巢氏云∶小儿变蒸者，以长血气也。变者上气，蒸者体热。钱仲阳曰∶变者，易也。小儿在母
腹中，乃生骨气，五脏六腑成而未全。自生之后，即长骨脉、脏腑之神志，自内而长，自下而上。
故以生之日后三十二日一变蒸，即觉情志有异于前，何也？长生意志脏腑故也。何谓三十二日长骨
添精神？盖人有三百六十五骨节，以应天数，内除手足中四十五碎骨外，共有三百二十数，自下生
骨，一日十段而上之，十日百段，而三十二日计三百二十段为一遍，亦曰一蒸。凡一周遍，乃生虚
热诸病，如是十周，则小蒸毕也。故初三十二日一变，生肾志；六十四日二变一蒸，生膀胱；九十
六日三变，生心喜；一百二十八日四变二蒸，生小肠；一百六十日五变，生肝哭；一百九十二日六
变三蒸，生胆；二百二十四日七变，生肺声；二百五十六日八变四蒸，生大肠；二百八十八日九变
，生脾；三百二十日十变五蒸，生胃，此所谓小蒸毕也。又手厥阴经为脏，手少阳经三焦为腑，
此一脏一腑俱无状，故不变不蒸也。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，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。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。其治法，平和者微表之，实热微利之，用紫霜丸、黑散子、柴胡散
。有寒无热，并吐泻不乳多啼者，当归散、调气散主之。
薛立斋曰∶《全婴方论》云∶变蒸者，以长气血也。变者上气，蒸者发热也。轻则体热虚惊，
耳冷微汗，
唇生白泡，三日可愈。重则寒热脉乱，腹痛啼叫，不能乳食，食即吐 五日方愈。古方以黑散子、
紫霜丸主之。窃谓此证，小儿所不免者，虽勿药可也，况前药乃属峻厉，非惟脏腑不能胜，抑且反
伤气血，慎之，慎之！余尝见一小儿，至二变发热有痰，投以抱龙丸一粒，卒至不救，观此可验
矣。若不热不惊，略无证候而暗变者，盖受胎气壮实故也。
景岳曰∶小儿变蒸之说，古所无也，至西晋王叔和始一言之，继自隋、唐巢氏以来，则日相
传演，其说益繁。然以余观之，则似有未必然者，何也？盖儿胎月足离怀，气质虽未成实，而脏腑
已皆完备。及既生之后，凡长养之机，则如月如苗，一息不容有间，百骸齐到，自当时异而日不同
，岂复有此先彼后，如一变生肾，二变生膀胱，及每变必三十二日之理乎？又如小儿之病与不病，
余所见所治者，盖亦不少，凡属违和，则不因外感必以内伤，初未闻有无因而病者，岂真变蒸之谓
耶？又见保护得宜，而自生至长，毫无疾痛者不少，抑又何也？虽有暗变之说，终亦不能信然。余
恐临证者有执迷之误，故道其愚昧若此，及如前薛氏之戒，皆不可不察也。明达者以为然否？
巢元方说：小儿的变蒸，是为了增长血气。所谓“变”，是指上部的精气变化；所谓“蒸”，是指身体发热。钱仲阳说：“变”，就是更替的意思。小儿在母腹中时，才形成骨气和脏腑，五脏六腑虽然成形但尚未完备。出生之后，就开始生长骨骼脉络、脏腑的神志功能，由内向外生长，由下向上生长。所以从出生之日起三十二天进行一次变蒸，这时就会发觉孩子的情志表现与以前不同，为什么呢？是因为脏腑的生机意志在生长的缘故。为什么说三十二天长骨添精神呢？大概人有三十六个骨节（注：原文为三百六十五，此处依原文翻译），以对应天数，除去手足中的四十五块碎骨外，共有三百二十块，从下部开始生骨，一天长十段向上延伸，十天长一百段，而三十二天共计三百二十段为一遍，这也叫作一次“蒸”。凡经历一个周期，就会出现虚热等病状，像这样经过十个周期，小蒸就结束了。所以前三十二天第一次变，产生肾志；六十四天第二次变一次蒸，产生膀胱；九十六天第三次变，产生心的喜悦之情；一百二十八天第四次变两次蒸，产生小肠；一百六十天第五次变，产生肝的哭泣之声；一百九十二天第六次变三次蒸，产生胆；二百二十四天第七次变，产生肺的声音；二百五十六天第八次变四次蒸，产生大肠；二百八十八天第九次变，产生脾；三百二十天第十次变五次蒸，产生胃，这就是所谓的小蒸结束。另外，手厥阴心包经作为脏，手少阳三焦经作为腑，这一脏一腑都没有具体的形态表现，所以不参与变蒸。太仓说：气进入四肢，生长碎骨，在十次小蒸之后的六十四天为一次大蒸，共计三百八十四天；又过六十四天为第二次大蒸，共计四百四十八天；又过六十四天为第三次大蒸，共计五百一十二天；到五百七十六天时变蒸全部结束，婴儿才算成人。变，是生成五脏；蒸，是滋养六腑。每次经历一变一蒸，情态就会有所不同，轻则发热微汗，症状类似惊风；重则高热，脉象紊乱且快，或者出汗或者呕吐，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。治疗方法，平和者轻微解表，实热者轻微通利，使用紫霜丸、黑散子、柴胡散。如果有寒无热，并伴有呕吐腹泻、不吃奶、多啼哭的，用当归散、调气散主治。
薛立斋说：《全婴方论》记载：变蒸，是为了增长气血。变是上部精气变化，蒸是身体发热。轻则身体发热、虚惊，耳朵发凉、微汗，嘴唇生出白泡，三天可愈。重则寒热交替、脉象紊乱，腹痛啼叫，不能进食吃奶，吃了就吐，五天才能痊愈。古方用黑散子、紫霜丸主治。我认为这种病症，是小儿不可避免的，即使不用药也可以，况且前面的药物属于猛烈之剂，不仅脏腑承受不了，反而还会损伤气血，务必谨慎，务必谨慎！我曾经见过一个小儿，到了第二次变蒸时发热有痰，投服一粒抱龙丸，最终导致死亡，看这个例子就可以验证了。如果不发热不惊恐，几乎没有证候而暗中变化的，这是因为受胎时气壮实的原因。
张景岳说：关于小儿变蒸的说法，古代是没有的，直到西晋的王叔和才开始提及，接着自隋朝、唐朝巢元方以来，便日日相传演绎，说法越来越繁杂。然而在我看来，似乎未必如此，为什么呢？大概胎儿月份足月离开母体后，气质虽然尚未完全结实，但脏腑都已经完备。等到出生后，凡是生长发育的机理，就像月亮盈亏、禾苗生长一样，呼吸之间不容间断，百骸同时到达，自然应该每天不同、日新月异，哪里会有先此后彼，比如第一次变生肾，第二次变生膀胱，以及每次变必须间隔三十二天的道理呢？又如小儿生病与不生病，我所见到和治疗的，也不少，凡是身体不适，要么因为外感，要么因为内伤，从未听说过没有原因就生病的，这难道真是所谓的变蒸吗？又见那些保护得当的，从出生到长大，毫无疾痛的不少，这又是为什么呢？虽然有暗变的说法，终究也不能相信是真的。我恐怕临证医生有固执迷惑的错误，所以说出我的愚昧见解如此，以及前面薛氏的告诫，都是不可不考察清楚的。明达的人认为是否如此呢？
