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。）
巢元方说：小儿脏腑有热，口渴想喝水浆，导致发生泄泻痢疾，日久则气血虚弱，不能向上充养脑髓，所以囟门凹陷像坑一样，不能平满。《圣济总录》用当归散（方剂见腹痛篇）和地黄丸。（见前文）。
曾氏说：囟门凹陷，是虚损到了极点。胃气虚寒就会导致囟门凹陷，在慢惊风中可见此症。因胃寒脾困导致呕吐泄泻的，属于极度虚损，应立即用金液丹、固真汤（均用于慢惊风）以及诸救元等药物治疗，外用贴敷乌附膏。如果有后枕部凹陷的，病情尤其严重，治疗方法与囟陷相同，若无效，也难以治疗，这是大虚极的表现，百中无一能活。
乌附膏 用于治疗囟门凹陷。
绵川乌（生用） 绵附子（生用。各五钱） 雄黄（二钱）
以上药物研为细末，用生葱连根带叶切碎，捣烂，加入前面的药末一同煎煮，空腹时制成膏状，贴敷于凹陷处。
《太平圣惠方》生干地黄散 治疗小儿脏腑壅滞有热，气血不能荣润，导致囟门凹陷不平的病症。
生干地黄（二两） 乌鸡骨（一两，涂酥炙至黄色）
以上捣碎，过细筛成粉末，不限时候，用米粥汁调服半钱。
又治疗小儿囟门凹陷的方子：
取猪牙车骨髓，煎煮如膏状。涂抹在囟门上效果良好。
又一方：将狗头骨炙烤至黄色，捣碎过筛成粉末。用鸡蛋清调和后涂抹。
又一方：将天灵盖（人顶骨）炙烤至黄色，捣碎过筛成粉末，用生油调和后涂抹。
《千金方》治疗小儿囟门凹陷，灸脐上下各半寸，以及鸠尾骨端，还有足太阴经穴位，各灸一壮。
囟填，是指囟门肿起。脾主肌肉，哺乳不规律，饥饱无度，或受寒或受热，邪气侵犯脾脏，致使脏腑功能不调，气机上冲，造成胀满，囟门突起而高，像物体堆积起来，伴有自汗出，毛发黄且短，这就是囟填的症状。如果寒气上冲，囟门就会坚硬隆起（“牢HT”音昂，指鞋头，形容肿胀坚硬如鞋头突起）；热气上冲则柔软。另外，小儿胁下有积滞，咳嗽啼哭且气机上逆的，啼哭很久气息未定就喂奶的，肝气盛风热上冲的，都能导致囟门肿胀，应当逐一审察病因并治疗。寒证用温法，热证用凉法，气机上逆的用降气和平之法，肝气盛的以泻青为主。热证里多者用大连翘汤，表多者用柴胡散，虚证用补中益气汤送服地黄丸。神妙之处在于灵活运用，言语难以尽意。
曾氏说：世人认为囟门肿胀都是热证，殊不知有阴阳两种证型，务必详细辨别。坚硬为阴证，红软为阳证。所以《婴孩宝书》说：“寒气上冲则坚硬隆起，热气上冲则柔软”，正是这个意思。如果是阴证，用匀气散、理中汤主治。阳证用玉露饮、当归散、防风汤治疗。《玉环集》歌诀说：“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》歌诀说：“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。”积滞有冷有热，都能导致肿胀。冷积则大便色白，或有酸臭气冲人，也有虫排出，食物皆不能消化，腹胀满而多困倦，喉中也有鸣响。热积则口渴多饮，大便色赤，面色黄赤，口内臭气，也有虫排出。各自根据证候调理治疗，并且必须分清水谷积滞并调理气机，冷证则温脾胃，热证则清热，化涎止渴。囟门凹陷则是寒证，肿胀则是热证。积热导致的囟门虚肿，宜用时令气门中的三十六种除湿散，用浓煎的桑白皮汤送下。《形证论》说：肺热生风，痰鸣囟肿，服用一二服白丁香膏，或者一二服南星丸，即可消退。《秘要指迷论方》说：凡小儿出生一个月内，出现囟门肿胀，这是受胎时的热气所致，即用黄柏膏涂抹于足心涌泉穴。如果囟门凹陷，即用半夏膏涂抹手心，这是婴儿肾中受冷气，邪气干扰心脏，导致生病。（黄柏和半夏都研为粉末，用冷水调和贴敷。）
Chao Yuanfang stated: When a child's internal organs have heat, causing thirst and desire to drink water or gruel, leading to diarrhea and dysentery, prolonged illness results in deficiency of Qi and Blood. Unable to ascend and nourish the brain marrow, the fontanelle becomes depressed like a pit and cannot be flat. *Shengji Zonglu* (General Records of Sage Benevolence) uses Danggui San (Formula for Abdominal Pain) and Dihuang Wan (see previous text).
Zeng Shi stated: Depression of the fontanelle indicates extreme deficiency. Deficiency-cold of the Stomach Qi causes depression of the fontanelle, which can be seen in slow convulsions. Vomiting and diarrhea caused by 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 there is depression at the back of the head, the condition is particularly severe. The treatment method is the same as for general fontanelle depression; if ineffective, it is difficult to treat, indicating extreme Great Deficiency, where fewer than one in a hundred survives.
