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Chao Yuanfang stated: When a child's internal organs have heat, causing thirst and desire to drink water or gruel, leading to diarrhea and dysentery, prolonged illness results in deficiency of Qi and Blood. Unable to ascend and nourish the brain marrow, the fontanelle becomes depressed like a pit and cannot be flat. *Shengji Zonglu* (General Records of Sage Benevolence) uses Danggui San (Formula for Abdominal Pain) and Dihuang Wan (see previous text).

Zeng Shi stated: Depression of the fontanelle indicates extreme deficiency. Deficiency-cold of the Stomach Qi causes depression of the fontanelle, which can be seen in slow convulsions. Vomiting and diarrhea caused by Stomach cold and Spleen stagnation represent extreme deficiency; one should immediately treat with Jin Ye Dan, Guzhen Tang (both for slow convulsions), and other Yuan-rescuing medicines, applying Wufu Gao externally. If there is depression at the back of the head, the condition is particularly severe. The treatment method is the same as for general fontanelle depression; if ineffective, it is difficult to treat, indicating extreme Great Deficiency, where fewer than one in a hundred survives.

Wufu Gao (Aconite and Cinnamon Paste): Treats depressed fontanelle.
Mian Chuanwu (Raw Rhizoma Aconiti Carmichaeliani) [5 qian], Mian Fuzi (Raw Radix Aconiti Lateralis Preparata) [5 qian], Xionghuang (Realgar) [2 qian].
Grind the above into powder. Finely chop raw scallions including roots and leaves, pound them until mushy, add the aforementioned powders, and decoct together. Apply as a paste to the depressed area on an empty stomach.

Taiping Shenghui Fang (Holy惠民 Formulas from the Taiping Era): Shenggandihuang San (Raw Dried Rehmannia Powder) treats children whose internal organs are obstructed with heat, and Qi and Blood fail to nourish, resulting in an uneven, depressed fontanelle.
Shenggandihuang (Raw Dried Rehmanniae Radix) [2 liang], Wuji Gu (Bone of Black-bone Chicken) [1 liang, coated with butter and roasted until yellow].
Pound the above, sift finely through a fine sieve. Take half a qian mixed with rice broth at any time.

Another formula for treating depressed fontanelle in children:
Take the bone marrow from the jaw of a pig, decoct until it resembles a paste. Apply to the fontanelle; this is effective.

Another formula: Roast a dog’s skull until yellow, pound and sift into powder. Mix with egg white and apply.

Another formula: Roast Tianlinggai (Human Vertex Bone) until yellow, pound and sift into powder. Mix with raw sesame oil and apply.

Qianjin Fang (Formulas Worth a Thousand Gold): For depressed fontanelle in children, moxa points half a cun above and below the navel, the end of the Jiuwei bone, and points on the Foot-Taiyin Meridian, one moxa cone each.

Fontanelle bulging (Xitian) refers to the swelling of the fontanelle. The Spleen governs muscles. Irregular feeding, excessive hunger or fullness, or invasion by cold or heat pathogens affecting the Spleen, cause disharmony of the internal organs. Qi rushes upward, causing distension and bulging, making the fontanelle protrude high like piled objects, accompanied by spontaneous sweating, yellow and short hair. This is the presentation of fontanelle bulging. If Cold Qi rushes upward, the fontanelle becomes hard and elevated ("Laoting" sounds like 'ang', referring to the toe-cap of a shoe, describing swelling that is hard and protrudes like a shoe-toe); if Hot Qi rushes upward, it remains soft. Additionally, children with accumulations under the ribs who cough and cry with rebellious Qi, those fed while still crying heavily with unsettled Qi, and those with flourishing Liver Qi and ascending Wind-Heat, can all cause fontanelle bulging. One must carefully examine the cause and treat accordingly. Treat cold with warming methods, heat with cooling methods, rebellious Qi with descending and harmonizing methods, and flourishing Liver Qi primarily with purging Green (Liver). For interior Heat predominance, use Dalianqiao Tang; for exterior predominance, use Chaihu San; for deficiency, use Buzhong Yiqi Tang to deliver Dihuang Wan. Divine efficacy lies in flexible application; words cannot fully express the intent.

Zeng Shi stated: The world believes fontanelle swelling is always due to Heat, not knowing there are two types: Yin and Yang. Careful differentiation is essential. Hardness indicates Yin; redness and softness indicate Yang. Thus, *Yinghan Baoshu* (Treasure Book for Infants) states: "Cold Qi rushing upward causes hardness; Hot Qi rushing upward causes softness," which is exactly correct. For Yin syndromes, use Yunqi San and Lizhong Tang. For Yang syndromes, use Yulu Yin, Danggui San, and Fangfeng Tang. The song in *Yuhuan Ji* says: "Swelling of the fontanelle definitely indicates Wind; this condition requires careful handling. If it adds a pit like a cup foot, life will end within seven days." The song in *Shibi Jing* says: "Accumulation and Heat in the Spleen block flow, causing red face and lips, high chest, night cough, and distension. Do not let it spread to the Lungs with Wind. Sound in the throat and phlegm obstruction upward, fontanelle swelling rises with Heat. Only cool the Diaphragm and calm the Spirit Organs, and success can be achieved in three days." Accumulations, whether cold or hot, can cause swelling. Cold accumulation leads to white stool, possibly sour/foul odor, or worms, undigested food, abdominal distension, fatigue, and throat rales. Hot accumulation leads to excessive thirst, red stool, yellow-red complexion, foul breath, and worms. Treat according to symptoms, distinguishing between water/grain accumulation and regulating Qi. For cold, warm the Spleen and Stomach; for heat, clear the heat, resolve phlegm, and stop thirst. Fontanelle depression indicates cold; swelling indicates heat. For bulging due to accumulated Heat and deficiency, use the Thirty-Six Kinds of Shichu San from the Seasonal Qi Gate, taken with strongly decocted Sangbaipi Tang. *Xingzheng Lun* states: Lung Heat generating Wind, phlegm rattling, and swollen fontanelle can be resolved with one or two doses of Baixiang Ding Gao or Nanting Wan. *Mi Yao Zhimi Lun Fang* states: Within one month after birth, if the fontanelle swells, this is due to Heat received during conception; apply Huangbai Gao to the Yongquan point on the sole. If depressed, apply Banxia Gao to the palm; this is due to Cold Qi affecting the Kidney in infants, pathogenic factors interfering with the Heart, causing disease. (Huangbai and Banxia are both ground into powder and applied with cold water.)