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Jiechu (Splayed Sutures), refers to a condition where the cranial sutures split open and the skull fails to close. Ancient texts state: maternal deficiency and emaciation, or paternal deficiency, can lead to Jiechu. This arises from insufficient congenital endowment and severe depletion of the Kidney Yuan (Primordial Qi). The Kidneys govern the brain marrow; when the Kidneys are deficient, the Qi of the brain is insufficient, causing the cranial sutures to separate. However, without brain marrow, a person is like a tree without roots; within a thousand days, they will become disabled. Some theorists attribute Jiechu to insufficient paternal essence, often citing excessive scleral exposure as a diagnostic sign; others attribute it to maternal blood deficiency with excess heat. Symptoms include frequent melancholy and little joy, prominent sclerae, and a whitish appearance of the pupils. If resulting from post-illness conditions, the prognosis is particularly ominous. It is advisable to take Dihuang Wan (Rehmannia Pill) for an extended period and apply external fontanelle sealing methods. There are also cases caused by sudden fright to the fetus due to strong winds, heavy rain, or lightning during the fifth month of pregnancy, leading to the separation of cranial bones. However, if this condition persists into adulthood without healing, it inevitably leads to steaming heat in the bones, dry muscles, blackened skin, emaciated limbs, and exposed joints, resembling the legs of a crane. This is named He Xi (Crane Knee) or He Jie (Crane Joint). At this stage, it is crucial to regulate and tonify Tian Yuan (Heavenly Primordial Essence) to attempt a cure.

Pediatric Crane Knee results from congenital Kidney deficiency and insufficient Qi and Blood, leading to muscle wasting and a shape resembling a crane's knee. The external color remains unchanged, but there is pain inside the knee, making flexion and extension difficult. If swelling is red and suppurates, it is due to external factors and is treatable. If swelling is hard, white, and does not suppurate, it stems from intrinsic deficiency and is difficult to cure. For external causes, use Jingjie (Schizonepeta) and Fangfeng (Saposhnikovia) as main herbs, assisted by formulas that tonify Qi and nourish Ying (Nutritive Qi). For intrinsic causes, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) supplemented with Lurong (Deer Antler Velvet) to tonify essence and blood, while simultaneously regulating and tonifying the Spleen and Stomach to aid the source of transformation and generation.

Xitian (Fontanelle Distension) refers to the swelling of the anterior fontanelle. The Spleen governs muscles. Irregular breastfeeding, unregulated hunger and satiety, or invasion by cold or heat pathogens affecting the Spleen, can cause disharmony of the Zang-Fu organs. This leads to rebellious Qi rushing upward, causing distension and fullness, resulting in a protruding, high anterior fontanelle resembling stacked objects, accompanied by short, yellow hair, bone-steaming fever, and spontaneous sweating. Additionally, wind-heat injuring the Liver may cause Liver Wood stagnation and failure to disperse, leading to swelling. Lung heat generating wind may also cause fontanelle swelling and scorched hair, as the Lungs govern the skin and hair. Intrauterine heat retention is another cause. Swelling caused by cold Qi rushing upward is firm and hard; swelling caused by hot Qi rushing upward is soft and red. External over-warming, preventing Yang Qi from dispersing outward, can also cause red swelling. Cold patterns are treated with warming methods, and heat patterns with cooling methods. External application of Fengxin San (Fontanelle Sealing Powder) is appropriate.