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The *Chan Jing* (Classic of Childbirth) states: Six to seven days after birth, the infant's qi and blood converge, which may cause harm, leading to swelling in the mouth, tongue, cheeks, and neck. If there is a substance in the throat or on the tongue resembling water held within a reed husk, it is called "Xuan Yong" (Hanging Abscess), caused by qi distension. Similar conditions occurring under the tongue are called "Chong She" (Double Tongue). Those occurring above are called "Chong E" (Double Palate). Those occurring on the gums are called "Chong Yin" (Double Gums). All these should be treated by pricking to release blood and fluids, which is effective.

Wrap a long needle with cotton; the tip should not be sharp, about the size of a chestnut. Use it to prick and drain the lesion, allowing the pathogenic qi to escape and clearing out the clear, yellowish bloody fluid. This method is effective. One puncture is sufficient. Observe for one day; if it does not subside, prick again. Do not exceed three pricks, and it will naturally resolve. (This matches the record in *Duan Ju Fang*.)

The *Bing Yuan Lun* (Treatise on the Origins of Diseases) states: Infant "Bian Zheng" (Metamorphosis and Steaming) occurs to promote the growth of qi and blood. "Bian" refers to changes in upper jiao qi, and "Zheng" refers to body heat. Bian Zheng varies in severity. In mild cases, the body has slight heat and mild fright. The ears and hips are cold. The white flesh at the edge of the upper lip protrudes like the pupil of a dead fish. There is slight sweating. In balanced constitutions, it stops after a few days; in slower cases, it takes nine days to stop. In severe cases, the body has high fever and chaotic pulse. There may or may not be sweating. The infant loses appetite and vomits upon feeding, but suffers no distress. During Bian Zheng, the whites of the eyes are slightly red, and the pupils slightly white, yet there is no distress. After Bian Zheng concludes, vision becomes clear. The "Bian" phase lasts five days, followed by the "Zheng" phase for five days; within ten days, the heat subsides. At the onset of Bian Zheng, avoid startling the infant and keep crowds away. The timing of Bian Zheng varies; those following the correct schedule are rare. If the heat is severe during the initial phase, or persists beyond the expected days, carefully calculate the days to confirm it is indeed Bian Zheng. Administer Hei San (Black Powder) to induce sweating. If the heat persists, administer Zi Wan (Purple Pill); once the heat slightly improves, stop administration. If cold pathogens invade during Bian Zheng, cold and heat contend, causing abdominal pain, twisting cramps, and incessant crying. Boiled compresses will cure this. Bian Zheng resembles Wen Zhuang Shang Han (Warm Febrile Typhoid). If the infant has body heat, ear heat, and heat in the hips, it is another disease and should be treated accordingly. If it is confirmed as Bian Zheng, do not treat it as another disease. The days of Bian Zheng are cited from *Bing Yuan Lun*.

Additionally, signs of Bian Zheng include protrusion of the white flesh at the upper lip edge, resembling a dead fish's pupil, with slight sweating. It stops after a few days in fast cases, or nine days in slow cases.

At 32 days after birth, the first Bian occurs, characterized by hot ears. At 64 days, the second Bian occurs, accompanied by Zheng. The sign is the desire to lie straight. During the second Bian Zheng, the whites of the eyes may turn red, and the pupils slightly white. Upon completion, vision clarifies. At 96 days, the third Bian occurs, marked by the discharge from the umbilicus. At 128 days, the fourth Bian occurs, accompanied by Zheng; the infant can cough and smile. At 165 days, the fifth Bian occurs, completing the formation of joints ("Ji Guan"). At 192 days, the sixth Bian occurs, accompanied by Zheng, completing the five faculties ("Wu Ji"). At 224 days, the seventh Bian occurs; the infant learns to crawl. At 256 days, the eighth Bian occurs, accompanied by Zheng; the infant learns to speak. At 288 days, the ninth Bian occurs; the infant stands upright. This constitutes nine Bian and three Zheng. At 320 days, the tenth Bian occurs, accompanied by Zheng; the minor steaming cycle completes after 320 days. Then, a major Zheng occurs after 64 days, followed by another Zheng after 128 days. After accumulating 576 days, both major and minor steaming cycles complete, and the child becomes an adult. Thus, Bian Zheng nourishes the vessels and meridians and strengthens the five zang organs, so that after each cycle, changes in temperament are observed.

General signs of Zheng include high fever, chaotic pulse, sweating, unclear vision, slight fright, refusal to nurse, protrusion of white flesh at the upper lip edge resembling a dead fish's pupil, and redness/coldness of the ears and sacrum. This is the diagnostic pattern. It stops after five days in fast cases, or eight to nine days in slow cases. Carefully calculate the days of Zheng; acupuncture and medication should not be used.

During infant Bian Zheng, avoid startling the infant and keep crowds away. The timing of infant Bian Zheng varies, being either early or late.

If an infant undergoes nine months without Zheng, they will suffer deafness and blindness. If five months pass without Zheng, the body cannot walk. If nine months pass without Zheng, the five faculties do not form, resulting in Wei Jue (flaccidity and inability to walk).

