巢氏云∶小儿变蒸者，以长气血也，变者上气，蒸者体热。仲阳云∶变者易也。又云∶变蒸
者，自内而长，自下而上，又身热。故每变毕，即觉性情有异于前，何者？长生脏腑意智故
也。何谓三十二日长骨添精神？人有三百六十五骨以象天数，以应期岁，以分十二经络。自
初生至三十二日一变，生癸属足少阴经，肾藏精与志。六十四日二变一蒸，生壬属足太阳经
膀胱腑，其发耳与 冷，肾与膀胱合，俱主于水，天一生水，地六成之。至九十六日三变，
生丁属手少阴经，心藏神其性为喜。至一百二十八日四变二蒸，生丙属手太阳经小肠腑，其
发汗出而微惊，心与小肠合为火，地二生火，天七成之。至一百六十日五变，生乙属足厥阴
经，肝藏魂喜哭。至一百九十二日六变三蒸，生甲属足少阳经胆腑，其发目不闭（一作开）而赤
，肝与胆合主木，天三生木，地八成之。至二百二十四日七变，生辛属手太阴经，肺藏魄主
声。至二百五十六日八变四蒸，生庚属手阳明经大肠腑，其发肤热而汗或不汗，肺与大肠合
主金，地四生金，天九成之。至二百八十八日九变，生己属足太阴经，脾藏意与智。至三百
二十日十变五蒸，生戊属足阳明经胃腑，其发不食腹痛而吐乳，脾与胃主土，天五生土，地
十成之。又手厥阴经心包络为脏，手少阳经三焦为腑。此一脏一腑俱无状，故不变而不蒸也
。前十变五蒸，乃天地之数以生成之。此后如生齿能言知喜怒，故云始全也。太仓云∶气入
四肢，长碎骨于十变后六十四日为一大蒸，计三百八十四日，长其经脉，手受血故能持物；
足受血故能行立。经云∶变且蒸谓蒸毕而足一岁之日有余也。师曰∶不汗而热者发其汗，大
吐者微止不可别治。又六十四日为二大蒸，计四百四十八日。又六十四日为三大蒸，计五百
一十二日，至五百七十六日，变蒸既毕，儿乃成人也。变者生五脏也，蒸者养六腑也，变者
上气，蒸者发热，每经一变一蒸，情态即异，轻则发热微汗，其状似惊，重则壮热脉乱而数
，或汗或吐，或烦啼躁渴，轻者五日解，重者七八日解，其候与伤寒相似。亦有变蒸之余，
续感寒邪者，但变蒸则耳冷 冷，上唇发泡如浊珠，若寒邪搏之，则寒热交争，腹中作痛，
而啼叫之声，日夜不绝。变者易也，蒸于肝则目眩微赤；蒸于肺则嚏咳毛耸。凡五脏六腑筋
脉骨，循环各有证应，其治法平和者解表之，实热者微利之，可服紫霜丸、黑散子、柴胡汤
。有寒无热并吐泻不乳多啼者，当归散、调气散主之。变蒸之外，小儿体貌情态，自然平和
。大抵人得中和之道，以为纯粹，阴阳得所，刚柔兼济，气血和而百脉顺。所以心智益通，
精神俱备，脏腑充实，形体固壮，齿细发黑，声洪睡稳，此乃受气充足，禀性得中，而无疾
尔。前症盖小儿所不免者，虽勿药亦可也。前药峻烈，非惟脏腑之不胜，抑且反伤气血。余
常见一小儿，至一变发热有痰，投抱龙丸一粒，卒至不救，观此可验，慎之慎之！其有不热
不惊，略无症候而暗变者，盖受胎气壮实故也。
紫霜丸（方见撮口）
紫阳黑散 治变蒸解利热气。
麻黄（二两不去节） 大黄（半两） 杏仁（去皮，二分半，研）
上以前三味和一处杵碎，略烧存性，后入杏仁膏和之，蜜盛贮，每用一豆许，乳汁和咽之。
柴胡汤 治变蒸骨热心烦，啼叫不已。
人参（二钱） 甘草（微炙，二钱） 麦门冬（去心，二钱） 龙胆草（酒炒黑） 防风（各一钱） 柴胡（五分）
