(囟不合)
初虞世云∶父精不足，则解颅眼白多。〔钱〕解颅，生下而囟不合，肾气不成
故也，长必少笑，更有目白睛多， 白色瘦者，多愁少喜也，余见肾虚。〔汤〕
解颅者，囟大，头缝不合如开解，故曰解颅，此由肾气不成故也。（云云见前总论）凡得此者，
不过千日，其间亦有数岁者，乃废人也。人之无脑髓，如木无根，古人虽有良方，
吾所以不录者，劳而无功也，亦不可束手待毙，宜根据钱氏补肾，万一有可生之理。
（钱氏补肾，如地黄丸加鹿茸之类是。）〔曾〕凡得此候，不及千日之内，间有数岁者，偶因他
疾攻激，遂成废人，若气色精明，能饮食者，多服调元散、补肾地黄丸，旬月内颇见效
者，次第调理，或有可治，若投药后如故，亦难疗矣。〔田〕解颅治法，宜用生地
散。〔丹〕小儿解颅，乃是母气血虚与热多耳，用四君子、四物，有热加酒炒黄连、
生甘草煎服，外以绵束紧，用白蔹末敷之。
钱氏地黄丸（见前并鹤节条）
天南星散 治囟开不合，鼻塞不通，天南星大者，微泡，去皮为细末，米醋涂调绯
帛上，贴囟上，炙手，频熨之，立效。
调元散 主禀受元气不足，颅囟开解，肌肉消瘦，腹大如肿，致语迟行迟，手足如
筒，神色昏慢，齿生迟，服之效。
干山药（去黑皮，五钱） 人参（去芦） 白茯苓（去皮） 茯神（去皮、木） 白术 白芍药 熟地黄（酒
洗） 当归（酒洗） 黄 （蜜水炙。各二钱半） 川芎 甘草（炙。二味各三钱） 石菖蒲（二钱）
上碎。每服二钱，水一盏，姜二片，枣一枚，煎七分，无时温服。如婴儿幼嫩，
与乳母同服。
〔张涣〕玉乳丹 治婴儿头骨应合而不合，头缝开解。
钟乳粉（根据古法制炼者） 柏子仁（别研） 熟干地黄（根据法蒸焙者） 当归（洗，焙干。各半两） 防风（锉） 补
骨脂（净拣，微炒。各一分） 或加黄 、茯苓
上件，除别研者，碾为细末，次入钟乳粉等拌匀，炼蜜和如黍米大。每服十粒，
煎茴香汤下，乳食前。
《婴孺方》狗脑丸 治小儿脑长喜摇头，解颅。
狗脑（一个） 漆（即五加皮） 甘草（炙） 白术 防风 钟乳石 干地黄（各一分） 牛黄（二分）
上，以狗脑丸小豆大。一岁饮下二丸，日再。未知、加之。又云∶儿囟常令暖，冷即病死。
小儿锢囟药
芍药粉
上取黄雌鸡临儿囟上，刺其冠，以血滴囟上，血止，以芍药粉敷之，使血不见，
一日，立瘥。
治小儿解颅虎骨方
虎骨 败龟板 不灰木 乳香（各半两）
上为末，用生猪血于手心内调，涂在头缝开处，以旧绵子包裹七日，第八日
以葱汤水洗去前药，再用此药涂之，经年者已减一分，又歇三日，方再用药涂之。
又服参苓散。
人参 茯苓 白附子（炮） 羌活 甘草（炙） 芍药 白术（水煮。各一分） 犀角屑 京芎
藿香（后三味减半）
上为末。每服半钱，水一盏，用少金银同薄荷三叶，煎至三分，温服，通惊气。
《千金》治小儿囟开不合方
防风（一两半） 柏子仁 白芨（各一两）
上三味，末之，以乳和敷囟上。十日知，二十日愈，日一。
《庄氏家传方》治脑缝不合。
山茵陈（一两） 车前子 百合（各半两）
上为末，用乌牛乳汁调涂脚及脑缝上，用帛子裹头。三日一换，五上必效。
〔王氏〕
封囟散 治囟开不合，头缝开张，囟开崎陷，咳嗽鼻塞。
柏子仁 防风 天南星（各四两）
上为细末，每用一钱，以猪胆汁调匀，稀稠得所，摊在绯绢帛上，看囟子大小
剪贴。一日一换，不得令干，时时以汤润动。
三辛散（三因） 治小儿骨应合而不合，头骨开也，名曰解颅。
细辛 桂心（各半两） 干姜（七钱半）
上为末，以姜汁和敷颅上贴之。儿面赤，即愈。
又方用蛇蜕炒焦为末，用猪颊车中髓调敷顶上，日三四度。曾有人作头巾裹遮护之，
久而自合，亦良法也。
灸法 脐上脐下各五分，各灸三壮，灸疮未发，先合。
（囟门不合）
初虞世说：父亲精气不足，会导致孩子出现解颅、眼白多露的症状。〔钱乙〕解颅，是指婴儿出生后囟门迟迟不闭合，这是由于肾气未能充盛所致。这类孩子长大后往往少言寡笑，且伴有眼白多、面色苍白消瘦的表现，性格多忧愁而少喜悦，其余症状表现与肾虚相同。〔汤〕所谓解颅，是指囟门宽大，头骨缝隙像裂开一样无法合拢，因此称为“解颅”，这也是因为肾气不成所致。（其他内容见前文总论）。凡是患上此病的人，寿命通常不超过一千天，其间也有活到几岁的，但都会成为废人。人如果没有脑髓，就像树木没有根一样。古人虽然有良方，但我之所以不收录，是因为治疗劳而无功。然而也不能束手待毙，应当依据钱乙的方法进行补肾，万一还有生机。〔钱氏补肾，例如地黄丸加鹿茸等药物〕。〔曾〕凡是出现这种证候的，大多在千日之内死亡，间或有活到几岁的，偶尔因其他疾病刺激，最终成为废人。如果患儿气色精明，能够进食，多服用调元散、补肾地黄丸，若在旬月内颇见效验，再依次调理，或许还有治愈的可能；若服药后情况依旧，也难以治疗了。〔田〕治疗小儿解颅的方法，宜使用生地散。〔丹〕小儿解颅，是由于母亲气血虚弱兼有热邪所致。可用四君子汤、四物汤，若有热象加酒炒黄连、生甘草煎服，外用绵布束紧头部，并敷上白蔹粉末。
钱氏地黄丸（见前文及鹤节条）
天南星散 治疗囟门裂开不合，鼻塞不通。取大的天南星，稍微浸泡，去皮研成细末，用米醋调和涂在绯色丝帛上，贴在囟门上，用手加热，频繁熨烫，立即见效。