Wufu Gao (Aconite and Cinnamon Paste): Treats depressed fontanelle.
Mian Chuanwu (Raw Rhizoma Aconiti Carmichaeliani) [5 qian], Mian Fuzi (Raw Radix Aconiti Lateralis Preparata) [5 qian], Xionghuang (Realgar) [2 qian].
Grind the above into powder. Finely chop raw scallions including roots and leaves, pound them until mushy, add the aforementioned powders, and decoct together. Apply as a paste to the depressed area on an empty stomach.
Taiping Shenghui Fang (Holy惠民 Formulas from the Taiping Era): Shenggandihuang San (Raw Dried Rehmannia Powder) treats children whose internal organs are obstructed with heat, and Qi and Blood fail to nourish, resulting in an uneven, depressed fontanelle.
Shenggandihuang (Raw Dried Rehmanniae Radix) [2 liang], Wuji Gu (Bone of Black-bone Chicken) [1 liang, coated with butter and roasted until yellow].
Pound the above, sift finely through a fine sieve. Take half a qian mixed with rice broth at any time.
Another formula for treating depressed fontanelle in children:
Take the bone marrow from the jaw of a pig, decoct until it resembles a paste. Apply to the fontanelle; this is effective.
Another formula: Roast a dog’s skull until yellow, pound and sift into powder. Mix with egg white and apply.
Another formula: Roast Tianlinggai (Human Vertex Bone) until yellow, pound and sift into powder. Mix with raw sesame oil and apply.
Qianjin Fang (Formulas Worth a Thousand Gold): For depressed fontanelle in children, moxa points half a cun above and below the navel, the end of the Jiuwei bone, and points on the Foot-Taiyin Meridian, one moxa cone each.
Fontanelle bulging (Xitian) refers to the swelling of the fontanelle. The Spleen governs muscles. Irregular feeding, excessive hunger or fullness, or invasion by cold or heat pathogens affecting the Spleen, cause disharmony of the internal organs. Qi rushes upward, causing distension and bulging, making the fontanelle protrude high like piled objects, accompanied by spontaneous sweating, yellow and short hair. This is the presentation of fontanelle bulging. If Cold Qi rushes upward, the fontanelle becomes hard and elevated ("Laoting" sounds like 'ang', referring to the toe-cap of a shoe, describing swelling that is hard and protrudes like a shoe-toe); if Hot Qi rushes upward, it remains soft. Additionally, children 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 bulging. 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 purging Green (Liver). For interior Heat predominance, use Dalianqiao Tang; for exterior predominance, use Chaihu San; for deficiency, use Buzhong Yiqi Tang to deliver Dihuang Wan. Divine efficacy lies in flexible application; words cannot fully express the intent.
Zeng Shi stated: The world believes fontanelle swelling is always due to Heat, not knowing there are two types: Yin and Yang. Careful differentiation is essential. Hardness indicates Yin; redness and softness indicate Yang. Thus, *Yinghan Baoshu* (Treasure Book for Infants) states: "Cold Qi rushing upward causes hardness; Hot Qi rushing upward causes softness," which is exactly correct. For Yin syndromes, use Yunqi San and Lizhong Tang. For Yang syndromes, use Yulu Yin, Danggui San, and Fangfeng Tang. The song in *Yuhuan Ji* says: "Swelling of the fontanelle definitely indicates Wind; this condition requires careful handling. If it adds a pit like a cup foot, life will end within seven days." The song in *Shibi Jing* says: "Accumulation and Heat in the Spleen block flow, causing red face and lips, high chest, night cough, and distension. Do not let it spread to the Lungs with Wind. Sound in the throat and phlegm obstruction upward, fontanelle swelling rises with Heat. Only cool the Diaphragm and calm the Spirit Organs, and success can 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, undigested food, abdominal distension, fatigue, and throat rales. Hot accumulation leads to excessive thirst, red stool, yellow-red complexion, foul breath, and worms. Treat according to symptoms, distinguishing between water/grain accumulation and regulating Qi. For cold, warm the Spleen and Stomach; for heat, clear the heat, resolve phlegm, and stop thirst. Fontanelle depression indicates cold; swelling indicates heat. For bulging due to accumulated Heat and deficiency, use the Thirty-Six Kinds of Shichu San from the Seasonal Qi Gate, taken with strongly decocted Sangbaipi Tang. *Xingzheng Lun* states: Lung Heat generating Wind, phlegm rattling, and swollen fontanelle can be resolved with one or two doses of Baixiang Ding Gao or Nanting Wan. *Mi Yao Zhimi Lun Fang* states: Within one month after birth, if the fontanelle swells, this is due to Heat received during conception; apply Huangbai Gao to the Yongquan point on the sole. If depressed, apply Banxia Gao to the palm; this is due to Cold Qi affecting the Kidney in infants, pathogenic factors interfering with the Heart, causing disease. (Huangbai and Banxia are both ground into powder and applied with cold water.)