上每服一钱，水煎。
当归散 治变蒸有寒无热。
当归（二钱） 木香 官桂（辣者） 甘草（炙） 人参（各一钱）
上每服一钱，姜枣水煎。
调气散 治变蒸吐泻，不乳多啼，欲发慢惊。
木香 香附子 人参 橘皮 藿香 甘草（炙。各一钱）
上为末，每服一钱，姜枣水煎服。
巢元方说：小儿的变蒸，是用来生长气血的。“变”是指上部的阳气变化，“蒸”是指身体发热。钱乙（字仲阳）说：“变”就是改变的意思。他又说：变蒸是从体内向外生长，从下部向上升发，同时伴有身体发热。所以每次变蒸结束后，就会觉得孩子的性情与之前有所不同，为什么呢？这是因为脏腑、意念和智慧在生长的缘故。
什么是“三十二日长骨添精神”？人体有三百六十五块骨头以象征天数的周流，对应一年的周期，并分属十二经络。从出生到第三十二天为第一次变，生成癸水，归属于足少阴肾经，肾藏精与志。第六十四天为第二次变兼第一次蒸，生成壬水，归属于足太阳膀胱经，其表现为耳朵和尻部发冷，肾与膀胱相表里，都主司水，天一生水，地六成之。第九十六天为第三次变，生成丁火，归属于手少阴心经，心藏神，其情志为喜。第一百二十八天为第四次变兼第二次蒸，生成丙火，归属于手太阳小肠经，其表现为出汗且轻微惊悸，心与小肠相表里属火，地二生火，天七成之。第一百六十天为第五次变，生成乙木，归属于足厥阴肝经，肝藏魂，喜欢哭泣。第一百九十二天为第六次变兼第三次蒸，生成甲木，归属于足少阳胆腑，其表现为眼睛不闭（一说睁开）且发红，肝与胆相表里主木，天三生木，地八成之。第二百二十四天为第七次变，生成辛金，归属于手太阴肺经，肺藏魄，主管声音。第二百五十六天为第八次变兼第四次蒸，生成庚金，归属于手阳明大肠腑，其表现为皮肤发热且有汗或无汗，肺与大肠相表里主金，地四生金，天九成之。第二百八十八天为第九次变，生成己土，归属于足太阴脾经，脾藏意与智。第三百二十天为第十次变兼第五次蒸，生成戊土，归属于足阳明胃腑，其表现为不吃东西、腹痛且吐奶，脾与胃相表里主土，天五生土，地十成之。另外，手厥阴心包络为脏，手少阳三焦为腑。这一脏一腑都没有具体的形态表现，所以不参与变蒸。前十次变五次蒸，是天地之数生成的规律。此后如长出牙齿、能说话、知晓喜怒，所以说此时发育才算完整。太仓公（淳于意）说：气进入四肢，在十变之后六十四天为一次大蒸，共计三百八十四天，以此生长经脉，手得到血的滋养就能拿取物品；脚得到血的滋养就能行走站立。医经说：变且蒸，是指蒸毕后满一岁有余。老师说：如果不出汗而发热，应用发汗法治疗；如果剧烈呕吐，应轻微止呕，不可另行其他治疗。又过六十四天为第二次大蒸，共计四百四十八天。再过六十四天为第三次大蒸，共计五百一十二天。到第五百七十六天时，变蒸结束，孩子才算是成人。变是生长五脏，蒸是养育六腑；变是上部气机变化，蒸是身体发热。每经历一变一蒸，情态就会有异样，轻则发热微汗，症状类似惊风；重则高热、脉象紊乱且快速，或有汗或呕吐，或烦躁啼哭、躁动口渴，轻者五天缓解，重者七八天缓解，其征候与伤寒相似。也有在变蒸余气未清时，再次感受寒邪的，只是变蒸时耳朵和尻部发凉，上唇起水泡像浑浊的珠子；如果是寒邪搏击，则寒热交争，腹中疼痛，啼叫之声日夜不停。