巢氏曰∶小儿变蒸者,以长气血也,变者上气,蒸者体热。仲阳曰∶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,何谓三十二日长骨肉、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,属太阳经膀胱腑,其发耳与 冷,肾与膀胱合,俱主于水,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。至一百九十二,六变三蒸生甲,属足少阳经胆腑,其
发目不闭而赤,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。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,肺与大肠合生金,地四生金,天九成之。至二百八十八日,九变生己,属太阴经,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,设六十四日为一大蒸,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。变蒸者上气,蒸者体热。每经一变一蒸,情态即异,轻者发热微
汗,其状似惊,重则壮热,脉乱而数,或汗或吐,或烦啼燥渴,轻者五六日解,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,则嚏嗽毛耸。凡五脏六腑、筋脉骨节,循环各有证应,其治法平和者,微
表之;实热者,微利之,可服紫丸、黑散、柴胡汤。有汗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,阴阳所得,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,此乃受气充之,禀性得中而无疾耳。前症盖小儿所不免者,虽无药
亦可也。前药峻厉,非惟脏腑不胜,抑且反伤气血。余尝见一小儿,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。
〔附方〕
紫丸 即紫霜丸,见小儿初生诸疾。
黑散 麻黄 大黄 杏仁
柴胡汤 人参(三钱) 甘草(二钱) 门冬(二钱) 胆草(一钱,酒炒) 防风(一钱) 柴胡(五分)
当归散 见诸泻症内。
调气散 木香 香附 人参 陈皮 火香 甘草
巢元方说:小儿的变蒸,是为了生长气血。所谓“变”,是指上部的阳气变化;所谓“蒸”,是指身体发热。钱乙(字仲阳)说:“变”就是改变的意思。又说变蒸是从体内向外生长,从下向上发展,并且伴有身体发热,所以每次变蒸结束后,孩子的性情表现就会与之前有所不同。为什么呢?因为这是在生长脏腑的意识和智慧。什么是三十二天长骨肉、添精神呢?人有三十六十五块骨头,以象征天数的三百六十五天,对应一年,并分属十二经络。从出生到第三十二天,第一次“变”产生癸水,归属于足少阴肾经。肾藏精与志。第六十四天,第二次“变”和第一次“蒸”产生壬水,归属于太阳膀胱腑,表现为耳朵发冷,肾与膀胱相合,都主司水,地数六成之。到了第九十六天,第三次“变”产生丁火,归属于手少阴心经,心藏神,其情志为喜。第一百二十八天,第四次“变”和第二次“蒸”产生丙火,归属于手太阳小肠腑,表现为出汗且轻微惊悸,心与小肠相合为火,地二生火,天数七成之。第一百六十天,第五次“变”产生乙木,归属于足厥阴肝经,肝藏魂,情志易悲哭。第一百九十二天,第六次“变”和第三次“蒸”产生甲木,归属于足少阳胆腑,表现为眼睛不闭合且发红,肝与胆相合主木,天数三生木,地数八成之。
第二百二十四天,第七次“变”产生辛金,归属于手太阴肺经,肺藏魄。第二百五十六天,第八次“变”和第四次“蒸”产生庚金,归属于手阳明大肠腑,表现为皮肤发热且有汗或无汗,肺与大肠相合生金,地四生金,天数九成之。第二百八十八天,第九次“变”产生己土,归属于足太阴脾经,脾藏意与智。第三百二十天,第十次“变”和第五次“蒸”产生戊土,归属于足阳明胃腑,表现为不吃东西,腹痛并吐乳,脾与胃主土,天数五生土,地数十成之。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,所以不参与变蒸过程。前十变五蒸,是天地生成之数。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。《太仓经》说:气进入四肢,在第十变时长碎骨,如果将六十四天视为一次大蒸,共计三百八十四天,以此长养经脉。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。《内经》说:变且蒸,意思是蒸毕后还余下一岁日期的零头。老师说:不出汗而发热的要发散其汗,剧烈呕吐的要轻微止呕,不可单独另治。又六十四天为第二次大蒸,共计四百四十八天。再六十四天为第三次大蒸,共计五百十二天,到第五百七十六天,变蒸结束,孩子才算是成人。变是生长五脏,蒸是养育六腑。变是上部阳气变化,蒸是身体发热。每经历一变一蒸,神态情志就会不同,轻者发热微汗,症状类似惊风,重者高热,脉象紊乱且快,或者出汗或呕吐,或者烦躁啼哭、燥渴,轻者五六天缓解,重者七八天缓解,其征候与伤寒相似。也有在变蒸之余,又感受寒邪的,但变蒸时耳朵冷、嘴唇发冷,上唇起水泡像浑浊的珠子,如果是寒邪搏击,则寒热交争,腹中疼痛且啼叫之声日夜不停。
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、筋脉骨节,循环各有证候反应,治疗平和的,用轻微解表法;实热的,用轻微通利法,可服用紫霜丸、黑散、柴胡汤。有汗无热并伴有呕吐腹泻、不吃奶、多啼哭的,用当归散、调气散主治。除了变蒸之外,小儿体貌情态自然平和,大体上人得中和之道,成为纯粹,阴阳所得,刚柔兼济。气血调和则百脉顺畅,所以心智日益通达,精神具备,脏腑充实,形体坚固强壮,牙齿细密头发黑亮,声音洪亮睡眠安稳,这是受气充盈,禀性得中而无疾病的表现。前面的症候大概是小儿所难免的,即使不用药也可以。前面的药物峻烈,不仅脏腑承受不住,反而还会损伤气血。我曾经见过一个小孩,到第一次变蒸时发热有痰,投服一粒抱龙丸,立刻导致死亡,看这个例子可以验证,务必谨慎!务必谨慎!那些不发热不惊悸,完全没有症状而暗中变蒸的,是因为胎气壮实的原因。
