变蒸者，阴阳水火蒸于血气，而使形体成就，是五脏之变气，而七情之所由生也。盖儿生之日，
至三十二日一变，每变蒸毕，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。故初生至三十二日一变生癸，属足少阴肾，
藏精与志；六十四日二变一蒸生壬，属足太阳膀胱，其发耳与 冷；至九十六日三变生丁，属手少阴心经，
心藏神，其性为喜；一百二十八日四变二蒸生丙，属手太阳小肠，其发汗出而微惊；一百六十日五变生
乙，属足厥阴肝，肝藏魂，喜哭；一百九十二日六变三蒸生甲，属足少阳胆，其发目不闭而赤；二百二十
四日七变生辛，属手太阴肺，肺藏魄，生声；二百五十六日八变四蒸生庚，属手阳明大肠，其发肤热而汗，
或不汗；二百八十八日九变生己，属足太阴脾，脾藏意智；至三百二十日十变五蒸生戊，属足阳明胃，其
发不食，肠痛而吐乳。又手厥阴心包络、手少阳三焦，此二经俱无形状，故不变而不蒸也。前十变五蒸，
乃天地之数以生成之，然后始生齿，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，长其经脉手足，手受血故能持握，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。又六十四日三大蒸，计五百一十二日。共
五百七十六日，变蒸既毕，儿乃成人也。变者，变生五脏也。蒸者，蒸养六腑也，所以成人。变者上气，蒸者
体热。每经一变一蒸，情能既异，轻则发热微汗，其状似惊，重则壮热脉乱而数，或吐或汗，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，状如
泡珠。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
则嚏嗽毛耸。凡五脏六腑筋脉骨节，循环各有证应，其治法和平之剂微表之，热实者微利之，或不治亦自愈。
〔汤〕《千金》变蒸论云∶凡儿生三十二日一变，六十四日再变，变且蒸。九十六日三变，一百二十八日四
变，变且蒸。一百六十日五变，一百九十二日六变，变且蒸。二百二十四日七变，二百五十六日八变，变且蒸。
二百八十八日九变，三百二十日十变，变且蒸。积三百二十日小蒸毕．后六十四日大蒸，蒸后六十四日复大蒸，
蒸后一百二十八日复大蒸，凡小儿自生三十二日一变，再变为一蒸，凡十变而五小蒸，又三大蒸，积五百七十
六日大小蒸都毕，乃成人。小儿所以变蒸者，是荣其血脉，改其五脏，故一变竟，辄觉情态有异。其变蒸之候，
变上气者，蒸者体热。变蒸有轻重，其轻者体热而微惊，耳冷尻冷，上唇头白泡起，如鱼目珠子，微汗出。重
者体壮热而脉乱，或汗或不汗，不欲食，食辄吐 ，目白睛微赤，黑精微白。又云∶目白者重，赤黑者微，变
蒸毕，自精明矣。此其证也。单变小微，兼蒸小剧，凡蒸，平者五日而衰，远者十日而衰。先期五日，后期五
日，为十日之中，热乃除耳。或违日数不歇，切不可妄治及灸刺。（海藏云∶言变蒸通一十八次，盖前三百
二十日为十小蒸，后二百五十六日为十大蒸也。 ，乎典切，不呕而吐也。）
〔无〕若身热耳热尻亦热，此乃他病，可作别治。
紫霜丸 治小儿变蒸发热不解，并挟伤寒温壮热，汗后热不渴，及腹中有痰癖，哺乳不进，乳则吐 ，
食痫，先寒后热者。
代赭石（醋淬，一两） 赤石脂（一两） 巴豆（三十粒，去油） 杏仁（五十个，去皮尖）
上先将杏仁、巴霜细研为膏，却入二石相合，更捣一二千杵，当自相得。若硬，入少蜜同杵之。密器中收。
三十日儿，服如麻子大一粒，与少乳汁令下。食顷后与少乳，勿令多，至日中当小下除热。若未全除，明日
更与一粒。百日儿，服如小豆大一粒，以此准定增减。紫霜丸无所不治，虽下亦不虚人。
变蒸，是指阴阳水火在血气中蒸腾，促使形体发育成熟的过程。这是五脏发生变化的气机，也是七情产生的根源。大概婴儿出生之日起，每过三十二天发生一次“变”，每次变蒸结束后，孩子的性情就会表现出与之前不同的特点。为什么呢？这是因为脏腑的意智得以生长的缘故。什么叫作“三十二天长骨添精神”呢？人体有三十六五块骨头以象征天数，对应一年三百六十五天，并分属十二经络。所以从初生到三十二天第一次变，生出癸水，归属于足少阴肾经，肾藏精与志；六十四天第二次变、第一次蒸，生出壬水，归属于足太阳膀胱经，其表现为耳朵和臀部发冷；九十六天第三次变，生出丁火，归属于手少阴心经，心藏神，其情绪表现为喜；一百二十八天第四次变、第二次蒸，生出丙火，归属于手太阳小肠经，其表现为出汗且轻微惊悸；一百六十天第五次变，生出乙木，归属于足厥阴肝经，肝藏魂，表现为爱哭；一百九十二天第六次变、第三次蒸，生出甲木，归属于足少阳胆经，其表现为眼睛不闭合且发红；二百二十四天第七次变，生出辛金，归属于手太阴肺经，肺藏魄，表现为发声；二百五十六天第八次变、第四次蒸，生出庚金，归属于手阳明大肠经，其表现为皮肤发热出汗，或者无汗；二百八十八天第九次变，生出己土，归属于足太阴脾经，脾藏意智；到三百二十天第十次变、第五次蒸，生出戊土，归属于足阳明胃经，其表现为不吃东西、肠痛并吐乳。另外，手厥阴心包络和手少阳三焦这两条经络都没有具体的形状，所以不参与变蒸过程。前十次变和五次小蒸，是依据天地之数来生成发育的，之后才开始长牙齿，能说话，知道喜怒，所以说此时身体才算完整。太仓公说：气进入四肢，生长碎骨，在十变之后的六十四天进行一次大蒸，共计三百八十四天，滋养手足的经脉，手得到血液滋养就能持握，脚得到血液滋养就能行走站立。医经中说：变且蒸，意思是蒸腾完毕相当于过了一岁有余的时间。老师说：不出汗而发热的，用发汗法治疗。呕吐严重的，稍微止住即可，不可另行特殊治疗。又过六十四天进行第二次大蒸，共计四百四十八天。再过六十四天进行第三次大蒸，共计五百一十二天。总共五百七十六天，变蒸结束后，孩子才算是成人。所谓“变”，是变化生成五脏；所谓“蒸”，是蒸养六腑，以此来成就成人之体。“变”表现为上焦气盛，“蒸”表现为身体发热。每一经经历一变一蒸，性情就会有所改变。轻症则低热微汗，症状类似惊风；重症则高热脉象紊乱且快，或者呕吐或者出汗，或者烦躁啼哭口渴。轻症五天缓解，重症七八天缓解，其征候与伤寒相似。也有在变蒸余绪期间再次感受寒邪的，但变蒸时耳朵和臀部发凉，上唇起水泡，形状像珍珠泡珠。如果寒邪与之相搏结，则寒热交争，腹中疼痛，啼叫之声日夜不停。所谓“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。凡五脏六腑筋脉骨节，循环往复各有证候反应，其治疗方法是用平和的药物轻微解表，若热实证则轻微通下，或者不治也能自愈。
