钱仲阳云∶小儿解颅，或久不合者，因肾气有亏，脑髓不足。故儿多愁少喜，目睛多白，而
身瘦。盖人之脑髓，如木无根，有数岁而成废人者，服钱氏地黄丸。更用南星微炮为末，米
醋调，敷绯帛，烘热贴之，其柏子仁散、三辛散、封囟散俱效。夫肾主骨，肾气实则脑髓充
，而囟早合，骨脉盛而齿早生。肾气怯则脑髓虚，而囟不合，此由父母精血不足，宜用地黄
丸补之。若在乳下，当兼补其母，更以软帛紧束其首，使其易合，皆虚火上冲，当调补脾肾
为喜。囟填囟陷，亦因所禀肾气不足，及乳哺失宜，脾胃亏损所致。夫脾主肌肉，气逆上冲
而为填胀，元气下陷而为囟陷也。并用补中益气汤、地黄丸，及用狗头骨炙黄为末，以鸡子
清调敷囟门。亦有泻痢气血虚，脾胃不能上充者，亦用前法。若手足并冷，前汤加姜、桂，
未应，虚寒甚也，急加附子，缓则多致不救。
治验
一小儿颅解足软，两膝渐大，不能行履，用六味地黄丸加鹿茸治之，三月而起。
一小儿十四岁，解囟自觉头大，视物昏大。畏日羞明，此禀赋肾气怯弱。用六味丸加鹿茸，
及补中益气汤加山药、山茱萸，半载愈；二载而囟合。既婚之后，仍觉囟门开解，足心如炙
。喜其断色欲，薄滋味，日服前药二剂，三载而愈。后入房两腿痿软，又教以服前丸，守前戒而愈。
一小儿年十四岁，而近女色，发热吐痰。至有室，两目羞明，头觉胀大，仍不断欲，其头渐
大，囟门忽开，用地黄丸、益气汤之类，断色欲年余，而愈。
一小儿年十三岁，患前症，内热晡热，形体倦怠，食少作渴，用六味丸加鹿茸补之，不越月
一小儿吐泻发热，囟陷作渴，用七味白术散，母子并服而愈。
一小儿久病发热，其囟或陷或填，手足或温或冷。余用补中益气汤加蔓荆子、炮姜，治之而安。
一小儿囟陷吐泻，手足并冷，用白术散加木香、炮姜，治之而愈。后伤食腹痛，手足复冷，
用六君、炮姜治之，更加昏愦，口角流涎，此脾胃虚寒之甚也，急加附子遂愈。
一小儿病后，其囟或陷或填，此脾胃虚热也，朝用补中益气汤加蔓荆子、炮姜、木香，治之
而囟平。但作泻口干，用白术散以生胃气而愈。
柏子仁散 治囟门不合。
防风（一两五钱） 柏子仁（一两）
上为末，乳汁调涂囟门，十日自合。
三辛散 治脑角骨大，囟门不合。
细辛 桂心（各五钱） 干姜（一钱）
上为末，乳汁调涂囟上，干时再涂。
玉乳丹 治解颅。
钟乳粉（如法制） 熟地黄（自法制杵膏） 柏子仁（研膏） 当归（各半两） 防风 补骨脂（各一钱）
上各另为末，入二膏，加炼蜜，丸黍米大。每服一二十丸，煎茴香汤送下，加黄 、茯苓亦
封囟散（方见发搐）
地黄丸（方见肾脏）
济生当归散（方见黄胆）
Qian Zhongyang stated: In infants, "jie lu" (splitting of the skull, characterized by delayed closure of fontanelles and separation of cranial sutures), or prolonged failure of closure, is caused by deficiency of Kidney Qi and insufficiency of brain marrow. Consequently, children tend to be melancholic rather than joyful, have eyes with excessive white sclera relative to the iris, and exhibit emaciation. The brain marrow in humans is like a tree without roots; some children may become disabled by the age of several years. They should administer Qian Shi Di Huang Wan (Child's Rehmannia Pill). Additionally, use Nan Xing (Arisaema Rhizome) slightly roasted and powdered, mixed with rice vinegar, applied on red silk, warmed, and pasted onto the fontanelle. Bai Zi Ren San (Biota Seed Powder), San Xin San (Three Pungent Powders), and Feng Xin San (Fontanelle Sealing Powder) are also effective. The Kidneys govern bones; when Kidney Qi is substantial, brain marrow is充盈 (full/plentiful), leading to early closure of the fontanelles, and bone vessels are vigorous, leading to early tooth eruption. When Kidney Qi is timid/weak, brain marrow is deficient, resulting in unclosed fontanelles. This stems from insufficient essence and blood of the parents. It is appropriate to tonify using Di Huang Wan (Rehmannia Pill). If the infant is still nursing, the mother should be tonified simultaneously. Furthermore, tightly bind the head with soft cloth to facilitate closure. These conditions are generally due to deficieny fire rushing upward; thus, regulating and tonifying the Spleen and Kidneys is preferred. "Xian tian" (fontanelle bulging/protrusion) and "xian xian" (fontanelle depression/sunkenness) are also caused by congenital insufficiency of Kidney Qi, as well as improper breastfeeding and dietary management, leading to Spleen-Stomach damage. The Spleen governs muscles; rebellious Qi rushing upward causes bulging, while sinking of Yuan Qi (Original Qi) causes depression. Both conditions are treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Di Huang Wan. Additionally, roast dog skull bone until yellow, powder it, mix with egg white, and apply to the fontanelle. There are also cases where dysentery or diarrhea leads to Qi and Blood deficiency, preventing the Spleen-Stomach from nourishing the upper regions; these are also treated with the aforementioned methods. If the hands and feet are cold, add Sheng Jiang (Fresh Ginger) and Rou Gui (Cinnamon Bark) to the previous decoction. If there is no response, it indicates severe deficiency-cold; urgently add Fu Zi (Prepared Aconite Root). Delaying treatment often leads to untreatable conditions.
