巢氏云∶小儿变蒸者，以长血气也。变者上气，蒸者体热巢氏云上多变气。仲阳云∶变者易也。又生变蒸者，自内
而长，自上而下，又身热。故以生之日后至三十二日一变，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；故初生至三十二日，一变生癸，属
足少明经肾脏，藏精与志。至六十四日，二变一蒸生壬，属足太阳经膀胱腑，其发耳与KT 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，属手少阴经心脏，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，主火，地二生火，天七成之。至一百六十日，五变生乙，属足
厥阴经肝脏，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（一本作开）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，属手太阴肺脏，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，九变生巳，
属足太阴经脾脏，藏意与智。至三百二十日，十变五蒸生戊，属足阳明经胃腑，其发不食肠痛而吐乳，脾与胃合主土，
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，俱无形状，故不变而蒸也。前十变五
蒸，乃天地之数以生成之，此后始生齿能言，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。又一百二十
八日，为三大蒸，共计五百七十六日，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，情态即异，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KT 冷，上唇发泡，
状如浊珠，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，皆循环各有证应。其治法∶和平之剂微表，实热者微利之，或不治亦自愈，可服紫霜
丸一丸或二丸，并黑散子、柴胡汤。变蒸者有寒无热，并吐泻不乳多啼者，当归散、调气散主之。变蒸之外，小儿如常，
体貌情态，自然端正，鼻内喉中，绝无涎涕，头如青黛，唇似朱鲜，脸腮如花映竹，情意若天净月明，喜引方笑，似此
平安。议曰∶人得中之道，以为纯粹，阴阳得所，刚柔兼济，气血相和，百脉相顺，所以心志益通，精神俱备，脏腑充
实，形体固壮。凡观婴孩颅囟固合，睛黑神清，口方背浓，骨粗臀满，脐深肚软，齿细发黑，声洪睡稳，此乃受气充足，
禀赋得中，而无疾也。
紫霜丸 治证详见第三问。
代赭石（ ，醋淬七次） 赤石脂（各一钱） 杏仁（五十粒，去皮尖） 巴豆（三十粒，去皮膜心，出油）
上先将杏仁、巴霜入乳钵内，细研如膏，却入代赭、石脂末研匀，以汤浸蒸饼，为丸如粟子大，一岁服五丸，米饮
汤下；一、二百日内儿，三丸乳汁下；更宜量其虚实加减，微利为度。此药兼治惊痰诸疾，虽下不致虚人。
紫阳黑散 治变蒸，解利热气。
麻黄（一两，不去节） 大黄（五钱） 杏仁（去皮尖，二钱半）
上三味，同一处捣和，略烧存性，再以杏仁少许，研膏和之，密器盛贮，每用一豆许，乳汁调下。
柴胡汤 治变蒸，骨热心烦，啼叫不已。
人参 甘草（微炙） 麦门冬（去心，各二钱） 龙胆草 防风（各一钱） 柴胡（三钱）
上锉散，每服三钱煎服。
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）
上锉散，每服二钱，姜、枣煎服。
调气散 治变蒸，吐泻不乳，多啼慢惊欲发。
木香 香附子 人参 桔皮 藿香 甘草（炙，各一钱）
上为末，每服二钱，姜、枣煎服。
巢元方说：小儿的变蒸，是用来生长血气的。所谓“变”，是指上部的真气发生变化；所谓“蒸”，是指身体发热。巢元方又说：变主要表现为气的变化。钱乙（字仲阳）说：“变”就是改变的意思。凡是发生变蒸的孩子，气血是从体内向外、从上向下生长的，并且伴有身体发热。因此，从出生之日算起，每过三十二天就经历一次“变”，每次变结束后，孩子的情感和性格就会与之前有所不同。为什么呢？这是因为脏腑的意智得以生长的缘故。
什么叫“三十二天长骨添精神”呢？人体有三百六十五块骨头，以象征一年的天数，对应一年的周期，并分属于十二经络。所以从初生到第三十二天，第一次“变”产生癸水，归属于足少阴肾经和肾脏，肾藏精与志。到了第六十四天，第二次“变一蒸”产生壬水，归属于足太阳膀胱经和膀胱腑，其表现是耳朵和尻部发冷。肾与膀胱相表里，都主司水液代谢，“天一生水，地六成之”。到了第九十六天，第三次“变”产生丁火，归属于手少阴心经和心脏，心藏神，其情志为喜。到了第一百二十八天，第四次“变二蒸”产生丙火，归属于手太阳小肠经和小肠腑，其表现为出汗且轻微惊悸。心与小肠相表里，主司火，“地二生火，天七成之”。到了第一百六十天，第五次“变”产生乙木，归属于足厥阴肝经和肝脏，肝藏魂，表现为喜欢哭泣。到了第一百九十二天，第六次“变三蒸”产生甲木，归属于足少阳胆经和胆腑，其表现为眼睛不闭（另一版本作开）且发红。肝与胆相表里，主司木，“天三生木，地八成之”。到了第二百二十四天，第七次“变”产生辛金，归属于手太阴肺经和肺脏，肺藏魄，主声音。到了第二百五十六天，第八次“变四蒸”产生庚金，归属于手阳明大肠经和大肠腑，其表现为皮肤发热且有汗或无汗。肺与大肠相表里，主司金，“地四生金，天九成之”。到了第二百八十八天，第九次“变”产生巳土，归属于足太阴脾经和脾脏，脾藏意与智。到了第三百二十天，第十次“变五蒸”产生戊土，归属于足阳明胃经和胃腑，其表现为不吃东西、腹痛并吐奶。脾与胃相表里，主司土，“天五生土，地十成之”。另外，手厥阴心包络作为脏，手少阳三焦作为腑，这一脏一腑都没有具体的形状，所以只经历“蒸”而不经历“变”。前十变五蒸，符合天地生成的数理，此后婴儿才开始长牙齿、能说话、懂得喜怒，所以说此时形体才算是完备。
太仓公说：气进入四肢，促进碎骨的生长。在第十变之后的第六十四天，进行一次大蒸，累计三百八十四天，以此滋养手足的经脉。手得到血的濡养，就能拿取物品；脚得到血的濡养，就能行走站立。经书说“变且蒸”，意思是经过变蒸之后，大约过了一岁多一点的时间。老师说：如果不出汗而发热，应当用发汗法治疗；如果剧烈呕吐，应轻微止呕，不可单独针对其他症状治疗。再过六十四天，进行第二次大蒸，累计四百四十八天。再过一百二十八天，进行第三次大蒸，累计五百七十六天。变蒸过程结束后，孩子才算真正成人。所谓“变”，是变化生成五脏；所谓“蒸”，是蒸腾滋养六腑，以此来成就成人之体。“变”表现为上部之气变化，“蒸”表现为身体发热。每经历一变一蒸，孩子的神态就会有所不同。轻度的表现为发热微汗，症状类似惊风；重度的表现为高热，脉搏紊乱且快，或者呕吐、出汗、烦躁啼哭、口渴。轻症五到六天缓解，重症七到八天缓解，其征候与伤寒相似。也有孩子在变蒸余势未消时，又感受寒邪的，这种情况下，变蒸的表现是耳朵和尻部发冷，上唇出现水泡，状如浑浊的珠子；若是寒邪与之搏结，则会出现寒热交争、腹中疼痛，啼叫声日夜不停。
