《万全方》云∶小儿有解颅候,有囟不合候,有囟陷候,此三者大同而小异也。
解颅者,谓小儿年长,囟应合而不合,头颅开解也。肾主骨髓,而脑为髓海,肾气
不成,则髓海不足,故骨缝开解也。其囟不合与囟陷,虽因脏腑有热,热气上冲,
致囟或不合或陷,然亦本于肾气不足也。〔薛〕肾主骨,骨气实则脑髓充而囟早合,
骨脉盛而齿早生,肾气怯则脑髓虚而囟不合,此由父母精血不足,宜用地黄丸补之,
若在乳下,当兼补其母,更以软帛紧束其首,使其易合,皆虚火上冲,当调补脾肾
为善。囟填、囟陷,亦因所禀肾气不足,及乳哺失宜,脾胃亏损所致,夫脾主肌肉,
气逆上冲而为填胀,元气下陷而为囟陷也,并用补中益气汤、地黄丸,及用狗头骨
炙黄为末,以鸡子清调敷囟门。亦有泻利气血虚,脾胃不能上充者,亦用前法。若
手足并冷,前汤加姜桂未应,虚寒甚也,急加附子,缓则多致不救。
〔张涣〕婴儿解颅、囟不合、囟填、囟陷下不平,皆由肾经虚热。宜用封囟散方
蛇蜕皮(一两,烧灰,细研) 防风 川大黄(湿纸裹,炒煨,存性) 白芨(各半两)
上件,碾为细末,入青黛半两,同研匀。每用半钱,以 猪胆汁调匀,用一纸
囟子摊之,四边回合各留少白纸,用淡生醋、面糊贴囟上。不住以温水润动,一
伏时换。
《万全方》记载:小儿有解颅证候,有囟门不合证候,有囟门凹陷证候,这三者大体相同而细节略有差异。
所谓解颅,是指小儿年龄增长后,囟门本应闭合却未闭合,头颅骨缝裂开。肾主司骨髓,而脑为髓之海,若肾气不充盛,则髓海不足,因此导致骨缝裂开。至于囟门不合与囟门凹陷,虽然是因为脏腑有热,热气上冲,致使囟门或不开合或凹陷,但根本原因仍在于肾气不足。〔薛己〕认为肾主骨,骨气充实则脑髓充盈而囟门早闭,骨脉旺盛则牙齿早生;肾气虚弱则脑髓空虚而囟门不合,这多由父母精血不足所致,适宜用地黄丸(六味地黄丸)进行补益。若患儿尚在哺乳期,应当同时补益其母亲,并用柔软的布带紧紧束住头部,使其容易闭合。这些情况都属于虚火上冲,调理补益脾肾最为妥当。囟填(囟门隆起)、囟陷(囟门凹陷),也是由于先天禀赋肾气不足,以及哺乳喂养不当,导致脾胃亏损所致。脾主肌肉,气逆上冲则表现为囟门填胀,元气下陷则表现为囟门凹陷。这两种情况均可使用补中益气汤、地黄丸,并将狗头骨炙烤至黄后研成粉末,用鸡蛋清调和敷于囟门处。也有因腹泻导致气血虚弱,脾胃不能上充滋养的,也采用上述方法。如果手足冰冷,服用前述汤药无效,说明虚寒严重,需紧急加入附子,若拖延则大多难以救治。
〔张涣〕指出,婴儿出现解颅、囟门不合、囟门填胀、囟门凹陷不平,都是由肾经虚热引起。适宜使用封囟散方剂:蛇蜕皮(一两,烧成灰,细细研磨),防风,川大黄(用湿纸包裹,炒煨至保留药性),白芨(各半两)。以上药材,碾磨成细末,加入青黛半两,一同研磨均匀。每次取半钱,用猪胆汁调匀,摊在一层纸上,四周留少许白纸边,用淡的生醋和面糊贴在囟门上。不断用温水润湿保持药效,一个时辰(约两小时)更换一次。
The *Wanquan Fang* (Ten Thousand Complete Prescriptions) states: Infants may present with the syndrome of Jie Lu (splayed cranial sutures), the syndrome of fontanelle non-closure, and the syndrome of fontanelle depression. These three conditions are largely similar but differ slightly in specifics.
Jie Lu refers to a condition where, as the 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 will be deficient, thereby causing the cranial sutures to split open. Regarding fontanelle non-closure and fontanelle depression, although they arise from heat in the Zang-Fu organs with hot qi rushing upward—leading to either non-closure or depression—the root cause remains an insufficiency of Kidney Qi. [Xue Ji] stated that the Kidney governs bones; when bone Qi is substantial, brain marrow is abundant and the fontanelle closes early, while robust bone meridians lead to early tooth eruption. Conversely, if Kidney Qi is timid/weak, brain marrow becomes deficient and the fontanelle fails to close. This is often due to insufficiency of the parents' essence and blood, and it is appropriate to tonify using Dihuang Wan (Rehmannia Pill). If the child is still nursing, the mother should also be tonified concurrently. Additionally, the head should be tightly bound with soft cloth to facilitate closure. All these scenarios involve defluxion of deficiency fire, making the regulation and tonification of the Spleen and Kidney the best approach. Fontanelle filling (protrusion) and fontanelle depression also result from congenital insufficiency of Kidney Qi and improper feeding practices leading to Spleen-Stomach damage. The Spleen governs muscles; when Qi rebels and rushes upward, it causes filling and distension; when Yuan Qi sinks downward, it causes depression. Both conditions can be treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Dihuang Wan, along with applying powder made from roasted dog skull bone mixed with egg white to the fontanelle. In cases where diarrhea leads to Qi and Blood deficiency, preventing the Spleen-Stomach from nourishing upwards, the aforementioned methods are also applicable. If the hands and feet are cold and the previous decoctions fail to produce results, indicating severe deficiency-cold, Fuzi (Aconite Root) must be added urgently; otherwise, delay will likely lead to untreatable outcomes.
[Zhang Huan] noted that infantile Jie Lu, fontanelle non-closure, fontanelle filling, and uneven fontanelle depression are all caused by deficiency-heat in the Kidney meridian. It is appropriate to use the Fengxin San (Fontanelle Sealing Powder): Shed snake skin (1 liang, burned to ash, finely ground), Fangfeng (Saposhnikovia Root), Chuan Dahuang (Rhubarb Root wrapped in wet paper, stir-fried and baked to retain its properties), Baiji (Bletilla Rhizome) (each 0.5 liang). Grind the above ingredients into a fine powder, add Qingdai (Indigo Naturalis, 0.5 liang), and mix thoroughly. Use half a qian each time, blend with pig bile, spread onto a piece of paper, leaving a small white border on all sides. Apply to the fontanelle using dilute raw vinegar and wheat paste. Keep moistening with warm water continuously, and change once every fu period (approximately two hours).