Case Records:
An infant presented with split skull and weak legs, with gradually enlarging knees, unable to walk. Treated with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Lu Rong (Deer Antler Velvet), he was able to stand and walk after three months.
A fourteen-year-old boy complained of an enlarged head due to unclosed fontanelle, blurred vision where objects appeared large, and photophobia. This was attributed to congenital weakness of Kidney Qi. Treated with Liu Wei Di Huang Wan plus Lu Rong, and Bu Zhong Yi Qi Tang plus Shan Yao (Dioscorea Rhizome) and Shan Zhu Yu (Cornus Fruit), he recovered in half a year, and the fontanelle closed after two years. After marriage, he still felt the fontanelle was open and his soles felt hot like burning. Fortunately, he abstained from sexual activity and rich flavors, taking two doses of the previous medicine daily, recovering after three years. Later, sexual intercourse led to flaccidity of the legs; he was advised to take the previous pill again and adhere to the previous abstinence, resulting in recovery.
A fourteen-year-old boy engaged in sexual activity, presenting with fever and phlegm expectoration. Upon entering a room, he experienced photophobia and a sensation of head distension. Continuing sexual activity, his head gradually enlarged, and the fontanelle suddenly opened. Treated with Di Huang Wan and Yi Qi Tang (Qi-Augmenting Decoction), and abstaining from sexual activity for over a year, he recovered.
A thirteen-year-old boy suffered from the aforementioned symptoms, including internal heat and afternoon fever, physical fatigue, poor appetite, and thirst. Tonified with Liu Wei Di Huang Wan plus Lu Rong; within a month... [text implies improvement/control].
An infant presented with vomiting, diarrhea, fever, sunken fontanelle, and thirst. Treated with Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder), administered to both mother and child, resulting in recovery.
An infant with prolonged illness and fever presented with alternating sunken and bulging fontanelles, and hands/feet that were sometimes warm and sometimes cold. I treated with Bu Zhong Yi Qi Tang plus Man Jing Zi (Vittex Seed) and Pao Jiang (Roasted Ginger), resulting in stabilization.
An infant presented with sunken fontanelle, vomiting, diarrhea, and cold hands and feet. Treated with Bai Zhu San (Atractylodes Macrocephala Powder) plus Mu Xiang (Aucklandia Root) and Pao Jiang, resulting in recovery. Later, food stagnation caused abdominal pain, and hands/feet became cold again. Treated with Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Pao Jiang, but condition worsened with drowsiness and drooling at the mouth corners, indicating severe Spleen-Stomach deficiency-cold. Urgently adding Fu Zi resulted in recovery.
An infant post-illness presented with alternating sunken and bulging fontanelles, indicating Spleen-Stomach deficiency-heat. Morning administration of Bu Zhong Yi Qi Tang plus Man Jing Zi, Pao Jiang, and Mu Xiang flattened the fontanelle. However, diarrhea and dry mouth occurred; treated with Bai Zhu San to generate Stomach Qi, resulting in recovery.
Bai Zi Ren San (Biota Seed Powder): Treats unclosed fontanelle.
Fang Feng (Saposhnikovia Root, 1 liang 5 qian) Bai Zi Ren (Biota Seed, 1 liang)
Powder above ingredients, mix with breast milk, apply to fontanelle. It will close naturally in ten days.
San Xin San (Three Pungent Powders): Treats prominent cranial angles and unclosed fontanelle.
Xi Xin (Asarum Root) Gui Xin (Cinnamon Heart) (each 5 qian) Gan Jiang (Dried Ginger, 1 qian)
Powder above ingredients, mix with breast milk, apply to fontanelle. Reapply when dry.
Yu Ru Dan (Jade Milk Pill): Treats jie lu (splitting of the skull).
Zhong Ru Fen (Halloysitum Rubrum Powder, prepared method) Shu Di Huang (Prepared Rehmannia Root, prepared paste) Bai Zi Ren (Biota Seed, prepared paste) Dang Gui (Angelica Sinensis Root) (each half liang) Fang Feng (Saposhnikovia Root) Gu Bo Zhi (Psoralea Fruit) (each 1 qian)
Process each into powder separately, combine with the two pastes, add refined honey, and form pills the size of millet seeds. Take 10-20 pills per dose, washed down with Fennel Decoction. Huang Qi (Astragalus Root) and Fu Ling (Poria) may also be added.
Feng Xin San (Fontanelle Sealing Powder) (See formula under "Convulsions")
Di Huang Wan (Rehmannia Pill) (See formula under "Kidney Organ")
Ji Sheng Dang Gui San (Life-Saving Angelica Powder) (See formula under "Jaundice")