《产经》云∶小儿初生后六七日，其血气收敛成害，则口舌颊里领领净也。若喉里舌上
有物如芦箨盛水状者，名悬痈，有气胀起也。又有着舌下如此者，名为重舌。又有上 如此
者，名为重 。又有着齿龈如此者，为重龈，皆刺去血汁之，良。
治奇以绵缠长针，未刃如栗以刺决之，令气泄之，去清黄血汁，良。一刺止之，消息一
日，不消又刺之，不过三刺，自消。（《短剧方》同。）
《病源论》云∶小儿变蒸者，以长血气也。变者上气，蒸者体热。变蒸有轻重，其轻者
体热而微惊。耳冷髋亦冷，上唇头白肉（ ）起如死鱼目珠子。微汗出，平者而歇，远者九
日乃歇。（远者八九日乃歇。）其重者，体壮热而脉乱，或汗，或不汗，不欲食，食辄吐 ，
无所苦也。变蒸之时，目白精（睛）微赤，黑精微白，亦无所苦。蒸毕，自明了矣。先变五
日，后（蒸）五日，为十日之中，热乃除耳。初变蒸之时，不欲惊动，勿令旁边多人，变蒸
或早或晚，依时如法者少。初变之时，或热甚者，或违日数不歇，审计日数，必是变蒸；服
黑散发汗，热不止者，服紫（双）丸，小瘥，便止，勿复服之。其变蒸之时，遇寒加之，即
寒（热）交争，腹痛夭娇，啼不止，煮熨之则愈。变蒸与温壮伤寒相似，若非变蒸；身热耳
热，体髋亦热，此乃为他病，可为余治。审是变蒸，不得为余治也。其变蒸日数（出《病源
论》。）
又，变蒸者，唇头白肉起，如死鱼目珠子。微汗，平者而歇，远者九日乃歇。
儿生三十二日始变，变者耳热也。至六十四日再变，再变且蒸。其状卧欲端正也。第二
变蒸时，或目白者赤，黑者微白，变蒸毕，目便精明矣。至九十六日三变，变者候丹孔出而
泄也。至一百二十八日四变，变且蒸，能咳笑也。至一百六十五日五变，以成机关也。至一
百九十二日六变，变且蒸，以知五机成也。至二百二十四日七变，以知匍匐也。至二百五十
六日八变，变且蒸，以知学语矣。至二百八十八日九变，以亭亭然也。凡九变三蒸也。至三
百二十日十变，变且蒸，蒸积三百二十日小蒸毕。后六十四日大蒸，后百二十八日复蒸。积
五百七十六日大小蒸毕，乃成人也。所以变蒸者，皆是荣其血脉，攻其五脏，故一变竟辄觉
情态有异者也。
凡蒸之候，身壮热、脉乱、汗出、目精不明，微欲惊、不乳哺、上唇头小白肉起如死鱼
目珠子，耳令尻赤冷，此其诊也，近者五日歇，远者八九日歇也。当审计其蒸日，不可针灸
服药。
凡儿变（蒸）之时，不欲惊动，勿令边多人也。小儿变时，或早或脱也。
凡儿生三月不蒸则耳聋目盲；五月不蒸身不行；九月不蒸五机不成，此为痿蹶不能行之
疾也。
《产经》云∶脉决曰∶凡小儿变蒸之时，汗出不用食，食辄吐 而脉乱，无所苦也。
《葛氏方》云∶凡小儿生后六十日，目瞳子成，能咳唆，识人。百五日经脉生，能反复。
百八十日尻骨成，能独坐。二百一十日掌骨成，能匍匐。三百日髌骨成，能独倚。三百六十
日为一期，膝骨成，乃能行。
治少小初变蒸时，有者服之，发干已止，黑散方∶
杏仁（二分） 大黄（一分） 麻黄（二两，去节）
上三物，先捣大黄、麻黄下筛，杏仁令如脂。纳散，令调，更粗筛筛之，盛以苇囊。二
十日儿以汁和之，如小豆一丸，分为二丸，易吞，浓衣包之，令汗，汗出毕，下帐、燃火解
衣、温粉粉之。百日儿取散如枣核大，以小阳和服之，汗出之后，消息如上法；当豫温粉，
不可解衣，乃温粉。（出《葛氏》。）
治已服黑散，发热不歇，服之热小瘥便止，勿复与。紫丸方∶
赤石脂（一两） 巴豆（三十枚） 代赭（一两） 杏仁（三十枚，一方五十枚，去皮）
上四物，先冶巴豆、杏仁，捣二千杵，乃纳代赭、赤石脂，更捣三千杵，拖也。药热即
成。一方云∶相和，与少蜜和之，盛以密器，无令药燥，燥则无热。以巴豆、杏仁自丸，常
