[Background Information]
Book: *Youyou Xinshu* (New Book for Infants and Children)
Author: Liu Fang
Dynasty: Song Dynasty
Chapter: Volume 6 / Jie Lu (Split Skull) Part 1
Category: Comprehensive

(Disorders Inherited from Conception) Total of Nineteen Sections

**On the Syndrome of "Jie Lu" in Children from *Chao Shi Bing Yuan*:**
The term "Jie Lu" refers to a condition where, as the child grows older, the fontanelle should have closed but remains open, and the cranial sutures are split. This is caused by the insufficiency of Kidney Qi. The Kidneys govern the bone marrow, and the brain is the sea of marrow. When Kidney Qi is insufficient, the marrow and brain are deficient and cannot consolidate into bone, resulting in the splitting of the cranial sutures.

**From *Ying Tong Bao Jian*:**
If children are injured by external wind pathogens affecting the fu organs, it leads to the separation of cranial bones and an unclosed fontanelle.

**On Formulas for Pediatric Head Diseases from *Da Wan Quan Fang*:**
Children may present with the syndrome of "Jie Lu," the syndrome of an unclosed fontanelle, or the syndrome of a depressed fontanelle. These three conditions are largely similar with minor differences. "Jie Lu" refers to the splitting of cranial sutures in older children. Since the Kidneys govern the bones, the failure of bones to close and the splitting of head sutures is due to insufficient Kidney Qi. Although the unclosed or depressed fontanelle is caused by heat in the zang-fu organs rising upward, the root cause remains insufficient Kidney Qi.

**Song on Syndromes of Bone-Qi Injury in Children from *Yu Jue*:**
Jie Lu and crane-knee deformity indicate wind pathogen injury to the fu organs; swollen fontanelle results from fright attacking the Stomach Qi. Slurred speech and delayed walking stem from rushed fetal qi; convulsed tendons and staring eyes signify Liver Wind.
This condition should first be treated by dispelling wind and phlegm from the diaphragm. Subsequently, harmonizing the zang-fu organs will ensure no error in treatment.

**Treatment for Pediatric Jie Lu from *Ge Shi Zhou Hou Fang*:**
Mix crab claw bone and Bai Lian (*Ampelopsis japonica*) in equal parts, grind into fine powder, mix with milk, and apply topically. Reapply when dry.

**Formula for Pediatric Jie Lu from *Qian Jin*:**
Roast snake skin, grind into powder, mix with marrow from the pig's jawbone, and apply to the vertex. Apply three to four times daily.

**Another Formula from *Qian Jin*:**
Apply marrow from the pig's jawbone to the fontanelle until healed.

**Banxia Ironing Method for Pediatric Brain Development Abnormalities, Jie Lu, Emaciation, Yellowish Complexion, and Inability to Walk at Four or Five Years Old from *Qian Jin*:**
Ban Xia (*Pinelliae Rhizoma*, washed seven times in hot water), Sheng Jiang (*Zingiberis Rhizoma Recens*), Xiong Diao (*Ligusticum striatum*), Xi Xin (*Asari Radix et Rhizoma*, 3 liang), Gui Xin (*Cinnamomi Ramulus*), Wu Tou (*Aconiti Radix*, ten pieces, peeled and navel removed).
Chop the above six herbs, soak in five sheng of strong vinegar. Boil three times, strain to remove dregs. Soak a piece of cotton in the medicinal liquid, adjust to a suitable temperature, and iron the fontanelle. Reheat when cool and repeat. Iron three to four times morning and evening until finished; cure within twenty days. (*Ying Ru Fang* contains only five herbs, without Sheng Jiang, and does not use vinegar.)

**Sanwu Xi Xin Powder for Pediatric Jie Lu from *Qian Jin*:**
Xi Xin (*Asari Radix et Rhizoma*), Gui Xin (*Cinnamomi Ramulus*, half liang each), Gan Jiang (*Zingiberis Rhizoma*, roasted, 18 zhu).
Grind into powder. Mix with milk and apply to the skull. Reapply when dry. The child's face turning red indicates healing.

**Treatment for Unclosed Fontanelle in Children from *Jian Yao Ji Zhong Fang*:**
Burn donkey hooves to ash regardless of quantity, grind finely, mix with raw oil, and apply to the cranial sutures. Continue until healed.

**Zhongru Pill for Large Fontanelle, Persistent Fever, Head Sweating, Abdominal Distension, Cough, Dyspnea, Leg Stiffness, Crossed Feet, and Inability to Walk at Three Years Old from *Sheng Hui Fang*:**
Zhong Ru Fen (*Gypsum Fibrosum Pulveratum*), Fang Feng (*Saposhnikoviae Radix*, de-rhizome), Shu Di Huang (*Rehmanniae Radix Preparata*), Niu Huang (*Bovis Calculus*, finely ground), Zhi Gan Cao (*Glycyrrhizae Radix et Rhizoma Preparata*), Qi Hua (*Eleutherococcus senticosus*, also known as Chai Qi in *Ying Ru Fang*).
Grind each ingredient separately into powder, sieve, mix with the already-ground ingredients, and further grind uniformly. Mix with dog brain marrow to form pills the size of hemp seeds. Administer three pills per dose with millet broth, taken in the morning, noon, and evening. Adjust dosage according to the child's age and size.