“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，都循环往复各有相应的证候。治疗方法：平和的药剂轻微解表，实热的情况轻微通下，或者不治也能自愈。可以服用紫霜丸一至二丸，以及黑散子、柴胡汤。如果是变蒸期间只有寒象没有热象，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，如果孩子像平常一样，体态神情自然端正，鼻内喉中绝无涎涕，头色如青黛，嘴唇似朱鲜，脸颊红润如花映竹，情意若天空明月般明朗，喜欢引颈微笑，这就是平安的状态。
议论说：人得中和之道，以为纯粹，阴阳各得其位，刚柔相互调剂，气血和谐，百脉顺畅，所以心志通达，精神具备，脏腑充实，形体坚固强壮。凡是观察婴幼儿，颅囟闭合坚固，眼睛黑白分明神采清亮，口型方正背部厚实，骨骼粗壮臀部丰满，肚脐深而腹部柔软，牙齿细密头发乌黑，声音洪亮睡眠安稳，这是受气充足，禀赋得中，而没有疾病的表现。
紫霜丸 治疗的证候详见第三问。
代赭石（用醋淬炼七次） 赤石脂（各一钱） 杏仁（五十粒，去皮尖） 巴豆（三十粒，去皮膜及心，去油）
先将杏仁、巴豆放入乳钵中，细细研磨成膏状，然后加入代赭石、赤石脂的粉末研匀，用热水浸泡蒸饼，制成如粟米大小的丸药。一岁儿童服五丸，米饮送下；一百至二百日内的婴儿，服三丸，乳汁送下；更应根据患儿的虚实情况进行加减，以轻微腹泻为度。此药兼治惊痰等各种疾病，虽然具有泻下作用但不会导致人体虚弱。
紫阳黑散 治疗变蒸，解除热气。
麻黄（一两，不去节） 大黄（五钱） 杏仁（去皮尖，二钱半）
将这三味药放在一处捣碎混合，稍微烧制保留药性，再用少许杏仁研成膏调和，装入密封容器中保存。每次取一粒豆子大小的量，用乳汁调服。
柴胡汤 治疗变蒸，骨中发热心烦，啼叫不止。
人参 甘草（微炙） 麦门冬（去心，各二钱） 龙胆草 防风（各一钱） 柴胡（三钱）
切碎成散剂，每次服三钱，煎汤服用。
当归散 治疗变蒸，有寒象无热象。
当归（二钱） 木香 官桂（辛辣者） 甘草（炙） 人参（各一钱）
切碎成散剂，每次服二钱，加生姜、大枣煎汤服用。
调气散 治疗变蒸，呕吐腹泻不肯吃奶，多啼哭欲发慢惊风。
木香 香附子 人参 桔皮 藿香 甘草（炙，各一钱）
研成粉末，每次服二钱，加生姜、大枣煎汤服用。
Chao Yuanfang stated: The "bianzheng" (periodic growth and transformation) in infants serves to nourish blood and qi. "Bian" refers to the alteration of upper-body vital qi, while "zheng" refers to bodily heat. Chao further noted that bian primarily manifests as changes in qi. Qian Yi (courtesy name Zhongyang) explained that "bian" means change. In cases of bianzheng, growth proceeds from the interior to the exterior and from the top down, accompanied by fever. Therefore, starting from birth, a "bian" occurs every thirty-two days. Upon completion of each bian, the infant's temperament and behavior differ from before. Why is this? It is because the faculties of the zang-fu organs, including intention and intelligence, are developing.
What is meant by "lengthening bones and enriching spirit every thirty-two days"? The human body has three hundred and sixty-five bones, symbolizing the days of a year, corresponding to the annual cycle, and distributed among the twelve meridians. Thus, from birth to the thirty-second day, the first "bian" generates Gui Water, belonging to the Foot Shaoyin Kidney Meridian and the Kidney organ, which stores essence and willpower. By the sixty-fourth day, the second "bian with one zheng" generates Ren Water, belonging to the Foot Taiyang Bladder Meridian and the Bladder organ; its manifestation includes cold ears and cold sacrum. The Kidney and Bladder are internally-externally related and both govern water metabolism, following the principle that "Heaven generates One with Water, Earth completes it with Six." By the ninety-sixth day, the third "bian" generates Ding Fire, belonging to the