A bulging fontanel in infants, known as a "bulging fontanel," can be categorized based on the degree of protrusion. A slightly raised fontanel is referred to as a "swollen fontanel," while a significantly raised and protruding fontanel is called a "bulging fontanel." However, some may not distinguish between the two.

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1. Fire Toxin Attacking Upward︰The fontanel is highly swollen, as if piled with objects, and feels soft and floating upon palpation. The skin over the fontanel is red, and the hair is short and yellow. Symptoms include headache, dry mouth, steaming bone fever, spontaneous sweating, a flushed face and shoulders, or feverish convulsions, high chest and rapid breathing, scanty dark urine, a deep red tongue with yellow, dry coating, a floating and rapid pulse, and purple-stagnant finger veins. This condition is commonly seen in infants and young children affected by seasonal pathogens such as viruses. Due to the upward flaring of intense heat attacking the head, the fontanel becomes bulging and scorching hot. It is often accompanied by symptoms of excessive internal heat, such as headache, dry mouth, a flushed face and red lips, fever, and panting. Treatment should focus on dispersing wind and dissipating fire, clearing heat, and removing toxins. Da Forsythia Drink can be used, along with Huadu Dan.
2. Cold Qi Coagulation︰The fontanel is swollen and protuberant, firm and hard to the touch. The skin over the fontanel appears pale, the complexion is pallid, and the hands and feet are cold. There may also be an abnormally large head with separated cranial sutures, or symptoms resembling non-wind convulsions, such as spasms and convulsions in the hands and feet. The tongue is pale with a white, slippery coating, the pulse is deep and slow, and the finger veins appear pale blue. This condition is commonly seen in children with an inherently cold and deficient constitution. Due to spleen-stomach yang deficiency, the qi and blood fail to be warmed and circulated, leading to the accumulation of cold qi in the upper body. As a result, the fontanel becomes swollen and hard without fever, often accompanied by a pale face, cold hands and feet, occasional spasms and convulsions, poor appetite, loose stools, and other signs of yang deficiency. It may also be observed in emaciated children with an unusually large head and ununited skull (hydrocephalus). Treatment should focus on warming the middle and dispelling cold, and Middle-Regulating Decoction may be used.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．"Bulging fontanel in infants is caused by irregular breastfeeding, improper feeding schedules, or exposure to heat or cold, which affects the spleen and stomach, leading to zang-fu organ imbalance and the rising of qi. The symptoms include a bulging fontanel, as if filled with something underneath, accompanied by sweating and short, yellow hair. If the rising of qi is due to cold, the fontanel becomes firm; if due to heat, it becomes soft. Additionally, if there is an accumulation under the ribs, or if the body is full of qi and heat, the heat can affect the organs, causing the rising of qi to impact the brain fontanel, also leading to a bulging fontanel. Furthermore, coughing and crying can cause the qi to rise and affect the organs, leading to illness. Prolonged crying without calming the qi before breastfeeding can also cause a bulging fontanel. This is because during crying, the yin-yang qi counterflows upward."
2. Youyou Jicheng．"Treatment of head and fontanel conditions": "Swelling of the fontanel... can also be caused by overly tight wrapping and excessive covering, preventing yang qi from escaping, which also leads to redness and swelling."