〔方剂〕《千金方》变蒸论中说：凡是婴儿出生三十二天一次变，六十四天两次变，变且蒸。九十六天三次变，一百二十八天四次变，变且蒸。一百六十天五次变，一百九十二天六次变，变且蒸。二百二十四天七次变，二百五十六天八次变，变且蒸。二百八十八天九次变，三百二十天十次变，变且蒸。累计三百二十天小蒸结束。之后六十四天大蒸，大蒸后六十四天再次大蒸，大蒸后一百二十八天又一次大蒸。凡是小儿自出生起三十二天一次变，两次变算作一次蒸，共十变而五次小蒸，加上三次大蒸，累计五百七十六天大小蒸全部结束，孩子才成为成人。小儿之所以变蒸，是为了荣养血脉，改换五脏，所以每一次变蒸结束，总觉得情态有所不同。其变蒸的征候，变表现为上焦气盛，蒸表现为身体发热。变蒸有轻重之分，轻者身体发热且轻微惊悸，耳朵和臀部发冷，上唇头起白泡，像鱼目珠子一样，微微出汗。重者身体壮热且脉象紊乱，或者出汗或者无汗，不想吃东西，吃了就吐，眼白睛微红，黑眼球微白。又说：眼白重的为重，赤黑为轻，变蒸结束后，自然眼神精明。这就是其证候。单变轻微，兼蒸较重。凡是蒸，平和的五天热度消退，远的十天消退。提前五天或推迟五天，都在十日之内，热度才会消除。如果超过日数热度不退，切不可胡乱治疗及施灸刺。（海藏先生说：变蒸总共十八次，前三百二十天为十次小蒸，后二百五十六天为十次大蒸也。 ，音乎典切，指不呕而吐。）
〔朱丹溪云〕如果身体热、耳朵热、臀部也热，这是其他疾病，可以按别病治疗。
紫霜丸 治疗小儿变蒸发热不解，以及夹杂伤寒温壮热，发汗后热不退且不渴，以及腹中有痰癖，哺乳不进，吃奶就吐，食痫，先寒后热的病症。
代赭石（醋淬，一两） 赤石脂（一两） 巴豆（三十粒，去油） 杏仁（五十个，去皮尖）
先将杏仁、巴豆霜细细研磨成膏，然后加入两种石头粉末混合，再捣一千至两千杵，应当自然融合。如果太硬，加入少量蜂蜜同捣。装入密封容器中保存。三十天的婴儿，服用如麻子大一粒的药丸，喂少量乳汁送服。进食片刻后再喂少量乳汁，不要太多，到中午应当轻微腹泻以除热。如果未完全清除，第二天再给一粒。百天的婴儿，服用如小豆大一粒的药丸，以此为准增减剂量。紫霜丸无所不治，即使泻下也不会使人虚弱。
Bianzheng (Periodic Growth and Development in Infants) refers to the steaming process of Yin and Yang, Water and Fire within the Blood and Qi, which promotes the maturation of the physical form. It is the Qi of transformation of the Five Zang Organs and the origin of the Seven Emotions. Generally, from the day of birth, a "Bian" (Transformation) occurs every thirty-two days. After each Bianzheng cycle concludes, the infant's temperament shows differences from before. Why? Because the intent and wisdom of the internal organs are growing. What is meant by "growing bones and adding spirit every thirty-two days"? The human body has three hundred and sixty-five bones to symbolize the heavenly days, corresponding to the annual cycle, and dividing into the Twelve Meridians. Thus, from birth to thirty-two days, the first Bian generates Gui Water, belonging to the Foot Shaoyin Kidney Meridian; the Kidney stores Essence and Will. At sixty-four days, the second Bian and first Zheng (Steaming) generate Ren Water, belonging to the Foot Taiyang Bladder Meridian; its manifestation is cold ears and buttocks. At ninety-six days, the third Bian generates Ding Fire, belonging to the Hand Shaoyin Heart Meridian; the Heart stores Spirit, and its emotion is Joy. At one hundred and twenty-eight days, the fourth Bian and second Zheng generate Bing Fire, belonging to the Hand Taiyang Small Intestine Meridian; its manifestation is sweating and slight palpitations. At one hundred and sixty days, the fifth Bian generates Yi Wood, belonging to the Foot Jueyin Liver Meridian; the Liver stores Hun (Ethereal Soul), manifesting as crying. At one hundred and ninety-two days, the sixth Bian and third Zheng generate Jia Wood, belonging to the Foot Shaoyang Gallbladder Meridian; its manifestation is eyes not closing and redness. At two hundred and twenty-four days, the seventh Bian generates Xin Metal, belonging to the Hand Taiyin Lung Meridian; the Lung stores Po (Corporeal Soul), manifesting as vocalization. At two hundred and fifty-six days, the eighth Bian and fourth Zheng generate Geng Metal, belonging to the Hand Yangming Large Intestine Meridian; its manifestation is skin fever and sweating, or no sweating. At two