〔附方〕
紫霜丸 即紫霜丸,见小儿初生诸疾章节。
黑散 麻黄 大黄 杏仁
柴胡汤 人参(三钱) 甘草(二钱) 麦冬(二钱) 龙胆草(一钱,酒炒) 防风(一钱) 柴胡(五分)
当归散 见诸泻症内章节。
调气散 木香 香附 人参 陈皮 火麻仁 甘草
Chao Yuanfang stated: The "bianzheng" (periodic growth and fever) in infants serves to generate Qi and Blood. "Bian" refers to the transformation of upper Qi, while "zheng" refers to bodily heat. Qian Yi (courtesy name Zhongyang) said: "Bian" means change. It is also stated that bianzheng grows from within outwardly and from below upwardly, accompanied by body heat; therefore, after each completion of a cycle, the infant's temperament exhibits differences from before. Why? Because this process generates the consciousness and wisdom of the Zang-Fu organs. What is meant by "thirty-two days to grow bones and flesh, add spirit"? Humans have three hundred sixty-five bones, symbolizing the three hundred sixty-five days of heaven, corresponding to a year, and distributed among the twelve meridians. From birth to thirty-two days, the first "Bian" produces Gui Water, belonging to the Foot Shaoyin Kidney Meridian. The Kidney stores Essence and Zhi (Will). At sixty-four days, the second "Bian" and first "Zheng" produce Ren Water, belonging to the Taiyang Bladder Fu-organ, manifesting as cold ears; the Kidney and Bladder are interior-exteriorly related and both govern Water, with the Earth number six completing it. At ninety-six days, the third "Bian" produces Ding Fire, belonging to the Hand Shaoyin Heart Meridian; the Heart stores Shen (Spirit), and its emotion is Joy. At one hundred twenty-eight days, the fourth "Bian" and second "Zheng" produce Bing Fire, belonging to the Hand Taiyang Small Intestine Fu-organ, manifesting as sweating and slight fright; the Heart and Small Intestine are interior-exteriorly related and belong to Fire, with the Earth number two generating Fire and the Heaven number seven completing it. At one hundred sixty days, the fifth "Bian" produces Yi Wood, belonging to the Foot Jueyin Liver Meridian; the Liver stores Hun (Ethereal Soul) and tends toward weeping. At one hundred ninety-two days, the sixth "Bian" and third "Zheng" produce Jia Wood, belonging to the Foot Shaoyang Gallbladder Fu-organ, manifesting as eyes remaining open and red; the Liver and Gallbladder are interior-exteriorly related and govern Wood, with the Heaven number three generating Wood and the Earth number eight completing it.
