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According to *Wan Quan Fang* (Prescriptions of Wan Quan): Infants may present with Jie Lu syndrome (fontanelle separation), fontanelle non-closure syndrome, or sunken fontanelle syndrome. These three conditions are largely similar but have minor differences.

Jie Lu refers to a condition where, as an infant grows older, the fontanelle fails to close when it should, resulting in the splitting open of the cranial sutures. The Kidney governs bone marrow, and the brain is the sea of marrow. If Kidney Qi is insufficient, the sea of marrow becomes deficient, leading to the opening of the bony sutures. Regarding fontanelle non-closure and sunken fontanelle, although they are caused by heat in the Zang-Fu organs rising upward, causing the fontanelle to either remain open or sink, the root cause lies in the insufficiency of Kidney Qi. [Xue Ji] stated: The Kidney governs bones; when bone Qi is substantial, brain marrow is abundant, and the fontanelle closes early; when bone vessels are vigorous, teeth erupt early. If Kidney Qi is weak, brain marrow is deficient, and the fontanelle does not close. This results from insufficient essence and blood of the parents. It is appropriate to use Di Huang Wan (Rehmannia Pill) for tonification. If the infant is still breastfeeding, the mother should also be treated concurrently. Additionally, the head should be tightly bound with soft cloth to facilitate closure. These cases are generally due to deficiency fire rushing upward, so regulating and tonifying the Spleen and Kidney is the best approach. Fontanelle filling (bulging fontanelle) and fontanelle depression are also caused by congenital insufficiency of Kidney Qi and improper feeding, which damages the Spleen and Stomach. The Spleen governs muscles; when Qi rebels and rushes upward, it causes bulging; when Yuan Qi sinks, it causes depression. Both conditions can be treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Di Huang Wan. Furthermore, dog skull bone can be roasted until yellow, ground into powder, mixed with egg white, and applied to the fontanelle. In cases of diarrhea leading to Qi and Blood deficiency, where the Spleen and Stomach cannot nourish upwards, the aforementioned methods are also used. If the hands and feet are cold and there is no improvement after taking the previous decoction with added Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Gui Zhi (Cinnamomi Ramulus, Cinnamon Twig), it indicates severe deficiency-cold. Fuzi (Aconite Lateralis Radix Praeparata, Prepared Aconite Root) must be added urgently; otherwise, delay will likely lead to untreatable outcomes.

[Zhang Huan] pointed out: Infantile Jie Lu, fontanelle non-closure, bulging fontanelle, and sunken/uneven fontanelle are all caused by deficiency-heat in the Kidney meridian. The Feng Xin San (Seal Fontanelle Powder) formula is suitable: She Tui Pi (Snake Slough, 1 liang, burned to ash and finely ground), Fang Feng (Saposhnikoviae Radix, 0.5 liang), Chuan Da Huang (Rhei Radix et Rhizoma, wrapped in wet paper, stir-fried/warmed until character remains, 0.5 liang), and Bai Ji (Bletillae Rhizoma, 0.5 liang). Grind these ingredients into a fine powder, add Qing Dai (Indigo Naturalis, 0.5 liang), and mix thoroughly. Use half a qian of this powder each time, mix evenly with Zhu Dan Shi (Porci Bile, Pig Gallbladder Juice), spread onto a piece of paper, apply to the fontanelle leaving a small white border on all sides, and secure with dilute raw vinegar and wheat paste. Keep moistened with warm water continuously, and change once every fu (approx. two hours).