变就是改变，蒸于肝则目眩微红；蒸于肺则打喷嚏咳嗽、毫毛竖起。凡五脏六腑筋脉骨，循环各有证候反应，其治疗方法：平和者解表，实热者轻微通利，可服用紫霜丸、黑散子、柴胡汤。有寒无热并伴有呕吐腹泻、不肯吃奶、多啼哭的，用当归散、调气散主治。除了变蒸之外，小儿的体貌情态，自然是平和的。大抵人得中和之道，成为纯粹之体，阴阳各得其位，刚柔相互济助，气血调和而百脉顺畅。所以心智日益通达，精神具备，脏腑充实，形体坚固强壮，牙齿整齐头发黑亮，声音洪亮睡眠安稳，这是受气充足，禀性得中，而没有疾病的表现。前面的症状大概是小儿所难免的，即使不用药也可以痊愈。前面的药物峻烈，不仅脏腑难以承受，反而还会损伤气血。我常见一个小孩，到了第一次变蒸时发热有痰，投服一粒抱龙丸，竟然导致死亡，看这个例子可以验证，务必谨慎！那些没有发热惊悸，完全没有症候而暗中变蒸的，是因为胎气壮实的缘故。
紫阳黑散 治疗变蒸后解除余热。
麻黄（二两，不去节） 大黄（半两） 杏仁（去皮，二分半，研碎）
以上前三味混合捣碎，稍微烧存性，然后加入杏仁膏调和，用蜜封盛储存，每次用一粒豆大小的量，用乳汁调和咽下。
柴胡汤 治疗变蒸时骨节发热心烦，啼哭不止。
人参（二钱） 甘草（微炙，二钱） 麦门冬（去心，二钱） 龙胆草（酒炒至黑） 防风（各一钱） 柴胡（五分）
以上每服一钱，用水煎煮。
当归散 治疗变蒸时有寒无热。
当归（二钱） 木香 官桂（辛辣者） 甘草（炙） 人参（各一钱）
以上每服一钱，用姜枣水煎煮。
调气散 治疗变蒸时呕吐腹泻，不肯吃奶多啼哭，欲发慢惊风。
木香 香附子 人参 橘皮 藿香 甘草（炙。各一钱）
以上研为细末，每服一钱，用姜枣水煎服。
Chao Yuanfang stated: The "bianzheng" (periodic growth and fever) in infants is for the generation of Qi and Blood. "Bian" refers to the transformation of upper Qi, while "Zheng" refers to body heat. Qian Yi (courtesy name Zhongyang) said: "Bian" means change. He further stated that bianzheng grows from within outward, from below upward, accompanied by body heat. Therefore, after each bianzheng cycle concludes, one perceives a difference in the child's temperament compared to before. Why is this? It is because the Zang-Fu organs, intentions, and intelligence are growing.