苦不能尽屑，当稍稍纳之令相丸。二十日儿服如黍米一丸讫，小乳小乳之，令药得下。却两
食顷，乃复乳之，勿令饱耳。平旦一服药，日中热尽；日西夕时复小增丸，至鸡鸣时，若复
与一丸，愈者止。三十日儿服如大黍米一丸。三十日儿服如麻子一丸。六七十日儿如胡豆一
丸。百日儿服如小豆一丸。不下故热者，增半丸，以下利为度。
又方说∶服紫丸，当须完出，若不出，出不完，为病未尽，当更服之。有热乃服紫丸，
无热但有寒者勤服乳头。单当归散、黄 散。变蒸服药后微热者，亦可与除热黄芩汤方。（出
《僧深方》。）
黄芩汤少小辈变蒸时服，药下后有朝夕热吐利。除热方∶
黄芩（一两） 甘皮（六铢） 人参（一两） 干地黄（六铢） 甘草（半两，炙） 大
枣（五枚，去核）
凡六物，切之，以水三升，煮取一升，绞去滓。二百日儿服半合，三百日儿服一合，日
再。热瘥止。变蒸，儿有微热可服。（出张仲。）
又云∶经曰∶天不足西北，故令儿腮后合；地不足东南，故儿髌后生成；人法于三，故
令齿后。故腮合乃而言，髌成乃而行。大阴气不足而大阳气有余者，故令儿羸瘦 胫三岁乃
而行。
《产经》说：婴儿出生后六七天，其气血收敛形成危害，导致口腔、舌头、脸颊内部及颈部出现肿胀。如果喉咙里或舌头上有像芦苇壳盛水那样的东西，称为悬痈，这是气胀引起的。又有长在舌头下面的类似情况，称为重舌。又有长在上面的，称为重腭（注：原文“重 ”疑为“重腭”之误）。又有长在牙龈上的，称为重龈，都用针刺放出血和津液的方法治疗，效果很好。
用绵絮缠绕长针，针尖不锋利如栗子大小，用来刺破患处，使邪气泄出，清除清稀的黄血汁，效果很好。刺一次即可，观察一天，如果不消退再刺，不超过三次，自然就会消退。（《短剧方》记载相同。）
《诸病源候论》说：小儿变蒸，是为了生长气血。变是指上焦之气变化，蒸是指身体发热。变蒸有轻重之分，轻的表现为身体微热且轻微惊悸。耳朵凉，髋部也凉，上唇边缘的白色肉膜突起，像死鱼眼睛里的珠子一样。微微出汗，体质平和者几天就停止，间隔长的要九天才能停止。（间隔长的八九天停止。）重的表现为身体壮热且脉象紊乱，有的出汗，有的不出汗，不想吃东西，吃了就吐，但并没有痛苦。变蒸的时候，眼白部分微红，黑眼球微白，也没有痛苦。变蒸结束后，眼睛自然就明亮了。先变五天，后蒸五天，在十天之内，热势才会消除。刚开始变蒸时，不要受惊动，不要让旁边人多，变蒸时间有早有晚，能按时按法进行的很少。刚开始变的时候，如果热很严重，或者过了天数还不退，仔细计算天数，必定是变蒸；服用黑散发汗，如果热不退，服用紫丸，热稍微减轻就停止，不要再服。在变蒸期间，如果遇到寒邪侵袭，就会导致寒热交争，腹痛绞痛，啼哭不止，煮药热敷就会痊愈。变蒸与温壮伤寒相似，如果不是变蒸，而是身体热、耳朵热，身体和髋部也都热，这就是其他疾病，可以按其他病治疗。如果是确切的变蒸，不得按其他病治疗。变蒸的天数出自《诸病源候论》。
另外，变蒸的表现是：上唇边缘白色肉膜突起，像死鱼眼睛里的珠子。微微出汗，平和者几天停止，间隔长的九天停止。
婴儿出生三十二天开始第一次变，变的表现是耳朵热。到六十四天第二次变，第二次变伴随蒸。表现是想躺得端正。第二次变蒸时，有时眼白变红，黑眼球微白，变蒸结束后，眼睛就精明了。到九十六天第三次变，变的征兆是肚脐孔排出分泌物。到一百二十八天第四次变，伴随蒸，能咳嗽笑。到一百六十五天第五次变，以完成机关（关节）的形成。到一百九十二天第六次变，伴随蒸，五机（五官机能）形成。到二百二十四天第七次变，知道爬行。到二百五十六天第八次变，伴随蒸，知道学说话。到二百八十八天第九次变，亭亭玉立（指站立姿态）。总共九变三蒸。到三百二十天第十次变，伴随蒸，经过三百二十天小蒸结束。之后六十四天大蒸，之后一百二十八天再次蒸。累计五百七十六天大小蒸结束，才成为成人。之所以变蒸，都是为了滋养血脉，攻补五脏，所以每次变蒸结束后，都会觉得孩子的神态有异样。