Chao Yuanfang stated: The "bianzheng" (growth and maturation process) in infants serves to nourish blood and qi. "Bian" refers to the transformation of upper-level energy, while "zheng" refers to bodily heat. Qian Zhongyang said: "Bian" means change or replacement. While in the mother's womb, an infant develops bone structure and qi, and the five zang organs and six fu organs take shape but are not yet fully complete. After birth, growth begins in the bones, vessels, and the spiritual consciousness of the zang and fu organs, developing from the interior outward and from the bottom upward. Therefore, thirty-two days after birth constitutes one cycle of "bianzheng," at which point one may notice changes in the child's emotional state compared to before. Why is this? It is because the vital will of the zang organs is growing. What does it mean that thirty-two days promote bone growth and spirit enrichment? Humans have three hundred and sixty-five joint nodes, corresponding to the days of the year. Excluding forty-five small bones in the hands and feet, there remain three hundred and twenty. Bone growth starts from the lower body, ten segments per day ascending; over ten days, one hundred segments grow; thus, over thirty-two days, three hundred and twenty segments constitute one full cycle, also called one "zheng." Upon completing one cycle, deficiency-heat and other conditions may arise. After ten such cycles, the minor "bianzheng" concludes. Specifically: at thirty-two days (first bian), kidney zhi (willpower) is generated; at sixty-four days (second bian, first zheng), the bladder is generated; at ninety-six days (third bian), heart xi (joy) is generated; at one hundred and twenty-eight days (fourth bian, second zheng), the small intestine is generated; at one hundred and sixty days (fifth bian), gan ku (crying associated with liver) is generated; at one hundred and ninety-two days (sixth bian, third zheng), the gallbladder is generated; at two hundred and twenty-four days (seventh bian), fei sheng (voice associated with lung) is generated; at two hundred and fifty-six days (eighth bian, fourth zheng), the large intestine is generated; at two hundred and eighty-eight days (ninth bian), spleen pi (speech associated with spleen) is generated; at three hundred and twenty days (tenth bian, fifth zheng), stomach wei is generated. This marks the completion of minor "bianzheng." Furthermore, the Hand Jueyin Pericardium Meridian acts as a zang organ, and the Hand Shaoyang Sanjiao Meridian acts as a fu organ; since these two lack distinct morphological forms, they do not undergo "bian" or "zheng." Taicang stated: Qi enters the four limbs and grows the small bones. Sixty-four days after the ten minor cycles constitute one major "zheng," totaling three hundred and eighty-four days; another sixty-four days constitute the second major "zheng," totaling four hundred and forty-eight days; another sixty-four days constitute the third major "zheng," totaling five hundred and twelve days; by five hundred and seventy-six days, "bianzheng" is fully completed, and the infant becomes an adult. "Bian" generates the five zang organs; "zheng" nourishes the six fu organs. With each "bian" and "zheng," the child's demeanor changes. Mild cases present with low-grade fever and slight sweating, resembling wind-stroke (Jing Feng); severe cases present with high fever, chaotic and rapid pulse, sweating or vomiting, irritability, crying, and thirst. Mild cases resolve in five days; severe cases in seven to eight days. The symptoms resemble Shanghan (Cold Damage). Treatment methods: for mild/peaceful cases, use slight diaphoresis; for excess-heat cases, use slight purgation, employing Zishuang Wan (Purple Frost Pill), Heisanzi (Black Powder), or Chaihu San (Bupleurum Powder). For cases with cold but no heat, accompanied by vomiting, diarrhea, refusal to nurse, and excessive crying, use Danggui San (Angelica Powder) or Tiaoqi San (Regulating Qi Powder).
