仲阳谓解颅，生下而囟不合，肾气不成也，长必少笑，更有目白睛多， 白身瘦者，多愁少喜也，余见肾虚症。杨
氏曰∶小儿年大，头缝开解而不合者，肾主髓，脑为髓海，肾气有亏，脑髓不足，所以头颅开而不能合也。人乏脑髓，
如木无根，凡得此者，不远千日，其间亦有数岁，乃成废人。设有此症，不可束手待毙，宜与钱氏地黄丸，仍用南星微
炮为末，米醋调敷于绯帛，烘热贴之，亦良法也。柏子仁散、三辛散等剂敷之尤效。
地黄丸 见第八问。
柏子仁散 治小儿囟开不合。
防风（一两半） 柏子仁（一两）
上末，乳汁调涂囟门上。
三辛散 一名封囟散、一名桂号散、治婴孩小儿、脑囟大开。
细辛 桂心（各半两） 干姜（一钱）
上为末，乳汁调涂囟上，干时再涂，面赤为效。
囟陷者，始因脏腑有热，渴饮水浆，致成泄利，久则血气虚弱，不能上充脑髓，故囟陷如坑，不能平满，用狗头骨
炙黄为末，鸡子清调敷之。囟填者，囟门肿起也，脾主肌肉，乳哺不常，饥饱无度，或寒或热，乘于脾家，致使脏腑不
调，其气上冲，为之填胀，囟突而高，如物堆起，毛皮短黄自汗是也。若寒气上冲则牢靳，热气上冲则柔软，寒者温之，
热者凉之，剂量轻重，兼与调气。小儿肝盛，风热反攻亦然，此症未易退瘥，或热症用大连翘散以消之，有表热症，柴
胡散主之，又有封囟散掩之。论曰∶小儿胃气冲和，则脑髓充盛，囟顶渐合，若胃气热，熏蒸脏腑，则渴而引饮，因致
泄利，令脏腑壅热，血气虚弱不能上充脑髓，所以囟陷也，圣济经用当归散、地黄丸。
大连翘饮子 见第三问。
柴胡散 见第五十问。
封囟散 见第三十二问三辛散。
地黄丸 见第八问。
当归散 见第五十九问。
Qian Yi stated that Jie Lu (Splayed Sutures) refers to the failure of the fontanelle to close after birth, which is due to the insufficiency of Kidney Qi. As the child grows, they will likely speak little and smile rarely. Additionally, they may exhibit excessive white in the eyes, emaciation, and a disposition characterized by much sorrow and little joy. In my clinical experience, such symptoms are mostly attributed to Kidney Deficiency syndrome.
Yang Shi said: When a child grows older but the cranial sutures remain open and do not unite, it is because the Kidney governs the marrow, and the brain is the Sea of Marrow. If Kidney Qi is deficient and Brain Marrow is insufficient, the skull sutures will gape and fail to close. A person lacking brain marrow is like a tree without roots. Those who contract this illness typically do not survive beyond a thousand days; some may live for several years but ultimately become incapacitated. If one suffers from this condition, one should not wait passively for death. It is appropriate to administer Qian's Dihuang Wan (Rehmannia Pill), and simultaneously use prepared Arisaema Rhizome (Nanxing, 南星) ground into powder, mixed with rice vinegar, applied on red silk, warmed, and then patched onto the affected area. This is also an excellent method. Applications of Baiziren San (Platycladi Seed Powder) and Sanxin San (Three Acrid Powders) are particularly effective.
Dihuang Wan (Rehmannia Pill) See Question 8.
Baiziren San (Platycladi Seed Powder) Treats infants whose fontanelles remain open.
Fangfeng (1.5 liang) Baiziren (1 liang)
Grind the above into powder, mix with milk, and apply to the fontanelle.
Sanxin San (Three Acrid Powders), also known as Fengxin San (Fontanel-Sealing Powder) or Guihao San (Cinnamon-Horn Powder), treats large open fontanelles in infants.
Xixin (Asarum Root) Guixin (Cinnamon Twig Heart) (0.5 liang each) Ganjiang (Dried Ginger) (1 qian)
Grind the above into powder, mix with milk, and apply to the fontanelle. Reapply when dry. Redness of the face indicates efficacy.
Xian Xian (Sunken Fontanelle) initially arises from heat in the Zang-Fu organs, causing thirst and excessive drinking, leading to diarrhea. Over time, Blood and Qi become weak and cannot ascend to nourish the brain marrow, causing the fontanelle to sink like a pit and fail to flatten. One may roast dog skull bone until yellow, grind it into powder, mix with egg white, and apply externally.
Xian Tian (Protruding Fontanelle) refers to the swelling and protrusion of the fontanelle. The Spleen governs muscles. Irregular feeding, extreme hunger or fullness, or invasion by cold or heat damaging the Spleen-Stomach, can cause Zang-Fu dysfunction. Qi rushes upward, causing the fontanelle to swell and protrude like a mound, accompanied by yellowish hair and spontaneous sweating. If cold qi rushes upward, the fontanelle becomes hard and contracted; if hot qi rushes upward, it becomes soft. Cold conditions require warming, while hot conditions require cooling. Dosage should be adjusted according to severity, combined with regulating Qi. Children often have hyperactive Liver Qi, and counter-attack by Wind-Heat can produce similar effects. This condition is difficult to resolve. For heat syndromes, Dalianqiao Yinzi (Large Lonicera Decoction) can be used to dissipate the pathogen. For exterior heat syndromes, Chaihu San (Bupleurum Powder) is the primary treatment. Additionally, Fengxin San (Fontanel-Sealing Powder) can be applied externally. The treatise states: When a child's Stomach Qi is harmonious, Brain Marrow is abundant, and the fontanelle gradually closes. If Stomach Qi is hot, steaming the Zang-Fu organs, it causes thirst and drinking, leading to diarrhea. This results in stagnation and heat in the Zang-Fu, weakening Blood and Qi so they cannot ascend to nourish the brain marrow, thus causing sunken fontanelles. The *Shengji Jing* recommends Danggui San (Angelica Powder) and Dihuang Wan (Rehmannia Pill).
Dalianqiao Yinzi (Large Lonicera Decoction) See Question 3.
Chaihu San (Bupleurum Powder) See Question 50.
Fengxin San (Fontanel-Sealing Powder) See Question 32, Sanxin San.
Dihuang Wan (Rehmannia Pill) See Question 8.
Danggui San (Angelica Powder) See Question 59.