巢氏云∶小儿脏腑有热，渴引水浆，致成泄利，久则血气虚弱，不能上充脑髓，
故囟陷如坑，不能平满也。《圣济》用当归散（方见腹痛）地黄丸。（见前）
〔曾〕囟陷者，虚之极也，胃气虚寒则囟陷，慢惊中有之。胃寒脾困吐泻者为虚
极，急以金液丹、固真汤（俱慢惊）及诸救元等药治之，外则贴以乌附膏。有后枕陷者，
其证尤重，治法以囟陷药同，不效，亦为难疗，此大虚极，百无一活耳。
乌附膏 理囟门陷。
绵川乌（生用） 绵附子（生用。各五钱） 雄黄（二钱）
上件为末，用生葱和根叶细切，烂杵，入前药末同煎，空心作成膏，贴陷处。
《圣惠》生干地黄散 治小儿脏腑壅热，气血不荣，致囟陷不平者。
生干地黄（二两） 乌鸡骨（一两，酥涂，炙令黄）
上捣，细罗为末，不计时候，以粥饮调下半钱。
又治小儿囟陷方
上，取猪牙车骨髓，煎如膏。涂囟上良。
又方以狗头骨炙令黄，捣罗为末。以鸡子清调涂。
又方以天灵盖炙令黄，捣罗为末，以生油调涂。
《千金》小儿囟陷，灸脐上下各半寸，及鸠尾骨端，又足太阴、各一壮。
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，自汗出，毛发黄而短
是也。若寒气上冲则牢HT （音昂，履头也，肿，硬如履头突起。）热气上冲即柔软。又，小儿胁下
有积者，咳且啼而气上逆者，啼甚久其气未定，因而乳之者，肝气盛风热上冲者，
皆能令囟填，当一一审其因而治之，寒者温之，热者凉之，气上逆者和而降之，肝
气盛者泻青为主，热证里多，大连翘汤，表多柴胡散，虚者以补中益气汤送下地黄
丸，神而明之，存乎其人，言不尽意。〔曾〕世言囟肿皆以为热，殊不知有阴阳二
证，切宜详辨，坚硬为阴，红软为阳，故《婴孩宝书》云∶寒气上冲则牢HT ，热气
上冲则柔软，正比之谓。若阴证，以匀气散、理中汤主之。阳证用玉露饮、当归
散、防风汤为治。《玉环集》歌曰∶囟门肿起定为风，此候应须也不中，或若加
坑如盏足，七日之间命必终。《石壁经》歌曰∶积聚脾中热不通，致令面赤口唇红，
胸高夜嗽多 胀，休使流传肺有风，喉里作声涎上壅，囟门肿起热来冲，但教凉膈
安灵腑，能使三朝速有功。积有冷热，皆能作肿，冷则粪白，或酸臭气冲人，亦有
虫出，其食物皆不能化，腹胀满而多困，喉中亦鸣也。热则使多渴，其粪赤，面色
亦黄赤，口内臭气，亦虫出。各看其证候调治，且须分水谷去积并调气，冷则温脾
胃，热则去其热，化涎止渴。囟隐则冷也，肿则热也。积热囟虚肿，宜将时气门
中三十六种除湿散、浓煎桑白皮汤下。《形证论》云∶肺热生风，涎鸣囟肿，将白
丁香膏一二服，或南星丸一二服，便退。《秘要指迷论方》凡小儿生下一月日内，
或囟门肿，此乃受胎热气，即用黄柏膏涂于足心涌泉穴。如陷，即用半夏膏涂手心，
此乃婴儿肾流受冷气，邪干心，致令病生。（黄柏半夏皆为末皆冷水调贴。）
Chao Yuanfang stated: When there is heat in the internal organs of infants, they feel thirsty and desire to drink water or gruel, leading to diarrhea and dysentery. Over time, Qi and Blood become deficient, failing to ascend and nourish the brain marrow, causing the fontanelle to sink like a pit and fail to be level. *Shengji Zonglu* uses Danggui San (Formula for Abdominal Pain) and Dihuang Wan (see previous section).
Zeng Shi stated: A sunken fontanelle indicates extreme deficiency. Stomach Qi deficiency and cold cause the fontanelle to sink, which can be seen in slow convulsions (Man Jing Feng). Cases involving vomiting and diarrhea due to 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 the posterior occipital region is sunken, the condition is particularly severe. The treatment method is the same as for general fontanelle sinking; if ineffective, it is difficult to treat, representing extreme deficiency where survival is rare.