What is meant by "thirty-two days to grow bones and add spirit"? The human body has three hundred and sixty-five bones to symbolize the celestial cycle, corresponding to the annual period, and distributed among the twelve meridians. From birth to the thirty-second day constitutes the first Bian, generating Gui Water, belonging to the Foot Shaoyin Kidney Meridian; the Kidney stores Essence and Will. On the sixty-fourth day, the second Bian and first Zheng occur, generating Ren Water, belonging to the Foot Taiyang Bladder Organ; its manifestation is coldness in the ears and sacrum. The Kidney and Bladder are interior-exterior pairs, both governing Water; Heaven generates Water with One, Earth completes it with Six. On the ninety-sixth day, the third Bian occurs, generating Ding Fire, belonging to the Hand Shaoyin Heart Meridian; the Heart stores Spirit, and its emotion is Joy. On the hundred-and-twenty-eighth day, the fourth Bian and second Zheng occur, generating Bing Fire, belonging to the Hand Taiyang Small Intestine Organ; its manifestation is sweating and slight fright. The Heart and Small Intestine are interior-exterior pairs governing Fire; Earth generates Fire with Two, Heaven completes it with Seven. On the hundred-and-sixtieth day, the fifth Bian occurs, generating Yi Wood, belonging to the Foot Jueyin Liver Meridian; the Liver stores Hun (Ethereal Soul) and tends toward weeping. On the hundred-and-ninetieth day, the sixth Bian and third Zheng occur, generating Jia Wood, belonging to the Foot Shaoyang Gallbladder Organ; its manifestation is eyes remaining open (or closed, depending on the text version) and redness. The Liver and Gallbladder are interior-exterior pairs governing Wood; Heaven generates Wood with Three, Earth completes it with Eight. On the two-hundred-and-twenty-fourth day, the seventh Bian occurs, generating Xin Metal, belonging to the Hand Taiyin Lung Meridian; the Lung stores Po (Corporeal Soul) and governs voice. On the two-hundred-and-fifty-sixth day, the eighth Bian and fourth Zheng occur, generating Geng Metal, belonging to the Hand Yangming Large Intestine Organ; its manifestation is skin heat with or without sweating. The Lung and Large Intestine are interior-exterior pairs governing Metal; Earth generates Metal with Four, Heaven completes it with Nine. On the two-hundred-and-eighty-eighth day, the ninth Bian occurs, generating Ji Earth, belonging to the Foot Taiyin Spleen Meridian; the Spleen stores Yi (Intellect) and Zhi (Memory). On the three-hundred-and-twentieth day, the tenth Bian and fifth Zheng occur, generating Wu Earth, belonging to the Foot Yangming Stomach Organ; its manifestation is anorexia, abdominal pain, and regurgitation of milk. The Spleen and Stomach are interior-exterior pairs governing Earth; Heaven generates Earth with Five, Earth completes it with Ten. Additionally, the Hand Jueyin Pericardium is a Zang organ, and the Hand Shaoyang Sanjiao (Triple Burner) is a Fu organ. These two have no distinct physical manifestations, thus they do not undergo bian or zheng. The previous ten Bians and five Zhengs follow the numbers of Heaven and Earth for generation and completion. Thereafter, such as the eruption of teeth, ability to speak, and understanding of joy and anger, indicate that development is complete. Chunyu Yi (courtesy name Taicang) stated: Qi enters the four limbs; sixty-four days after the ten Bians constitutes a major Zheng, totaling three hundred and eighty-four days, to grow the meridians. When the hands receive blood, they can grasp objects; when the feet receive blood, they can walk and stand. The classics state: "Bian and Zheng" implies that after the Zheng cycles conclude, more than one year has passed. The masters say: If there is fever without sweating, induce sweating; if there is severe vomiting, mildly stop vomiting and do not apply other treatments. Another sixty-four days later constitutes the second major Zheng, totaling four hundred and forty-eight days. Another sixty-four days later constitutes the third major Zheng, totaling five hundred and twelve days. By five hundred and seventy-six days, the bianzheng process is complete, and the child becomes an adult. Bian generates the five Zang organs, and Zheng