At two hundred twenty-four days, the seventh "Bian" produces Xin Metal, belonging to the Hand Taiyin Lung Meridian; the Lung stores Po (Corporeal Soul). At two hundred fifty-six days, the eighth "Bian" and fourth "Zheng" produce Geng Metal, belonging to the Hand Yangming Large Intestine Fu-organ, manifesting as skin heat with or without sweat; the Lung and Large Intestine are interior-exteriorly related and generate Metal, with the Earth number four generating Metal and the Heaven number nine completing it. At two hundred eighty-eight days, the ninth "Bian" produces Ji Earth, belonging to the Foot Taiyin Spleen Meridian; the Spleen stores Yi (Intellect) and Zhi (Memory). At three hundred twenty days, the tenth "Bian" and fifth "Zheng" produce Wu Earth, belonging to the Foot Yangming Stomach Fu-organ, manifesting as anorexia, abdominal pain, and vomiting milk; the Spleen and Stomach govern Earth, with the Heaven number five generating Earth and the Earth number ten completing it. Additionally, the Hand Jueyin Pericardium is a Zang organ, and the Hand Shaoyang Sanjiao is a Fu organ; these one Zang and one Fu lack distinct morphological manifestations, thus they do not undergo Bian or Zheng. The previous ten Bians and five Zhengs constitute the numbers of Heaven and Earth for generation and completion. Thereafter, such as growing teeth, speaking, and knowing joy and anger, it is said that development is complete. The *Taicang* states: Qi enters the four limbs, growing fine bones at the tenth Bian. If sixty-four days are considered one major Zheng, totaling three hundred eighty-four days, it nourishes the meridians. The hands receive blood and thus can hold objects; the feet receive blood and thus can walk and stand. The *Classic* states: "Bian and Zheng" implies that after Zheng completes, there remains surplus days of a year. The Master said: For those with fever but no sweat, induce sweating; for severe vomiting, mildly stop it; do not treat separately. Another sixty-four days constitute the second major Zheng, totaling four hundred forty-eight days. Another sixty-four days constitute the third major Zheng, totaling five hundred twelve days. At five hundred seventy-six days, Bianzheng concludes, and the child becomes an adult. Bian generates the Five Zang organs; Zheng nourishes the Six Fu organs. Bian is the transformation of upper Qi; Zheng is bodily heat. With each Bian and Zheng, demeanor changes: mild cases involve low-grade fever and slight sweat, resembling wind-stroke; severe cases involve high fever, chaotic and rapid pulse, or sweating/vomiting, or irritability, crying, dryness, and thirst. Mild cases resolve in five to six days; severe cases in seven to eight days. The signs resemble Cold Damage (Shanghan). Some may contract cold pathogens during the residual phase of Bianzheng; however, during Bianzheng, ears are cold, lips are cold, and blisters like turbid pearls appear on the upper lip. If cold pathogens contend, cold and heat struggle, causing abdominal pain and ceaseless day-and-night crying.
"Bian" means change. Zheng affecting the Liver causes dizziness and slight redness of the eyes; Zheng affecting the Lung causes sneezing, coughing, and erecting of hair. All Five Zang and Six Fu organs, sinews, vessels, bones, and joints have cyclical corresponding syndromes. For mild treatments, use slight exterior-releasing methods; for excess-heat, use slight purgative methods. Zi Shuang Wan (Purple Frost Pill), Hei San (Black Powder), and Chaihu Tang (Bupleurum Decoction) may be taken. For cases with sweat but no fever, accompanied by vomiting, diarrhea, refusal to nurse, and excessive crying, Danggui San (Angelica Sinensis Powder) and Tiaoqi San (Regulating Qi Powder) are indicated. Outside of Bianzheng, infants' physical appearance and demeanor are naturally peaceful. Generally, humans attain the Way of Zhonghe (Central Harmony), becoming pure; Yin and Yang are obtained, with rigidity and flexibility complementing each other. When Qi and Blood harmonize, all vessels flow smoothly; thus, mental faculties become clearer, spirit is complete, Zang-Fu organs are solid, physique is robust, teeth are fine, hair is black, voice is resonant, and sleep is steady. This results from abundant received Qi and balanced constitution free of disease. The aforementioned symptoms are inevitable for infants; medication is not strictly necessary. 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 once witnessed an infant who, at the first Bian, had fever and phlegm; after administering one pill of Baolong Wan (Embracing Dragon Pill), he died instantly. This case serves as verification: be cautious! Be cautious! Those who do not have fever or fright, showing no symptoms but undergoing hidden Bianzheng, do so because their prenatal Qi is strong.
[Attached Formulas]
Zishuang Wan: Same as Zishuang Wan, see Diseases of Newborns.
Heisan: Ephedrae Herba (Mahuang, 麻黄), Rheomi Radix Et Rhizoma (Dahuang, 大黄), Armeniacae Semen Amarum (Xingren, 杏仁).
Chaihu Tang: Ginseng Radix (3 qian), Glycyrrhizae Radix et Rhizoma (2 qian), Ophiopogonis Tuber (2 qian), Gentianae Radix (1 qian, wine-fried), Saposhnikoviae Radix (1 qian), Bupleuri Radix (0.5 fen).
Danggui San: See Diarrhea Syndromes.
Tiaoqi San: Aucklandiae Radix (Muxiang, 木香), Cyperi Rhizoma (Xiangfu, 香附), Ginseng Radix (Renshen, 人参), Citri Reticulatae Pericarpium (Chenpi, 陈皮), Cannabis Fructus (Huoxiang, 火香 - *Note: Text says Huoxiang but lists Huoxiang/Cannabis contextually often implies aromatic damp-resolving, here likely Cannabis Fructus or Agastache depending on local variant, sticking to literal translation of ingredient name provided*), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草).