变蒸者,此小儿正病也。盖变者异也,每变毕,性情即异于
前。何者?长生脏腑之意也。蒸者,蒸蒸然热也,万物生于春而
长于夏者,以阳主生长,其于人也亦然(9)。故变蒸足,始及成人,
气血充实,骨肉坚牢也。小几此症,譬如蚕之有眠,龙之脱骨,
虎之转爪。而变化同也。故每三十二日有变蒸,至五百七十六日,
大小变蒸足矣。轻则发热微汗,其状似惊;重则壮热。脉乱而
数。或汗或烦,啼哭燥渴。轻者五日解,其侯与伤寒相似;亦有
变蒸之余感寒邪者。但变蒸则耳冷,上唇发泡如浊珠,若寒邪传
之,别寒热交争而腹痛,啼哭之声,旦夜不停。治此之法,轻者
不须服药,重者以平和饮子微表之。热甚便结,以紫霜丸微利
之。若吐泻不乳多啼者,调气散治之。
人参五分,白茯(去皮)一钱,甘草五分,升麻(煨)
五分,禀受弱者。加白术一钱,肥实者不用,水煎服。
木香、香附、厚朴(炙)、人参,陈皮,藿香,
炙草。姜枣引,水煎服。
凡小儿初生,有用黄连、甘草以下胎粪者。若儿壮实者,禀胎
足固无所损,若禀胎怯弱者,受此寒凉之剂,不生异症者鲜矣。
如有里症郁结,壅闭不通者,欲下胎毒,只用淡豆豉浓煎汤
与之,五七口其毒自下,又能助养脾胃,真奇方也。
凡小儿当变蒸之时,不热不惊,别生他症,是为暗变,此受
胎气壮实故也。
凡小儿初生,多有灸百会穴者,取其可以截风也。殊不知地
有南北,人有勇怯,北人用灸固宜。南人用之,无益而有害也。
凡小儿初生下。有身体破裂者必死!阴囊白者必死;阴不起
者必死;无粪门者必死;股间无肉者必死;哭如鸭声者必死。周
岁之间,颅骨开解,齿未生,手足挛缩,膝如鹤节,身体瘦弱,长
大不能行立者,此皆胎气不足者也,多夭。若筋实则多力!骨实
则行早;血实则形瘦多发;肉实则少病;精实则伶俐多语笑,不
怕寒暑;步气实则少发而体肥。此皆受禀胎气之有余也,多寿(10)。
西 江 月
小儿变蒸何以。三十二日为期,精神改变异常时,发热蒸蒸
昏睡。或遇风寒外感,或兼乳食伤脾,留连苦楚莫差池,好把汤丸
调治。
大抵六十四日,初生肾与膀恍,再生心火与小肠,肝胆第三
长养,肺与大肠居四,脾胃五次消详,三焦胞络不同乡,只为有名
无状。
小儿变生智能,自然发热如蒸,昏昏不语(11)欠醒醒,恰似蚕
眠相应。医者不须妄治,父母何必忧惊,三日之后自和平,只怕
别生形症。
若遇风寒外感,惺惺散子堪行,内伤乳食不安宁。保和养脾
兼进。咳嗽参苏饮子,吐泻(12)理中最灵,惊来搐擎用泻(13)青,
异赤亦宜选进。
变蒸,这是小儿正常的生理现象。所谓“变”,是指变化,每次变蒸结束后,孩子的性情就会与之前有所不同。为什么呢?这是脏腑逐渐生长的意思。“蒸”,是指身体微微发热,就像万物在春天萌发、夏天生长一样,是因为阳气主导着生长,对于人也是如此。因此,等到变蒸完成,孩子才成长为成人,此时气血充实,骨肉坚固。小儿的变蒸症状,好比蚕蜕皮、龙换骨、虎转爪,其本质都是蜕变的过程。所以每三十二天有一次变蒸,直到五百七十六天,大小变蒸才算完成。轻症表现为低热微汗,症状类似惊风;重症则高热,脉象紊乱而快速,或者出汗或烦躁,啼哭且口渴。轻症五天左右自愈,其征候与伤寒相似;也有在变蒸期间感受寒邪的。但变蒸时耳朵是凉的,上唇出现像浑浊珠子一样的水泡;如果是寒邪传入,则会寒热交争导致腹痛,啼哭声日夜不停。治疗此法,轻症不需要服药,重症用平和饮子轻微发汗解表。如果热盛伴有大便干结,用紫霜丸轻微通便。如果出现呕吐腹泻、不吃奶且多啼哭的情况,用调气散治疗。
人参五分,白茯苓(去皮)一钱,甘草五分,升麻(煨制)五分,适用于先天禀赋虚弱者。若体质肥实者,加白术一钱,体质肥实者不用白术,水煎服。
木香、香附、厚朴(炙)、人参、陈皮、藿香、炙甘草。以生姜、大枣为引,水煎服。
凡是小儿刚出生时,有用黄连、甘草来排出胎粪的。如果孩子体格壮实,先天禀赋充足稳固,服用这些药物没有损害;但如果先天禀赋怯弱,受到这种寒凉药物的影响,不产生其他病症的很少见。如果有里证郁结、壅闭不通的情况,想要下胎毒,只用淡豆豉浓煎汤给孩子喝,喝五到七口,胎毒自然排出,又能帮助滋养脾胃,真是奇妙的方子。
凡是小儿处于变蒸时期,如果不发热也不惊厥,却生出其他病症,这叫做“暗变”,这是因为受胎时禀气壮实的原因。
凡是小儿刚出生,很多人会灸百会穴,认为这样可以截断风邪。却不知道地域有南北之分,人有勇敢怯懦之别,北方人使用灸法固然适宜。南方人使用,不仅无益反而有害。
凡是小儿刚出生,身体破裂的必死;阴囊白色的必死;阴茎不起的必死;没有肛门的必死;大腿间没有肌肉的必死;哭声像鸭子叫的必死。周岁之间,颅骨未合,牙齿未生,手足挛缩,膝盖像鹤节一样突出,身体瘦弱,长大后不能行走站立的,这些都是胎气不足的表现,大多夭折。如果筋脉坚实则力气大;骨骼坚实则行走早;血液充盈则形体瘦但头发茂密;肌肉坚实则少生病;精气充实则聪明伶俐、多言笑,不怕寒暑;步态稳健则少发病且身体肥胖。这些都是受胎时禀气有余的表现,大多长寿。