调元散 主治先天元气不足，颅囟开解，肌肉消瘦，腹部胀大如肿，导致说话迟、行走迟，手足僵硬如筒状，神色昏沉迟钝，牙齿生长迟，服用此药有效。
干山药（去除黑皮，五钱） 人参（去芦头） 白茯苓（去皮） 茯神（去皮、木心） 白术 白芍药 熟地黄（酒洗） 当归（酒洗） 黄芪（蜜水炙。各二钱半） 川芎 甘草（炙。这两味各三钱） 石菖蒲（二钱）
以上药材切碎。每次服用二钱，加水一盏，生姜两片，大枣一枚，煎至七分，随时温服。如果是年幼脆弱的婴儿，可与乳母同服。
〔张涣〕玉乳丹 治疗婴儿头骨应合而不合，头缝开解。
钟乳粉（按照古法炼制者） 柏子仁（单独研磨） 熟干地黄（按法蒸焙者） 当归（洗净，焙干。各半两） 防风（锉碎） 补骨脂（净选，微炒。各一分） 也可加黄芪、茯苓
以上药材，除单独研磨的外，其余碾为细末，然后加入钟乳粉等拌匀，用炼蜜调和如黍米大小。每次服用十粒，煎茴香汤送下，在吃奶吃饭之前。
《婴孺方》狗脑丸 治疗小儿脑部发育异常喜欢摇头，解颅。
狗脑（一个） 漆（即五加皮） 甘草（炙） 白术 防风 钟乳石 干地黄（各一分） 牛黄（二分）
以上药材，制成如小豆大小的丸剂。一岁的儿童饮服两丸，每日两次。若未见效，可增加剂量。又说：婴儿的囟门常令其保暖，受冷则病死。
小儿锢囟药
芍药粉
以上取黄色母鸡，在孩子囟门上方，刺破鸡冠，让血滴在囟门上，血止后，用芍药粉敷在上面，使血液不外露，一天即可痊愈。
治疗小儿解颅虎骨方
虎骨 败龟板 不灰木 乳香（各半两）
以上研为细末，用生猪血在手心中调和，涂抹在头骨裂缝处，用旧棉絮包裹七天，第八日用葱汤水洗去前面的药，再用此药涂抹。患病一年的，病情已减轻一分，又休息三天，才再次用药涂抹。
另外服用参苓散。
人参 茯苓 白附子（炮制） 羌活 甘草（炙） 芍药 白术（水煮。各一分） 犀角屑 京芎 藿香（后三味减半量）
以上研为细末。每次服用半钱，加水一盏，用少量金银同薄荷三叶，煎至三分，温服，以通利惊气。
《千金方》治疗小儿囟门开合不合方
防风（一两半） 柏子仁 白芨（各一两）
以上三味药，研为细末，用乳汁调和敷在囟门上。十天见效，二十天痊愈，每日一次。
《庄氏家传方》治疗脑缝不合。
山茵陈（一两） 车前子 百合（各半两）
以上研为细末，用乌牛乳汁调和涂抹脚底及脑缝上，用布巾包裹头部。三天换一次药，五次必效。
〔王氏〕
封囟散 治疗囟门开合不合，头缝开张，囟门凹陷，咳嗽鼻塞。
柏子仁 防风 天南星（各四两）
以上研为细末，每次用一钱，用猪胆汁调匀，稀稠适度，摊在绯色绢帛上，根据囟门大小剪裁粘贴。一天换一次，不得让其干燥，时时用汤水润湿。
三辛散（出自《三因方》） 治疗小儿骨骼应合而不合，头骨开裂，名为解颅。
细辛 桂心（各半两） 干姜（七钱半）
以上研为细末，用姜汁调和敷在颅门上贴之。如果孩子面红，即表示痊愈。
另一方法是用蛇蜕炒焦研末，用猪脸颊骨中的骨髓调和敷在头顶，每天三四次。曾经有人用头巾包裹遮挡保护，久而久之自然愈合，也是好方法。
灸法 脐上、脐下各五分处，各灸三壮，灸疮未发作时，囟门先合拢。
(Sutures of the fontanelle not closing)
Chu Yushi stated: If the father's essence and qi are insufficient, it will lead to the child suffering from *jie lu* (splayed skull) with excessive exposure of the whites of the eyes. [Qian Yi] *Jie lu* refers to the condition where the fontanelle fails to close after birth; this is due to the failure of Kidney Qi to mature. Such children will likely be taciturn in adulthood, accompanied by excessive whites of the eyes, pale and emaciated complexion, and a disposition that is melancholic rather than joyful. Other symptoms align with Kidney Deficiency. [Tang] The term *jie lu* describes a large fontanelle where the cranial sutures remain open as if split apart, hence the name, which is also caused by immature Kidney Qi. (See general discussion for other details). Those who contract this disease typically do not survive beyond one