and CRP in the &amp;gt;1\u2013\u22643 d stage was higher than that in the &amp;lt;1 d stage (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). (3) Tongue characteristics: Red tongue was predominant (134 cases, 93.71%), and the proportion of red tongue increased with disease progression (&amp;lt;1 d 92.00%, &amp;gt;3\u201314 d 100%). Thick coating was predominant (91 cases, 63.64%), and the proportion increased with prolonged disease duration (&amp;lt;1 d 60.00%, &amp;gt;3\u201314 d 73.33%). White coating was the most common (89 cases, 62.24%), while the proportion of yellow coating increased with disease progression (&amp;lt;1 d 30.00%, &amp;gt;3\u2013 14 d 60.00%). (4) TCM syndrome differentiation characteristics: The distribution of syndromes was as follows: heat-toxin attacking the lung syndrome (50 cases, 34.97%), wind-heat invading the exterior syndrome (47 cases, 32.87%), wind-cold constraining the exterior syndrome (29 cases, 20.28%), and dampness obstructing the defensive qi syndrome (17 cases, 11.89%). Stratification by sex showed that wind-heat invading the exterior syndrome was slightly more common in males (35.90%), while heat-toxin attacking the lung syndrome was slightly more common in females (38.46%). Stratification by age showed that in the 0\u2013\u22645 years and &amp;gt;5\u2013\u226410 years groups, wind-heat invading the exterior syndrome was more common (35.71% and 35.94%, respectively), whereas in the &amp;gt;10\u201316 years group, heat-toxin attacking the lung syndrome predominated (56.52%). Stratification by disease duration showed that the &amp;gt;3\u201314 d stage had the highest proportion of heat-toxin attacking the lung syndrome (53.33%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Spring influenza A in children was characterized by fever-dominant onset, frequent cough and constipation, early lymphopenia, dynamic inflammatory marker changes, and progressive tongue\/coating changes across disease-duration stages. The observed increase in red tongue, thick coating, yellow coating, and heat-related TCM syndromes suggests a possible disease-duration-related shift toward intensified heat signs. These findings may provide exploratory reference for integrated clinical assessment, but they should be interpreted with caution because of the single-center retrospective design, small late-stage subgroup, absence of treatment\/outcome data, and lack of standardized digital tongue imaging. Prospective multicenter studies are needed to validate these observations and clarify their clinical value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1879124","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:40:23Z","timestamp":1784180423000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics, tongue manifestations, and traditional Chinese medicine syndrome patterns of spring influenza A in children: a single-center retrospective study"],"prefix":"10.3389","volume":"14","author":[{"given":"Yuan","family":"Si","sequence":"first","affiliation":[{"name":"Department of Traditional Chinese Medicine, People\u2019s Hospital Affiliated to Shandong First Medical University","place":["Jinan, 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