凡是蒸的征候，身体壮热、脉象紊乱、出汗、眼睛不明亮、微微想惊悸、不吃奶、上唇边缘小白肉突起像死鱼眼睛珠子、耳朵和尾骶骨发红发冷，这是诊断依据，近的五天停止，远的八九天停止。应当仔细计算变蒸的天数，不可针灸服药。
凡是婴儿变蒸的时候，不要受惊动，不要让旁边人多。小儿变蒸的时间，有早也有晚。
凡是婴儿出生三个月不蒸则耳聋目盲；五个月不蒸身体不能行走；九个月不蒸五机不成，这是痿蹶不能行走的疾病。
《产经》说：脉诀说：凡是小儿变蒸的时候，出汗不吃东西，吃了就吐且脉象紊乱，但没有痛苦。
《葛氏方》说：凡是婴儿出生后六十天，瞳孔成形，能咳嗽吮吸，认识人。一百零五天经脉生成，能翻身。一百八十天尾骶骨成形，能独坐。二百一十天掌骨成形，能爬行。三百天膝盖骨成形，能独自依靠。三百六十天为一个周期，膝骨成形，才能行走。
治疗小儿刚开始变蒸时，如果有症状的服用此方，发干已止（注：此处原文可能有误，结合下文应为发汗止热），黑散方：
杏仁（二分） 大黄（一分） 麻黄（二两，去节）
以上三味药，先捣碎大黄、麻黄过筛，将杏仁捣成脂状。混入散剂中，调和均匀，再用粗筛过滤，装在苇草袋里。二十天的婴儿用汁液调和，像小豆大一丸，分成两丸，容易吞咽，穿厚衣服包裹，使其出汗，汗出完毕后，放下帐子，生火取暖，脱去衣服，用温粉扑身。百日的婴儿取散剂如枣核大，用小阳和汤送服，出汗后，护理方法同上；应当预先准备好温粉，不可脱衣，然后扑粉。（出自《葛氏方》。）
治疗已经服用黑散，发热不退的，服用此方热稍减就停止，不要再给。紫丸方：
赤石脂（一两） 巴豆（三十枚） 代赭石（一两） 杏仁（三十枚，一方五十枚，去皮）
以上四味药，先捣碎巴豆、杏仁，捣两千杵，然后加入代赭石、赤石脂，再捣三千杵，这就成了。药性热即成功。一方说：混合在一起，加少许蜂蜜调和，装在密封容器中，不要让药干燥，干燥了就失去热力。用巴豆、杏仁自己搓丸，常常苦于不能全部磨碎，应当慢慢加入使其成丸。二十天的婴儿服用如黍米大一丸，吃完后喂少量乳汁，让药下行。过两个饭的时间，再喂奶，不要让他吃饱。清晨服一次药，中午热尽；傍晚时分再稍微增加丸药，到鸡鸣时候，如果再给一丸，病愈就停止。三十天的婴儿服用如大黍米大一丸。三十天的婴儿服用如麻子大一丸。六七十天的婴儿服用如胡豆大一丸。百日的婴儿服用如小豆大一丸。如果下不去故热，增加半丸，以下利为度。
又一种说法：服用紫丸，必须完全排出，如果不排出，排出不全，说明病未尽，应当再服用。只有热才服用紫丸，没有热只有寒的要勤喂乳头。单当归散、黄芩散。变蒸服药后微热的，也可以给予除热黄芩汤方。（出自《僧深方》。）
黄芩汤供小儿变蒸时服用，药下后有早晚发热呕吐腹泻。除热方：
黄芩（一两） 甘草皮（六铢） 人参（一两） 干地黄（六铢） 甘草（半两，炙） 大枣（五枚，去核）
共六味药，切碎，用水三升，煮取一升，绞去渣滓。二百天的婴儿服用半合，三百天的婴儿服用一合，每天两次。热退即停。变蒸，婴儿有微热可服用。（出自张仲景。）
又说：经书说：天不足西北，所以让婴儿腮后闭合；地不足东南，所以婴儿膝盖后方生成；人效法天地三才，所以牙齿后面生成。所以腮闭合后才能说话，膝盖成形后才能行走。太阴气不足而太阳阳气有余，所以婴儿消瘦小腿细，三岁才能行走。
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.