thousand days; some may live for several years but become disabled. A person without brain marrow is like a tree without roots. Although ancients had effective prescriptions, I have chosen not to record them because treatment is laborious yet often ineffective. However, one should not resign oneself to death; instead, one should follow Qian's method of tonifying the Kidneys, hoping for a chance of survival. [Qian's method of tonifying the Kidneys includes formulas such as Dihuang Wan added with Deer Antler.] [Zeng] For those presenting this syndrome, death usually occurs within a thousand days, though some may survive for years. Occasionally, stimulation from other illnesses leads to disability. If the patient has a bright complexion and can eat, frequent administration of *Tianyuan San* and *Bushen Dihuang Wan*, followed by sequential regulation if improvement is seen within ten days or a month, may offer a cure. If there is no change after medication, treatment is difficult. [Tian] The treatment for pediatric *jie lu* should utilize *Shengdi San*. [Dan] Pediatric *jie lu* results from the mother's deficiency of Blood and Qi combined with excess Heat. Use *Sijunzi Tang* (Four Gentlemen Decoction) and *Siwu Tang* (Four Substances Decoction); if Heat is present, add wine-fried Huanglian (Coptis Rhizome) and raw Gancao (Licorice Root), decocted and taken orally. Externally, bind the head tightly with cotton and apply powder of Baijian (Ampelopsis Radix).
Qian Shi Dihuang Wan (See previous sections and Hejie entry)
Tiannanxing San treats an open fontanelle that does not close, along with nasal congestion. Take large Tiannanxing (Arisaematis Rhizoma), soak briefly, remove the skin, and grind into a fine powder. Mix with rice vinegar, spread on crimson silk, apply to the fontanelle, warm with hands, and frequently moxa/iron over it for immediate effect.
Tianyuan San governs congenital insufficiency of Yuan Qi, resulting in open cranial sutures, emaciation, abdominal distension resembling swelling, delayed speech and walking, stiff limbs like tubes, dull expression, and delayed dentition. It is effective when taken.