Hand Shaoyin Heart Meridian and the Heart organ, which stores the spirit (Shen); its emotional expression is joy. By the one-hundred-and-twenty-eighth day, the fourth "bian with two zhengs" generates Bing Fire, belonging to the Hand Taiyang Small Intestine Meridian and the Small Intestine organ; its manifestations include sweating and slight palpitations. The Heart and Small Intestine are internally-externally related and govern fire, following the principle that "Earth generates Two with Fire, Heaven completes it with Seven." By the one-hundred-and-sixtieth day, the fifth "bian" generates Yi Wood, belonging to the Foot Jueyin Liver Meridian and the Liver organ, which stores the ethereal soul (Hun); its manifestation is a tendency to cry. By the one-hundred-and-ninety-second day, the sixth "bian with three zhengs" generates Jia Wood, belonging to the Foot Shaoyang Gallbladder Meridian and the Gallbladder organ; its manifestations include eyes that do not close (another version says open) and redness. The Liver and Gallbladder are internally-externally related and govern wood, following the principle that "Heaven generates Three with Wood, Earth completes it with Eight." By the two-hundred-and-twenty-fourth day, the seventh "bian" generates Xin Metal, belonging to the Hand Taiyin Lung Meridian and the Lung organ, which stores the corporeal soul (Po) and governs voice. By the two-hundred-and-fifty-sixth day, the eighth "bian with four zhengs" generates Geng Metal, belonging to the Hand Yangming Large Intestine Meridian and the Large Intestine organ; its manifestations include skin heat with or without sweating. The Lung and Large Intestine are internally-externally related and govern metal, following the principle that "Earth generates Four with Metal, Heaven completes it with Nine." By the two-hundred-and-eighty-eighth day, the ninth "bian" generates Si Earth, belonging to the Foot Taiyin Spleen Meridian and the Spleen organ, which stores intention and intelligence. By the three-hundred-and-twentieth day, the tenth "bian with five zhengs" generates Wu Earth, belonging to the Foot Yangming Stomach Meridian and the Stomach organ; its manifestations include anorexia, abdominal pain, and regurgitation of milk. The Spleen and Stomach are internally-externally related and govern earth, following the principle that "Heaven generates Five with Earth, Earth completes it with Ten." Additionally, the Hand Jueyin Pericardium acts as a Zang organ, and the Hand Shaoyang Sanjiao (Triple Burner) acts as a Fu organ. Since these two lack distinct physical forms, they undergo only "zheng" and not "bian." The preceding ten bians and five zhengs align with the numerical generation of Heaven and Earth. After this period, infants begin to grow teeth, speak, and understand joy and anger, thus their form is considered complete.