hundred and eighty-eight days, the ninth Bian generates Ji Earth, belonging to the Foot Taiyin Spleen Meridian; the Spleen stores Intent and Wisdom. By three hundred and twenty days, the tenth Bian and fifth Zheng generate Wu Earth, belonging to the Foot Yangming Stomach Meridian; its manifestation is anorexia, abdominal pain, and vomiting milk. Furthermore, the Hand Jueyin Pericardium Meridian and Hand Shaoyang Sanjiao (Triple Burner) Meridian have no specific shape, so they do not undergo Bianzheng. The first ten Bians and five minor Zhengs follow the numbers of Heaven and Earth for generation and formation. Only then do teeth grow, speech begins, and emotions like joy and anger are known, thus it is said that the body becomes complete. Taicanggong stated: Qi enters the four limbs, growing fragmented bones. Sixty-four days after the ten Bians, a major Zheng occurs, totaling three hundred and eighty-four days, nourishing the meridians of the hands and feet. When the hands receive blood, they can grasp; when the feet receive blood, they can walk and stand. The Classics state: "Bian and Zheng" implies that completing the steaming is equivalent to having lived more than a year. The Master said: For fever without sweating, induce sweating. For severe vomiting, stop it slightly; do not treat separately. Another sixty-four days later, the second major Zheng occurs, totaling four hundred and forty-eight days. Another sixty-four days later, the third major Zheng occurs, totaling five hundred and twelve days. In total, five hundred and seventy-six days. Once Bianzheng is complete, the child becomes an adult. "Bian" means transforming and generating the Five Zang Organs; "Zheng" means steaming and nourishing the Six Fu Organs, thereby achieving adulthood. "Bian" manifests as upper Jiao Qi excess; "Zheng" manifests as body heat. With each meridian undergoing one Bian and one Zheng, the temperament changes. Mild cases present with low-grade fever and slight sweating, resembling fright; severe cases present with high fever, chaotic and rapid pulse, vomiting, sweating, irritability, crying, and thirst. Mild cases resolve in five days; severe cases in seven to eight days. The signs resemble Cold Damage (Shanghan). Some infants may contract cold pathogens during the residual phase of Bianzheng. However, during Bianzheng, the ears and buttocks are cold, and blisters appear on the upper lip, resembling pearl bubbles. If cold pathogens contend with this, cold and heat struggle, causing abdominal pain and ceaseless crying day and night. "Bian" means change; steaming the Liver causes dizziness and slight redness of the eyes; steaming the Lungs causes sneezing, coughing, and erecting of hair. All Five Zang and Six Fu Organs, tendons, vessels, bones, and joints have cyclical manifestations. Treatment involves mild exterior-releasing agents for peace, mild purgatives for heat-excess, or sometimes self-resolution.
