经曰∶头痛耳鸣，九窍不利，肠胃之所生也。陈飞霞曰∶小儿头囟之证，多有由脾胃而得。又头为六阳所会，
七窍居焉，故小儿之头，四时宜凉。但见头热即有病生，宜预防之。
解颅者，谓头缝开解，而颅不合也。是由禀气不足，先天肾元大亏。肾主脑髓，肾亏则脑髓不足，故颅为之
开解。然人无脑髓，犹树无根，不过千日，则成废人。其候多愁少喜，目白睛多，面 白色。若成于病后者尤凶。
宜久服地黄丸，外用封囟法，囟肿者，囟门肿起也。脾主肌肉，若哺乳不常，饱饥无度，或寒、或热，乘于脾家，
致使脏腑不调，其气上冲，为之 胀。囟突而高，如物堆垛，毛发短黄，骨蒸自汗。然亦有寒气上冲而肿者，则牢
蕲坚硬；热气冲上而肿者，则柔软红色。然寒肿十之一，热肿者十之九。更有包裹严密，盖复过浓，阳气不得外
出，亦令赤肿。皆用封囟法。热肿者，泻青丸；寒肿者，参苏饮。
囟陷者，有因泄泻久而气虚弱，不能上充脑髓，故下陷如
坑。此乃胃虚脾弱之极，宜急扶元气。若与枕骨同陷者，百无一救。此中有禀受父精不足，母血虚羸而陷者，
有因久病而陷者，然枕陷尤甚于囟陷。二者皆因肾气败绝之证也。俱参苓白术散，或八味地黄丸。天柱骨倒，
小儿外视体肥容壮，不为瘦悴。孰知形体过肥，中气愈弱，是盛于外而歉于内也。忽然项软倾倒者，此肝经风
热也。小柴胡加葛根、当归、白芍。有因于久病之后，或泄泻日久，忽然颈项倾侧，名天柱骨倒，最为危候。
速救真元，十全大补汤加鹿茸。
有小儿生下颈便软者，胎气不足也，由禀父之肾元虚败，峻补先天，其几庶矣。补肾地黄丸与六君子汤间
服。天柱骨例之证，虽则三条总系真阳大败之候，为小儿之恶症。宜保救真元，是其大要，外以生筋等药贴之
可也。
六味地黄汤（见前哮喘方内）
封囟法
天南星不拘多少，以姜汁炒枯，研细末，醋调涂于绢帛上，烘热贴囟上，以合为度。
泻青丸
羌活 川芎 栀子仁 龙胆草 当归 防风 大黄
上共为细末，炼蜜为丸，青黛为衣，黄豆大，清茶化下，酌量服用。
参苏饮 见前咳嗽方内
参苓白术散（见前疳症方内）
八味地黄汤（见前肿满方内）
小柴胡汤（见前咳嗽方内）
十全大补汤
熟地（三钱） 当归（一钱） 白芍（一钱） 川芎（七分） 党参（一钱） 白术（一钱） 茯苓（一钱）
甘草（一钱） 肉桂（五分） 黄 （一钱）
补肾地黄汤
熟地（二钱） 山药（二钱） 萸肉（一钱） 鹿茸（三分） 丹皮（一钱） 牛膝（一钱） 茯苓（一钱）
泽泻（一钱） 补骨脂（一钱） 五味子（一钱）
上为末，蜜丸，绿豆大，每服三钱，盐汤下。
六君子汤（见前咳嗽方内）
生筋散 治筋软无力，天柱骨倒。
木鳖子（六个） 蓖麻子（六十个，去壳净。）
以药研如泥，先抱头起，以手摩其颈令热，津唾调药，涂颈项。
又方 治项软。
生附子（二钱，去皮） 生南星（三钱，去皮）
共研末，摊贴患处。
The *Neijing* states: Headache, tinnitus, and dysfunction of the nine orifices (the seven sensory orifices plus the two excretory openings) arise from disorders of the stomach and intestines. Chen Feixia stated: Disorders of the fontanelle in infants often originate from spleen and stomach issues. Furthermore, the head is the convergence point of the six yang meridians, where the seven orifices reside; therefore, an infant's head should be kept cool throughout the four seasons. The appearance of heat in the head indicates the presence of pathogenic factors, necessitating preventive measures.
Jiechu (Splitting of the Cranial Sutures), referring to the separation of cranial sutures with failure of the skull to close, results from congenital insufficiency and severe depletion of the Kidney Yuan (Kidney Primordial Qi). The Kidneys govern brain marrow; when the Kidneys are deficient, brain marrow becomes insufficient, causing the cranial sutures to split. Without brain marrow, a person is like a tree without roots; within a thousand days, they will become incapacitated. Symptoms include melancholy with little joy, prominent whites of the eyes, and a pale complexion. If this condition arises after an illness, it is particularly ominous.
Long-term administration of Dihuang Wan (Rehmannia Pill) is indicated, combined with external application of the Fontanel Sealing Method. Xion Zhong (Fontanel Swelling), characterized by swelling of the anterior fontanelle, occurs because the Spleen governs muscles. Irregular breastfeeding, unregulated hunger and fullness, or invasion of cold or heat pathogens into the Spleen can cause disharmony of the zang-fu organs. This leads to rebellious qi rushing upward, resulting in swelling. The fontanel protrudes high, resembling a pile of objects, accompanied by short, yellowish hair, bone-steaming tidal fever, and spontaneous sweating. However, swelling caused by cold qi rushing upward presents as firm and hard, whereas swelling from heat qi presents as soft and red. Cold-type swelling accounts for one-tenth of cases, while heat-type swelling accounts for nine-tenths. Additionally, overly tight wrapping or excessive covering may trap yang qi, preventing its dispersion and also causing redness and swelling. All these conditions are treated with the Fontanel Sealing Method. For heat-type swelling, Xieqing Wan (Drain the Green Pill) is used; for cold-type swelling, Shensu Yin (Ginseng and Perilla Decoction) is used.