Cangtai Gong stated: Qi enters the four limbs and promotes the growth of small bones. Sixty-four days after the tenth bian, 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 objects; when the feet receive blood, they can walk and stand. The classics state "bian and zheng," meaning that after the completion of bianzheng, slightly more than one year has passed. The Master said: If there is fever without sweating, induce sweating; if there is severe vomiting, mildly stop it; do not treat other symptoms separately. Another sixty-four days later, a second major zheng occurs, totaling four hundred and forty-eight days. Another one hundred and twenty-eight days later, a third major zheng occurs, totaling five hundred and seventy-six days. Once bianzheng is complete, the child becomes an adult. "Bian" refers to the transformation generating the five Zang organs; "zheng" refers to the steaming nourishing the six Fu organs, thereby forming the adult body. "Bian" involves changes in upper qi; "zheng" involves bodily heat. With each bian and zheng, the infant's demeanor changes. Mild cases present with low-grade fever and slight sweating, resembling convulsions; severe cases present with high fever, chaotic and rapid pulse, vomiting, sweating, irritability, crying, and thirst. Mild cases resolve in five to six days; severe cases in seven to eight days. The presentation resembles Cold Damage (Shanghan). Some infants, while residual effects of bianzheng persist, contract cold pathogens. In such cases, bianzheng signs include cold ears and sacrum, and blisters on the upper lip resembling turbid pearls. If cold pathogens contend with these, it results in alternating chills and fever, abdominal pain, and ceaseless crying day and night.
"Bian" means change. Steaming in the Liver causes dizziness and slight redness of the eyes; steaming in the Lungs causes sneezing, coughing, and erection of hair. All five Zang and six Fu organs, tendons, vessels, bones, and joints have cyclical and specific corresponding signs. Treatment methods: Use mild releasing agents for harmonious conditions, mild purgatives for excess heat, or allow self-resolution. Zi Shuang Wan (Purple Frost Pill) one or two pills, Hei San Zi (Black Powder), or Chaihu Tang (Bupleurum Decoction) may be administered. For bianzheng presenting with cold but no heat, accompanied by vomiting, diarrhea, refusal to nurse, and excessive crying, Danggui San (Angelica Powder) and Tiaoqi San (Qi-Regulating Powder) are indicated. Outside of bianzheng periods, if the infant appears normal, with natural posture and demeanor, free of nasal and throat secretions, head color like dark cyan, lips bright red, cheeks rosy like flowers reflecting bamboo, and mind clear like the moon in a clean sky, smiling and happy, this indicates peace and health.