**Bai Ji Powder for Split Cranial Bones from *Sheng Hui Fang*:**
Bai Ji (*Bletillae Rhizoma*), Xi Xin (*Asari Radix et Rhizoma*), Fang Feng (*Saposhnikoviae Radix*, de-rhizome), Bai Zi Ren (*Platycladi Semen*).
Grind each ingredient separately into powder, sieve finely. Mix with milk and apply to the infant's skull. Apply twice daily.

**Gou Nao Pill for Head Shaking and Jie Lu Due to Brain Development Issues from *Ying Ru Fang*:**
Gou Nao (*Canis Cerebrum*, one), Chai Qi (*Eleutherococcus senticosus*), Zhi Gan Cao (*Glycyrrhizae Radix et Rhizoma Preparata*), Bai Zhu (*Atractylodis Macrocephalae Rhizoma*), Fang Feng (*Saposhnikoviae Radix*), Zhong Ru Shi (*Gypsum Fibrosum*), Gan Di Huang (*Rehmanniae Radix*, one fen each), Niu Huang (*Bovis Calculus*, two fen).
Mix with dog brain to form pills the size of adzuki beans. For one-year-olds, administer two pills with drink, twice daily. Increase if ineffective. It is also stated that the infant's fontanelle should always be kept warm; coldness leads to death.

**Medicine to Seal the Fontanelle and Prevent Excessive Brain Growth from *Ying Ru Fang*:**
Shao Yao Fen (*Paeoniae Radix Alba Pulveratum*).
Take a yellow hen, hold its head near the infant's fontanelle, pierce the comb, let blood drip onto the fontanelle, and cover the blood with Shao Yao powder to prevent exposure. Cure occurs immediately within one day.

**Gou Nao Pill for Large Fontanelle, Emaciation, Sweating, Lung Distension, Cough, Dyspnea, and Inability to Walk at Three to Five Years Old from *Ying Ru Fang*:**
Zhi Gan Cao (*Glycyrrhizae Radix et Rhizoma Preparata*), Di Huang (*Rehmanniae Radix*, three fen each), Fang Feng (*Saposhnikoviae Radix*), Bai Zhu (*Atractylodis Macrocephalae Rhizoma*, two fen each), Zhong Ru Fen (*Gypsum Fibrosum Pulveratum*), Niu Huang (*Bovis Calculus*, two zhu each).
Grind into powder, mix with dog brain to form pills the size of adzuki beans. For two-year-olds, administer seven pills with water, twice daily, gradually increasing the dose.

**Yuru Dan Prescribed by Zhang Huan for Unclosed Cranial Sutures:**
Zhong Ru Fen (*Gypsum Fibrosum Pulveratum*, prepared by ancient methods), Bai Zi Ren (*Platycladi Semen*, ground separately), Shu Di Huang (*Rehmanniae Radix Preparata*, steamed and baked), Dang Gui (*Angelicae Sinensis Radix*, washed and dried, half liang each), Fang Feng (*Saposhnikoviae Radix*, chopped), Bu Gu Zhi (*Psoraleae Fructus*, refined and fried, one liang each). Optionally add Huang Qi (*Astragali Radix*) and Fu Ling (*Poria*).
Grind all ingredients except those ground separately into fine powder, mix with Zhong Ru Fen, and bind with refined honey to form pills the size of millet seeds. Administer ten pills per dose with fennel decoction, before nursing or eating.

**Ci Shi Pill for Large Fontanelle, Persistent Fever, Head Sweating, Abdominal Distension, Cough, Dyspnea, Leg Stiffness, Crossed Feet, and Inability to Walk at Three Years Old from *Wan Quan Fang*:**
Ci Shi (*Magnetitum*, calcined, quenched in vinegar seven times, finely ground and sieved), Fang Feng (*Saposhnikoviae Radix*, de-rhizome), Shu Di Huang (*Rehmanniae Radix Preparata*), Niu Huang (*Bovis Calculus*, ground), Zhi Gan Cao (*Glycyrrhizae Radix et Rhizoma Preparata*), Gan Qi (*Rhei Radix et Rhizoma*, stir-fried until smoke appears, one fen each).
Grind and sieve into powder, mix with pre-ground ingredients, and grind uniformly. Mix with dog brain marrow to form pills the size of hemp seeds. Administer three pills per dose with millet broth, taken in the morning, noon, and evening. Adjust dosage according to the child's age and size.

**Hu Gu Formula Transmitted by Ding Shifa, a Physician from Changsha, for Pediatric Jie Lu:**
Hu Gu (*Pantheris Os*), Bai Gui Ban (*Testudinis Carapax et Plastrum*), Bu Hui Mu (*Travertine*), Ru Xiang (*Olibanum*, half liang each).
Grind into powder. Mix with fresh pig blood in the palm, apply to the split 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, reduce severity by one part, rest for three days, then reapply. Additionally, administer Shen Ling San:
Ren Shen (*Ginseng Radix*), Fu Ling (*Poria*), Bai Fu Zi (*Typhonii Rhizoma*, processed), Qiang Huo (*Notopterygii Rhizoma et Radix*), Zhi Gan Cao (*Glycyrrhizae Radix et Rhizoma Preparata*), Shao Yao (*Paeoniae Radix*), Bai Zhu (*Atractylodis Macrocephalae Rhizoma*, boiled, one fen each), Xi Jiao Xie (*Rhinocerotis Cornu Fragmenta*), Jing Xiong (*Ligusticum striatum*), Huo Xiang (*Pogostemonis Herba* - last three ingredients halved).
Grind into powder. Administer half qian per dose with one sheng of water, add a small amount of gold and silver, boil with three mint leaves until reduced to one-third, take warm to dispel shock qi.