Xion Xian (Fontanel Depression) may result from prolonged diarrhea leading to qi deficiency, failing to nourish the brain marrow upwards, causing depression into a pit-like shape. This represents extreme deficiency of the Stomach and weakness of the Spleen, requiring urgent support of primordial qi. If both the fontanel and the occiput are depressed, there is virtually no hope of recovery. Some cases stem from insufficient paternal essence and maternal blood deficiency, while others result from chronic illness. Depression of the occiput is more severe than that of the fontanel. Both scenarios indicate the exhaustion of Kidney qi. Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) or Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) should be administered.
Tian Zhu Gu Dao (Collapse of the Heavenly Pillar Bone), referring to neck weakness and head tilting, may present in infants who appear robust and fleshy externally, not emaciated. However, excessive corpulence indicates weakened middle qi (Spleen-Stomach qi); this is strength on the outside but deficiency on the inside. Sudden neck weakness and head tilting indicate wind-heat in the Liver meridian. Xiaochaihu Tang (Minor Bupleurum Decoction) is prescribed with added Gegen (Kudzu Root), Danggui (Angelica Sinensis), and Baishao (White Peony Root). In cases following chronic illness or prolonged diarrhea, sudden neck tilting is named Tian Zhu Gu Dao, representing a critical prognosis. Immediate rescue of true yuan (true primordial qi) is required using Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with added Lurong (Deer Antler Velvet).
Infants born with weak necks suffer from insufficient fetal qi due to depleted paternal Kidney Yuan. Vigorous tonification of congenital qi offers a chance of cure. Bushen Dihuang Wan (Kidney-Nourishing Rehmannia Pill) and Liujunzi Tang (Six-Gentlemen Decoction) should be taken alternately. Regarding cases of Tian Zhu Gu Dao, although the three types described above all represent severe failure of true yang and are considered malignant pediatric conditions, the primary principle of treatment is preserving and rescuing true yuan. Externally, Shengjin San (Sinew-Generating Powder) or similar preparations may be applied.
Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) (See Asthma Formula previously mentioned)
Fontanel Sealing Method
Tiannanxing (Arisaema Rhizome), quantity unspecified, is stir-fried with ginger juice until charred, ground into fine powder, mixed with vinegar, applied to silk fabric, warmed, and placed over the fontanel until closure is achieved.
Xieqing Wan (Drain the Green Pill)
Qianghuo (Notopterygium Rhizome), Chuanxiong (Ligusticum Rhizome), Zhizi Ren (Gardeniae Semen), Longdancao (Gentianae Radix), Danggui (Angelicae Sinensis Radix), Fangfeng (Saposhnikoviae Radix), Dahuang (Rhei Radix et Rhizoma).
Grind all ingredients into fine powder, mix with refined honey to form pills, coat with Qingdai (Indigo Naturalis), size of soybeans. Take with clear tea, dosage adjusted according to circumstances.
Shensu Yin (Ginseng and Perilla Decoction) (See Cough Formula previously mentioned)
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) (See Gan Syndrome Formula previously mentioned)
Bawei Dihuang Tang (Eight-Ingredient Rehmannia Decoction) (See Edema and Fullness Formula previously mentioned)
Xiaochaihu Tang (Minor Bupleurum Decoction) (See Cough Formula previously mentioned)
Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction)
Shudi (Prepared Rehmannia Root) (3 qian), Danggui (Angelica Sinensis Root) (1 qian), Baishao (White Peony Root) (1 qian), Chuanxiong (Ligusticum Rhizome) (0.7 qian), Dangshen (Codonopsis Root) (1 qian), Baizhu (Atractylodes Macrocephala Rhizome) (1 qian), Fuling (Poria) (1 qian), Gancao (Licorice Root) (1 qian), Rougui (Cinnamon Bark) (0.5 qian), Huangqi (Astragalus Root) (1 qian).
Bushen Dihuang Tang (Kidney-Nourishing Rehmannia Decoction)
Shudi (Prepared Rehmannia Root) (2 qian), Shanyao (Dioscorea Rhizome) (2 qian), Yurou (Cornus Fruit) (1 qian), Lurong (Deer Antler Velvet) (0.3 qian), Danpi (Moutan Cortex) (1 qian), Niuxi (Achyranthes Root) (1 qian), Fuling (Poria) (1 qian), Zexie (Alisma Rhizome) (1 qian), Buguzhi (Psoralea Fruit) (1 qian), Wuweizi (Schisandra Fruit) (1 qian).
Grind into powder, form pills with honey, size of mung beans. Take 3 qian per dose, washed down with salt water.
Liujunzi Tang (Six-Gentlemen Decoction) (See Cough Formula previously mentioned)
Shengjin San (Sinew-Generating Powder) Treats sinew weakness and Tian Zhu Gu Dao.
Miebiezi (Momordica Seed) (6 pieces), Bamazi (Castor Seed) (60 pieces, shelled and cleaned).
Grind herbs into a paste. Support the infant's head, massage the neck until warm, mix the powder with saliva, and apply to the neck.
Another Prescription for Neck Weakness
Sheng Fuzi (Raw Aconite Lateral Root) (2 qian, peeled), Sheng Tiannanxing (Raw Arisaema Rhizome) (3 qian, peeled).
Grind into powder, spread and apply to the affected area.