Commentary: Humans attain the Dao of the Mean, becoming pure and complete. Yin and Yang are balanced, rigidity and flexibility complement each other, Qi and Blood harmonize, and all pulses flow smoothly. Thus, the mind and will become clear, spirit is fully developed, Zang-Fu organs are robust, and the physique is strong. Observing infants: if the fontanelle is firm and closed, eyes are black and clear with bright spirit, mouth is square, back is thick, bones are coarse, buttocks are full, umbilicus is deep, abdomen is soft, teeth are fine, hair is black, voice is resonant, and sleep is steady, this indicates sufficient acquired Qi, proper endowment, and absence of disease.
Zi Shuang Wan (Purple Frost Pill): See Question 3 for detailed indications.
Dai Zhe Shi (Hematitum, calcined seven times in vinegar) [1 qian]
Chi Shi Zhi (Halloysitum Rubrum) [1 qian]
Xing Ren (Armeniacae Semen Amarum, peeled and cored) [50 grains]
Ba Dou (Crotonis Fructus, peeled, membrane and heart removed, oil expressed) [30 grains]
First, grind Xing Ren and Ba Dou finely in a mortar until paste-like. Then add Dai Zhe Shi and Chi Shi Zhi powders and mix evenly. Soak steamed wheat dough in hot water to bind, and form pills the size of millet seeds. Infants aged one year take five pills, washed down with rice broth. Infants aged one to two hundred days take three pills, washed down with breast milk. Dosage should be adjusted according to deficiency or excess, aiming for mild purgation. This formula also treats various disorders of phlegm and fright; although purgative, it does not weaken the patient.
Ziyang Heisan (Purple Sun Black Powder): Treats bianzheng, resolves heat.
Mahuang (Ephedrae Herba, one liang, stems intact)
Dahuang (Rhei Radix et Rhizoma, five qian)
Xing Ren (Armeniacae Semen Amarum, peeled and cored, two qian half)
Grind the three ingredients together, lightly roast until the original nature is preserved. Mix with a little Xing Ren paste. Store in a sealed container. Administer a dose the size of a soybean, mixed with breast milk.
Chaihu Tang (Bupleurum Decoction): Treats bianzheng, bone-heat, restlessness, and incessant crying.
Renshen (Ginseng Radix)
Gancao (Glycyrrhizae Radix, lightly roasted)
Mendong (Ophiopogonis Tuber, core removed) [each 2 qian]
Longdancao (Gentianae Radix)
Fangfeng (Saposhnikoviae Radix) [each 1 qian]
Chaihu (Bupleuri Radix) [3 qian]
Cut into pieces to make a powder. Take 3 qian per dose, decoct in water and drink.
Danggui San (Angelica Powder): Treats bianzheng, cold without heat.
Danggui (Angelicae Sinensis Radix) [2 qian]
Muxiang (Aucklandiae Radix)
Guigui (Cinnamomi Cortex, pungent variety)
Gancao (Glycyrrhizae Radix, roasted)
Renshen (Ginseng Radix) [each 1 qian]
Cut into pieces to make a powder. Take 2 qian per dose, decoct with fresh ginger and jujube, and drink.
Tiaoqi San (Qi-Regulating Powder): Treats bianzheng, vomiting, diarrhea, refusal to nurse, excessive crying, and impending slow convulsions.
Muxiang (Aucklandiae Radix)
Xiangfu (Cyperi Rhizoma)
Renshen (Ginseng Radix)
Jupi (Citri Reticulatae Pericarpium)
Huoxiang (Pogostemonis Herba)
Gancao (Glycyrrhizae Radix, roasted) [each 1 qian]
Grind into powder. Take 2 qian per dose, decoct with fresh ginger and jujube, and drink.