The *Chan Jing* cites the Mai Jue (Pulse Aphorisms): During infant Bian Zheng, there is sweating, refusal to eat, vomiting upon feeding, and chaotic pulse, yet no distress.

The *Ge Shi Fang* states: At 60 days after birth, the pupils form; the infant can cough and suck, and recognize people. At 105 days, the meridians generate; the infant can roll over. At 180 days, the sacrum forms; the infant can sit alone. At 210 days, the palm bones form; the infant can crawl. At 300 days, the patella forms; the infant can lean alone. At 360 days, one cycle completes; the knee bones form, enabling walking.

To treat infants at the onset of Bian Zheng, use the following formula if symptoms appear, to induce sweating and stop heat: Hei San Formula:
Xing Ren (Apricot Seed, 2 fen)
Da Huang (Rhubarb Root, 1 fen)
Ma Huang (Ephedrae Herba, 2 liang, remove nodes)
Crush Da Huang and Ma Huang and sift them separately. Grind Xing Ren into a paste. Mix into the powder, blend well, and sift through a coarse sieve. Store in a reed bag. For a 20-day-old infant, mix with liquid to form a pill the size of a small bean, divide into two pills for easier swallowing. Wrap in thick clothing to induce sweating. After sweating, lower the bed curtains, light a fire for warmth, remove clothes, and apply warm powder. For a 100-day-old infant, take powder the size of a date pit, administer with Xiao Yang He Decoction. After sweating, care follows the same method; prepare warm powder in advance. Do not remove clothes before applying powder. (From *Ge Shi Fang*.)

For infants who have taken Hei San but still have persistent fever, use this formula. Stop once the fever slightly improves; do not administer further. Zi Wan Formula:
Chi Shi Zhi (Halloysitum Rubrum, 1 liang)
Ba Dou (Crotonis Fructus, 30 seeds)
Dai Zhe Shi (Haematitum, 1 liang)
Xing Ren (Apricot Seed, 30 seeds; alternative recipe uses 50 seeds, peel removed)
Crush Ba Dou and Xing Ren, pounding 2,000 times. Add Dai Zhe Shi and Chi Shi Zhi, and pound 3,000 more times until the medicine is hot/ready. An alternative method says: Mix together, add a little honey, store in a sealed container to prevent drying, as dryness reduces efficacy. Form pills using Ba Dou and Xing Ren. For a 20-day-old infant, administer one pill the size of a millet grain. Feed a small amount of milk afterward to help the medicine descend. Wait two meal periods, then nurse again; do not overfeed. Administer one dose at dawn; the heat should cease by noon. In the late afternoon, slightly increase the dosage. At cockcrow, if administering another pill, stop if cured. For a 30-day-old infant, administer a pill the size of a large millet grain. For a 30-day-old infant (note: likely a typo in source, possibly referring to older infants), administer a pill the size of a hemp seed. For a 60-70 day old infant, administer a pill the size of a broad bean. For a 100-day-old infant, administer a pill the size of a small bean. If the heat persists due to lack of bowel movement, increase by half a pill; stop when diarrhea occurs.

Another explanation: When taking Zi Wan, the pill must be completely expelled. If not expelled or only partially expelled, the disease is not fully resolved, and it should be administered again. Only administer Zi Wan if there is heat. If there is no heat but only cold, frequently offer the breast. Dan Dang Gui San (Single Angelica Powder) and Huang Qin San (Scutellaria Powder) are also mentioned. For slight heat after taking medicine during Bian Zheng, Chu Re Huang Qin Tang (Heat-Removing Scutellaria Decoction) can be given. (From *Seng Shen Fang*.)

Huang Qin Tang is for infants during Bian Zheng. If morning/evening fever, vomiting, or diarrhea occur after administration, use this Heat-Removing Formula:
Huang Qin (Scutellariae Radix, 1 liang)
Gan Pi (Cortex Cinnamomi, 6 zhu) [Note: Likely Gan Cao or similar bark]
Ren Shen (Ginseng Radix, 1 liang)
Sheng Di Huang (Rehmanniae Radix Preparata, 6 zhu)
Gan Cao (Licorice Root, 0.5 liang, honey-fried)
Da Zao (Jujubae Fructus, 5 pieces, pitted)
Cut the six herbs. Boil in 3 sheng of water to obtain 1 sheng. Strain. A 200-day-old infant takes 0.5 he; a 300-day-old infant takes 1 he. Twice daily. Stop when fever resolves. For Bian Zheng with slight heat, this can be taken. (From Zhang Zhongjing.)

It is also stated: The Classics say: Heaven is deficient in the northwest, so the infant's cheeks remain closed initially. Earth is deficient in the southeast, so the infant's knees develop posteriorly. Humans emulate the Three Powers, so teeth develop later. Thus, speech begins when cheeks close, and walking begins when knees form. If Tai Yin qi is insufficient and Tai Yang yang is excessive, the infant becomes emaciated with thin calves and walks only at age three.