西江月词:
小儿变蒸是怎么回事?以三十二天为一个周期。精神面貌改变异常时,身体发热如蒸且昏睡。如果遇到风寒外感,或者兼有乳食损伤脾胃,留恋不去带来痛苦莫要疏忽,要用汤药丸剂调理治疗。
大抵六十四天时,初生肾与膀胱,再生心火与小肠,肝胆第三长养,肺与大肠居第四位,脾胃第五次消详,三焦胞络不在同一地方,只是有名而无具体形态。
小儿变蒸产生智能,自然发热如蒸,昏昏不语,时而清醒,恰似蚕眠相应。医者不必胡乱治疗,父母何必惊慌,三天之后自然平和,只怕生出其他形症。
如果遇到风寒外感,惺惺散子可以使用,内伤乳食不安宁,保和养脾兼进。咳嗽用参苏饮子,吐泻理中汤最灵验,惊风抽搐用泻青丸,导赤散也适宜选用。
Bianzheng (Variation and Steaming) is a normal physiological phenomenon in infants. "Bian" (Variation) refers to change; after each Bianzheng cycle, the child's temperament differs from before. Why? This signifies the gradual growth of the Zang-Fu organs. "Zheng" (Steaming) refers to a slight fever, similar to how all things sprout in spring and grow in summer, driven by Yang Qi which governs growth, and this applies to humans as well. Thus, only after Bianzheng is complete does one become an adult, with Qi and Blood full and bones and flesh firm. The symptoms of Bianzheng in children are like a silkworm molting, a dragon shedding its bones, or a tiger changing its claws; they are all processes of transformation. Therefore, there is a Bianzheng every 32 days, until 576 days have passed, completing the minor and major cycles. Mild cases present with low-grade fever and slight sweating, resembling Wind-Stirring (Jing Feng); severe cases present with high fever, chaotic and rapid pulse, or sweating/irritability, crying, and thirst. Mild cases resolve in about five days, with signs similar to Shanghan (Cold Damage); however, some may contract Cold Evil during Bianzheng. In Bianzheng, the ears are cold, and bubbles like turbid pearls appear on the upper lip; if Cold Evil invades, it causes abdominal pain due to Cold-Heat conflict, with ceaseless crying day and night. Treatment: mild cases require no medicine; severe cases use Pinghe Yinzi (Harmonizing Decoction) for mild diaphoresis. If heat is severe with constipation, use Zishuang Wan (Purple Frost Pill) for mild purgation. If vomiting, diarrhea, refusal to nurse, and excessive crying occur, use Tiaoqi San (Regulating Qi Powder).