nourishes the six Fu organs; Bian involves the ascent of Qi, and Zheng involves fever. With each Bian and Zheng, the demeanor changes. Mild cases present with low-grade fever and slight sweating, resembling wind-stroke; severe cases present with high fever, chaotic and rapid pulse, sweating or vomiting, irritability, crying, restlessness, and thirst. Mild cases resolve in five days, severe cases in seven to eight days. The symptoms resemble Cold Damage (Shanghan). Some infants, while residual qi from bianzheng remains, contract cold pathogenic factors. In bianzheng, the ears and sacrum are cold, and blisters like turbid pearls appear on the upper lip. If cold pathogenic factors contend, there is alternating chills and fever, abdominal pain, and ceaseless crying day and night. Bian means change; Zheng in the Liver causes dizziness and slight redness of the eyes; Zheng in the Lung causes sneezing, coughing, and erecting of hair. All five Zang and six Fu organs, tendons, vessels, and bones have cyclic corresponding syndromes. For treatment: mild cases require releasing the exterior; excess-heat cases require mild purgation. Zi Shuang Wan (Purple Frost Pill), Hei San Zi (Black Powder), and Chaihu Tang (Bupleurum Decoction) may be administered. For cases with cold but no heat, accompanied by vomiting, diarrhea, refusal to nurse, and excessive crying, Danggui San (Angelica Sinensis Powder) and Tiaoqi San (Regulating Qi Powder) are indicated. Apart from bianzheng, the infant's appearance and demeanor should naturally be peaceful. Generally, humans obtain the Way of Mean Harmony to become pure, with Yin and Yang in their proper places, rigid and soft assisting each other, Qi and Blood harmonious, and all meridians smooth. Thus, mental acuity increases, spirit is complete, Zang-Fu organs are full, the physique is solid and strong, teeth are fine, hair is black, voice is resonant, and sleep is steady. This indicates sufficient reception of Qi, balanced constitution, and absence of disease. The aforementioned symptoms are unavoidable for infants; even without medication, they will resolve. The aforementioned medicines are harsh; not only may the Zang-Fu organs fail to withstand them, but they may also damage Qi and Blood. I often saw an infant who, during the first Bian, had fever and phlegm. After administering one pill of Baolong Wan (Pill for Embracing the Dragon), the child died suddenly. This case serves as verification; one must be extremely cautious! Those who do not have fever or fright, show no symptoms, but undergo hidden bianzheng, do so because their prenatal Qi is robust.
Zi Shuang Wan (Formula see Cukou section)
Ziyang Heisan treats residual heat after the resolution of bianzheng.
Mahuang (Ephedrae Herba, two liang, nodes not removed) Dahuang (Rhei Radix et Rhizoma, half liang) Xingren (Prunus Armeniacae Semen, peeled, two fen and half, pounded)
Mix the above three ingredients, pound into powder, slightly roast until the original nature is preserved. Then mix with Xingren paste (Apricot Kernel Paste), store in honey. Take an amount the size of a bean per dose, mixed with breast milk and swallowed.
Chaihu Tang treats bone heat and vexation during bianzheng, with incessant crying.
Renshen (Ginseng Radix, two qian) Gancao (Licorice Root, lightly roasted, two qian) Maimendong (Ophiopogonis Radix, heart removed, two qian) Longdancao (Gentianae Radix, wine-fried until black) Fangfeng (Saposhnikoviae Radix, one qian each) Chaihu (Bupleuri Radix, five fen)
Take one qian per dose, decoct in water.
Danggui San treats bianzheng with cold but no heat.
Danggui (Angelicae Sinensis Radix, two qian) Muxiang (Aucklandiae Radix) Guigui (Cinnamomi Cortex, pungent variety) Gancao (Licorice Root, roasted) Renshen (Ginseng Radix, one qian each)
Take one qian per dose, decoct in water with ginger and jujube.
Tiaoqi San treats bianzheng with vomiting and diarrhea, refusal to nurse, excessive crying, and impending slow convulsion.
Muxiang (Aucklandiae Radix) Xiangfuzi (Cyperi Rhizoma) Renshen (Ginseng Radix) Jupi (Citri Reticulatae Pericarpium) Huoxiang (Agastaches Herba) Gancao (Licorice Root, roasted. One qian each)
Grind into powder. Take one qian per dose, decoct in water with ginger and jujube.