[Formula] The *Treatise on Bianzheng* in *Qianjin Fang* states: An infant undergoes one Bian at thirty-two days, two Bians at sixty-four days, Bian and Zheng. Three Bians at ninety-six days, four Bians at one hundred and twenty-eight days, Bian and Zheng. Five Bians at one hundred and sixty days, six Bians at one hundred and ninety-two days, Bian and Zheng. Seven Bians at two hundred and twenty-four days, eight Bians at two hundred and fifty-six days, Bian and Zheng. Nine Bians at two hundred and eighty-eight days, ten Bians at three hundred and twenty days, Bian and Zheng. Accumulating three hundred and twenty days completes the minor Zhengs. Then, sixty-four days later, a major Zheng occurs. Sixty-four days after that, another major Zheng. One hundred and twenty-eight days after that, yet another major Zheng. From birth, an infant has one Bian every thirty-two days; two Bians constitute one Zheng. Ten Bians and five minor Zhengs, plus three major Zhengs, accumulate to five hundred and seventy-six days, completing all minor and major Zhengs, marking adulthood. The reason for Bianzheng in infants is to nourish the Blood and Vessels and transform the Five Zang Organs. Hence, after each Bianzheng, the temperament appears different. Signs of Bianzheng: Bian manifests as upper Jiao Qi excess; Zheng manifests as body heat. Bianzheng has mild and severe forms. Mild: body heat, slight fright, cold ears and buttocks, white blisters on the upper lip like fish-eye pearls, slight sweating. Severe: high fever, chaotic pulse, sweating or no sweating, anorexia, vomiting upon eating, slightly red whites of the eyes, slightly white pupils. Also stated: White whites of the eyes indicate severity; red/black indicates mildness. After Bianzheng ends, vision naturally becomes clear. These are the signs. Single Bian is mild; combined Zheng is more intense. Generally, for Zheng, mild heat subsides in five days, distant in ten days. Within ten days (five days early or late), the heat should subside. If heat persists beyond the days, absolutely do not treat recklessly or use moxibustion/acupuncture. (Haizang said: Bianzheng totals eighteen times; the first three hundred and twenty days are ten minor Zhengs, the next two hundred and fifty-six days are ten major Zhengs. , pronounced 'hu dian', meaning vomiting without retching.)
[Zhu Danxi stated]: If the body, ears, and buttocks are all hot, this is another disease and should be treated differently.
Zishuang Wan (Purple Frost Pill) treats infantile Bianzheng fever that does not resolve, combined with Cold Damage or warm-febrile diseases where fever persists after sweating without thirst, phlegm-stagnation in the abdomen, refusal to nurse, vomiting upon nursing, food-induced epilepsy, and alternating chills and fever.
Dai Zhe Shi (Hematitum, prepared with vinegar, 1 liang) Chishi Zhi (Halloysitum Rubrum, 1 liang) Badou (Crotonis Fructus, 30 grains, oil removed) Xingren (Armeniacae Semen Amarum, 50 grains, peel and tip removed)
First, grind Xingren and Badou paste finely into a paste. Then mix in the two mineral powders and pound for one to two thousand strokes until they blend naturally. If too hard, add a little honey and pound together. Store in a sealed container. For a thirty-day-old infant, administer one pill the size of a hemp seed, given with a small amount of breast milk. After a short while, give a little more milk, but not too much. By noon, there should be mild diarrhea to remove the heat. If not fully resolved, give one more pill the next day. For a hundred-day-old infant, administer one pill the size of a mung bean, adjusting dosage accordingly. Zishuang Wan treats all conditions; even if it induces purgation, it does not weaken the patient.