Dried Shanyao (remove black skin, 5 qian) Renshen (remove rhizome) Baifuling (remove skin) Fushen (remove skin and wood core) Baizhu Baishao Shudihuang (wash with wine) Danggui (wash with wine) Huangqi (honey-roasted. Each 2.5 qian) Chuanxiong Gancao (roasted. These two each 3 qian) Shichangpu (2 qian)
Crush the ingredients. Take 2 qian per dose, add one cup of water, two slices of ginger, and one jujube. Decoct to 70% volume. Take warm at any time. For fragile infants, administer together with the nursing mother.
[Zhang Huan] Yuru Dan treats infants whose cranial bones fail to fuse and sutures remain open.
Zhongru Fen (refined according to ancient methods) Baiziren (separately ground) Shugan Dihuang (steamed and baked according to method) Danggui (washed, dried. Each half liang) Fangfeng (chopped) Buguzhi (cleaned, lightly fried. Each 1 fen) Alternatively, add Huangqi and Fuling.
Grind all ingredients except separately ground ones into fine powder. Add Zhongru Fen and mix well. Blend with refined honey to form pills the size of millet seeds. Take 10 pills per dose, washed down with fennel decoction, before milk or food intake.
*Yinglu Fang* Gounao Wan treats infants with abnormal brain development causing head shaking and *jie lu*.
Gounao (one dog brain) Qi (i.e., Wujia Pi/Acanthopanacis Cortex) Gancao (roasted) Baizhu Fangfeng Zhongrushí Gandidihuang (Each 1 fen) Niuhuang (2 fen)
Process into pills the size of adzuki beans. Infants aged one year take two pills with drink, twice daily. If ineffective, increase dosage. It is also said: Keep the infant's fontanelle warm; cold exposure leads to death.
Pediatric Fontanelle Sealing Medicine
Shaoyao Fen
Take a yellow hen, place it above the infant's fontanelle, prick the comb, and let blood drip onto the fontanelle. Once bleeding stops, apply Shaoyao Fen to cover the blood. Cure achieved in one day.
Hu Gu Fang for treating pediatric *jie lu*
Hu Gu (Tiger Bone) Baiguiban (Old Turtle Shell) Buhui Mu Rushxiang (Each half liang)
Grind into powder. Mix with fresh pig blood in the palm, apply to the open cranial suture. Wrap with old cotton for seven days. On the eighth day, wash off the previous medicine with scallion water, then reapply this medicine. For cases lasting a year, the condition reduces by one part. Rest for three days, then reapply.
Additionally, take Shenling San.
Renshen Fuling Baifuzi (processed) Qianghuo Gancao (roasted) Shaoyao Baizhu (water-boiled. Each 1 fen) Xijiao Jiejing Xiong Huoxiang (The last three ingredients halved)
Grind into powder. Take half qian per dose, add one cup of water, a small amount of gold/silver foil, and three mint leaves. Decoct to 30% volume. Take warm to dispel wind-phlegm and calm fright.
*Qianjin Fang* formula for treating unclosed infant fontanelles
Fangfeng (1.5 liang) Baiziren Baiji (Each 1 liang)
Grind these three ingredients into powder. Mix with milk and apply to the fontanelle. Effective in ten days, cured in twenty days. Apply once daily.
*Zhuang Family Prescribed Formula* for unclosed cranial sutures.
Shanyinchen (1 liang) Cheqianzi Baihe (Each half liang)
Grind into powder. Mix with black ox milk and apply to the soles of the feet and cranial sutures. Wrap the head with cloth. Change dressing every three days. Five applications guarantee efficacy.
[Wang Shi]
Fengxin San treats unclosed fontanelle, open cranial sutures, depressed fontanelle, cough, and nasal congestion.
Baiziren Fangfeng Tiannanxing (Each 4 liang)
Grind into fine powder. Use 1 qian per application. Mix with pig bile to appropriate consistency. Spread on crimson silk and cut to fit the fontanelle size. Change once daily. Do not let it dry; moisten with broth occasionally.
San Xin San (from *Sanyin Fang*) treats pediatric skeletal immaturity where bones fail to fuse, resulting in open cranial bones, named *jie lu*.
Xixin Guixin (Each half liang) Ganjiang (7.5 qian)
Grind into powder. Mix with ginger juice and apply to the skull. Cured when the child's face turns red.
Another method: Char snake slough until black, grind to powder. Mix with marrow from the pig's cheekbone and apply to the vertex. Apply three to four times daily. Someone previously used a cap to protect the area, leading to natural closure over time, which is also a good method.
Moxibustion Method: Moxa three cones at five fen above the navel and three cones at five fen below the navel. The fontanelle closes before the moxa sore develops.