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TCM pediatrics holds that thirty-two days after birth constitutes one "Bian" (Transformation), and sixty-four days constitutes one "Zheng" (Steaming). "Bian" refers to the generation and transformation of the Zang organs (Solid organs); "Zheng" refers to the nourishment and development of the Fu organs (Hollow organs), thereby increasing Qi and Blood, generating Spirit, and enhancing intelligence. This process is completed after accumulating five hundred and seventy-six days. Whenever a Bian or Zheng occurs, there must be body heat, possibly accompanied by startle or fear, but the color of the mouth, face, lips, and tongue remains unchanged. The degree of body heat may vary from light to heavy, yet the spirit and mental state remain identical to normal, and the breath exhaled from the mouth is warm; it heals itself within three to four days. If the fever does not subside, it is appropriate for the nursing mother to take Xiao Chai Hu Tang (Minor Bupleurum Decoction) to bring peace. This still counts as an outstanding statement among pediatric theories.

However, examining the formulas for Bian and Zheng, some use Pian Yin Wan (Pian Yin Pill), which contains Croton Seed (Ba Dou), Mercury (Shui Yin), Black Lead (Hei Qian), Beijing Ink (Jing Mo), and Musk (She Xiang) for drastic purgation. Since it is said to increase Qi and Blood, generate Spirit, and enhance intelligence, one should only assist its ascending and generating functions. Instead, using toxic and harsh substances destroys the source of transformation. Is this not merely ineffective and actually harmful? According to their theory, taking the 365 degrees of the celestial sphere corresponding to the 365 joints of the human body, and excluding more than 45 bones in the hands and feet, leaves only 320 units. Starting with ten segments on the first day of life, one hundred segments in ten days, thirty-two days would result in three hundred and twenty segments constituting one "Bian". Following the sequence of "Heaven generates One with Water, Earth generates Two with Fire," the first Bian affects the Kidney, the second the Bladder, the third the Heart, the fourth the Small Intestine, the fifth the Liver, the sixth the Gallbladder, the seventh the Lung, the eighth the Large Intestine, the ninth the Spleen, and the tenth the Stomach. Although lacking solid evidence, the logic seems acceptable. Even if taken as the standard, it serves as an unchangeable method for Bian and Zheng.

Yet others argue based on the mutual generation of Wood and Fire, suggesting the first Bian affects the Liver, the second the Gallbladder, the third the Heart, the fourth the Small Intestine, the fifth the Spleen, the sixth the Stomach, the seventh the Lung, the eighth the Large Intestine, the ninth the Kidney, and the tenth the Bladder. Still others argue based on the mutual overcoming of Metal and Wood, suggesting the first Bian affects the Liver, the second the Gallbladder, the third the Lung, the fourth the Large Intestine, the fifth the Heart, the sixth the Small Intestine, the seventh the Spleen, the eighth the Stomach, the ninth the Kidney, and the tenth the Bladder.

The Zang organs and bone structure of children are fixed at birth and cannot be altered in the slightest; therefore, Bian and Zheng should have fixed principles. Now, however, everyone promotes their own views and speculates arbitrarily. Does this mean the Zang organs can be inverted and bone structures rearranged? How can we investigate the truth and falsehood? If "Heaven generates One with Water" is correct, then Wood-Fire generation and Metal-Wood overcoming are wrong; if Wood-Fire generation and Metal-Wood overcoming are correct, then "Heaven generates One with Water" is wrong. This merely creates endless entanglements without a definitive conclusion, leaving future students unsure of what to follow. Fortunately, Bian and Zheng are not diseases, so their inversion and confusion can be allowed. But if Bian and Zheng were diseases, and one strictly followed classic prescriptions, would it not mean treating Kidney disease as Spleen disease, and Bladder disease as Stomach disease? In short, such rigid statements should not serve as guidelines.

Generally, the principles and numbers of Heaven and Earth's Yin and Yang are both limited and unlimited. For instance, Wu Yun Liu Qi (Five Movements and Six Qi) is a fixed rule, yet there are times when expected influences do not arrive, and unexpected ones do; there are cycles of excess and recovery, host and guest interactions, with differences in whether they manifest or not. Even Heaven and Earth are like this, let alone infants born into different wind and soil conditions, with varying endowments, seasonal differences, and diverse diets/nutrition. To use such fixed patterns to limit when they should transform or steam is inappropriate. I have practiced clinical medicine for over forty years and have never seen an infant develop fever exactly according to these dates for Bian or Zheng. Some go from birth to adulthood without ever having a fever; others frequently develop fevers within ten days or half a month of birth. Are these really Bian and Zheng? Fever in children generally has no fixed pattern and should not be rigidly adhered to. Later scholars should not stubbornly treat this as fact, mistaking actual diseases for Bian and Zheng, thereby delaying treatment and causing significant harm. Simply treating according to the syndrome will naturally ensure survival.

Zhang Jingyue stated: The theory of pediatric Bian and Zheng did not exist in ancient times; it was first mentioned by Wang Shuhe of the Western Jin Dynasty. Since Chao Yuanfang of the Sui and Tang Dynasties, it has been passed down and evolved, becoming increasingly complex. However, in my opinion, it seems unlikely to be true. Why? Because when a fetus reaches full term and leaves the womb, although its constitution is not yet fully matured, its Zang organs are already complete. After birth, the mechanism of growth and nourishment is continuous, like the waxing and waning of the moon or the growth of seedlings, allowing no interruption for even a breath. All parts develop simultaneously, changing daily. How could there be a sequence where one precedes another, such as the first Bian affecting the Kidney, the second the Bladder, or every Bian requiring thirty-two days? Furthermore, regarding children being sick or healthy, I have seen and treated many cases. Whenever there is discomfort, it is either due to external pathogens or internal injury; I have never heard of illness arising without cause. Could this truly be Bian and Zheng? I also see many children who are well-protected and grow up without any illness. What about this? Although there is a theory of "hidden transformation," I ultimately cannot believe it. However, fearing that clinicians might fall into the error of obsession, I state my humble opinions thus. Will the enlightened agree?