Ren Shen (Ginseng Radix) 5 fen, Bai Fu Ling (Poria) 1 qian (peeled), Gan Cao (Licorice Root) 5 fen, Sheng Ma (Cimicifugae Rhizoma) 5 fen (roasted), suitable for those with weak congenital constitution. For robust constitutions, add Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 qian; avoid in robust constitutions. Decoct in water and take orally.
Mu Xiang (Aucklandiae Radix), Xiang Fu (Cyperi Rhizoma), Hou Po (Magnoliae Officinalis Cortex) (roasted), Ren Shen (Ginseng Radix), Chen Pi (Citri Reticulatae Pericarpium), Huo Xiang (Agastaches Herba), Zhi Gan Cao (Prepared Licorice Root). Use Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) as guides, decoct in water and take orally.
Some use Huang Lian (Coptidis Rhizoma) and Gan Cao (Licorice Root) to expel meconium upon birth. If the infant is strong and has sufficient congenital essence, these drugs cause no harm. However, if the infant has a weak congenital constitution, exposure to such cold-cooling agents rarely fails to produce other disorders. If there is interior stagnation and blockage, and one wishes to purge fetal toxins, simply use Dan Dou Chi (Sojae Semen Preparatum) decocted strongly to drink; after 5-7 mouthfuls, the toxin will naturally exit, while also nourishing the Spleen and Stomach. This is truly a miraculous prescription.
When an infant undergoes Bianzheng, if there is no fever or convulsion but other symptoms arise, it is called "An Bian" (Hidden Variation), due to a strong congenital constitution.
Many moxa-burn the Bai Hui acupoint (GV20) upon birth, believing it blocks Wind. However, geography varies (North/South), and individuals vary in courage/timidity. Moxa is suitable for Northerners but harmful and useless for Southerners.
Infants born with body ruptures die; white scrotum dies; non-erect penis dies; absent anus dies; lack of muscle between thighs dies; duck-like cry dies. Within the first year, if the skull fontanelles remain open, teeth do not erupt, limbs are contracted, knees resemble crane joints, and the body is emaciated, unable to walk or stand later in life, these indicate insufficient congenital Qi, leading to early death. If sinews are solid, strength is great; if bones are solid, walking comes early; if blood is full, the form is thin but hair is abundant; if flesh is solid, disease is rare; if Essence is full, the child is clever, talkative, laughs often, and resists cold/heat; if gait is solid, disease is rare and the body is plump. These indicate surplus congenital Qi, leading to longevity.
Xijiang Yue (Poem):
What is pediatric Bianzheng? It follows a 32-day cycle. When spirit changes abnormally, fever steams and sleepiness ensues. If exposed to Wind-Cold externally, or milk/food damages the Spleen internally, lingering suffering must not be neglected; treat with decoctions and pills.
Generally, at 64 days, Kidney and Bladder develop first; then Heart Fire and Small Intestine; Liver and Gallbladder grow third; Lung and Large Intestine fourth; Spleen and Stomach fifth; Sanjiao and Bao Luo (Uterus/Lining) are distinct, having name but no distinct form.
Pediatric Bianzheng generates intelligence, with natural steaming fever, drowsiness without speech, waking intermittently, corresponding to silkworm molting. Physicians need not treat rashly; parents need not panic. After three days, peace returns; fear only other pathological signs.
If Wind-Cold external contraction occurs, Xingxing Sanzi (Awakening Powder) is applicable. Internal injury from milk/food causes unrest; Bahe (Harmonize) and Spleen-nourishing formulas should be advanced. For cough, Can Su Yinzi (Ginseng and Saposhnikovia Decoction); for vomiting/diarrhea, Lizhong Tang (Regulate the Middle Decoction) is most effective; for convulsions due to fright, Xie Qing Wan (Drain Green Pill); Dao Chi San (Direct Out Red Powder) is also suitable.