Xue Lizhai stated: The *Quan Ying Fang Lun* records: "Bianzheng" serves to nourish blood and qi. "Bian" involves upper energy transformation, and "zheng" involves fever. Mild cases present with body heat, false fright, cool ears, slight sweating, and white blisters on the lips, resolving in three days. Severe cases present with alternating chills and fever, chaotic pulse, abdominal pain, crying, inability to feed, and vomiting upon eating, resolving in five days. Ancient formulas used Heisanzi and Zishuang Wan. I believe this condition is unavoidable in infants; even without medication, it can pass. Moreover, the aforementioned medicines are harsh and acrid; not only can the zang-fu organs not withstand them, but they may also damage blood and qi. One must be extremely cautious! I once observed an infant who, during the second "bian," developed fever and phlegm. After administering one pill of Baolong Wan (Embrace Dragon Pill), the child died. This case serves as verification. If there is no fever or fright, and almost no symptoms appear during the hidden transformation, it is due to strong prenatal qi.
Zhang Jingyue stated: The theory of infant "bianzheng" did not exist in ancient times. It was first mentioned by Wang Shuhe of the Western Jin Dynasty. Subsequently, from Chao Yuanfang in the Sui and Tang dynasties onward, it was transmitted daily and演 (evolved), becoming increasingly complex. However, in my view, this seems unlikely. Why? When a fetus reaches full term and leaves the womb, although its constitution is not yet solid, the zang and fu organs are already complete. After birth, the mechanism of growth and nourishment proceeds like the phases of the moon or the growth of seedlings, allowing no interruption between breaths. All parts develop simultaneously, changing daily and differing day by day. How could there be a sequence where one precedes another, such as the first "bian" generating the kidney and the second generating the bladder, or the rule that every "bian" must occur every thirty-two days? Regarding infants falling ill or remaining healthy, I have seen and treated many. Whenever there is disharmony, it is either due to external pathogens or internal injury; I have never heard of illness occurring without cause. Could this truly be attributed to "bianzheng"? I have also seen many children who were well-protected and grew up free from disease from birth to adulthood. What explains this? Although the concept of "hidden bian" exists, I cannot ultimately accept it as true. Fearing that clinicians may fall into error through rigid adherence to this theory, I express my humble opinions as above. The warnings provided by Xue Shi should also be carefully considered. Do enlightened practitioners agree?