Wufu Gao treats sunken fontanelles.
Mian Chuanwu (Raw) Mian Fuzi (Raw. Each 5 qian) Xionghuang (2 qian)
Grind the above ingredients into powder. Finely chop raw scallions including roots and leaves, pound them until mushy, add the aforementioned powders, and decoct together. Form into a paste when taken on an empty stomach and apply to the depressed area.
Taiping Shenghui Fang's Shenggan Dihuang San treats infants with stagnant heat in the internal organs and Qi/Blood failing to nourish, resulting in a sunken and uneven fontanelle.
Shenggan Dihuang (2 liang) Wuji Gu (1 liang, coated with butter, roasted until yellow)
Pound the above, sift finely into powder. Take half a qian mixed with rice broth at any time.
Another formula for infant sunken fontanelles:
Take pig mandibular bone marrow, decoct until it resembles a paste. Apply to the fontanelle; this is effective.
Another formula: Roast dog skull bones until yellow, grind and sift into powder. Mix with egg white and apply.
Another formula: Roast Tianlinggai (human vertex bone) until yellow, grind and sift into powder. Mix with raw oil and apply.
Qianjin Fang suggests moxibustion for infant sunken fontanelles: moxa cones applied half a cun above and below the umbilicus, at the end of the Jiuwei bone, and on the Foot Taiyin channel points, one cone each.
Fontanelle filling (Xian Tian) refers to the swelling of the fontanelle. The Spleen governs muscles. Irregular feeding, excessive hunger or fullness, or exposure to cold or heat invading the Spleen, cause dysfunction of the internal organs. Qi rushes upward, causing distension and swelling, making the fontanelle protrude high like piled objects, accompanied by spontaneous sweating, yellow short hair. This is the presentation of fontanelle filling. If Cold Qi rushes upward, the fontanelle becomes hard and elevated ("Lao Hang" - sound ang, referring to the stiff toe-cap of shoes, describing hardness and elevation). If Heat Qi rushes upward, it remains soft. Additionally, infants 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 filling. 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 draining Green (Liver). For interior heat predominance, use Daliaqiao Tang; for exterior predominance, use Chaihu San. For deficiency, send down Dihuang Wan with Buzhong Yiqi Tang. Divine efficacy lies in flexible application; words cannot fully express the intent.
Zeng Shi stated: The world assumes fontanelle swelling is always heat, not knowing there are Yin and Yang syndromes. Careful differentiation is essential. Hardness indicates Yin; redness and softness indicate Yang. Thus, *Yinghan Baoshu* states: "Cold Qi rushing upward causes hardness; Heat Qi rushing upward causes softness," which is precisely correct. For Yin syndromes, use Yunqi San and Lizhong Tang. For Yang syndromes, use Yulu Yin, Danggui San, and Fangfeng Tang. *Yuhuan Ji* verse says: "Swelling of the fontanelle definitely indicates Wind; this condition requires [care], otherwise if it adds a pit like a cup foot, life will end within seven days." *Shibi Jing* verse says: "Accumulation and heat in the Spleen block flow, causing red face and lips, high chest, night coughs, and distension; prevent transmission to Lungs with Wind; sounds in throat and phlegm obstruction; fontanelle swelling rises with heat; only by cooling the Diaphragm and calming the Spirit Organs can rapid merit 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; food is undigested, abdomen is distended and tired, with throat rattling. Heat accumulation causes thirst, red stool, yellow-red complexion, foul breath, and worms. Treat according to symptoms, distinguishing between water/grain accumulation and removing accumulation while regulating Qi. For cold, warm the Spleen and Stomach; for heat, clear the heat, transform phlegm, and stop thirst. Sunken fontanelle indicates cold; swelling indicates heat. For deficiency-swelling due to accumulated heat, use the Thirty-Six Kinds of Chu Shi San from Seasonal Gate, taken with strong decoction of Sangbaipi Tang. *Xingzheng Lun* states: Lung heat generating Wind, phlegm rattling and fontanelle swelling; take Bai Dingxiang Gao one or two doses, or Nanting Wan one or two doses, and it will subside. *Mi Yao Zhimi Lun Fang* records: Within one month of birth, if the fontanelle swells, this is due to heat received during conception; apply Huangbai Gao to Yongquan point on the sole. If sunken, apply Banxia Gao to the palm; this is due to cold qi affecting the Kidney, pathogenic factors interfering with the Heart, causing disease. (Huangbai and Banxia ground to powder, mixed with cold water for application.)