A sunken fontanel, known as "sunken fontanel" in Chinese medicine. The "Secrets of Childcare" states, "A sunken fontanel refers to the depression of the fontanel forming a pit."

In infants within the first six months after birth, a slight depression of the anterior fontanel is not considered pathological. If due to spleen-stomach weakness, reduced food intake, thin body and skin, and the fontanel being visible, it is also not a sunken fontanel. However, if due to insufficient fetal endowment or after chronic diarrhea and slow convulsions, the fontanel becomes significantly sunken, even forming a pit, then it is considered a sunken fontanel. If the occipital area is also sunken simultaneously, it is called occipital depression, and the condition is particularly severe.

bubble_chart Pattern Analysis

1. Spleen-kidney Yang Deficiency︰The infant's fontanel is markedly sunken, resembling a pit. The complexion is pale yellow, with a lack of vitality, emaciation, poor appetite, cold limbs, and possibly loose stools. The tongue is pale with a white coating, and the pulse is deep, slow, and weak, with faint and sluggish fingerprints. This condition is often seen in cases of congenital kidney yang deficiency, prolonged illness damaging yang, or excessive use of cold and purgative treatments, leading to spleen-kidney yang deficiency and insufficient nourishment of the brain marrow. In addition to the sunken fontanel, symptoms include a pallid complexion, listlessness, shortness of breath, poor appetite, loose stools, cold limbs, and even depression of the occipital region. The tongue is pale, the pulse is deep, slow, and weak, and the fingerprints are faint and sluggish—all signs of yang deficiency. Treatment should focus on reinforcing the foundation and strengthening the kidneys, warming yang and nourishing the marrow. The recommended formula is Guzhen Tang (Solidifying the True Decoction), supplemented with external application of Wufu Gao (Aconite and Prepared Aconite Paste) on the sunken fontanel.
2. Exhaustion of Qi and Body Fluids, Sinking of Genui︰The fontanel is sunken, sometimes even forming a pit, with sudden onset of diarrhea or chronic diarrhea that does not heal, accompanied by fever, frequent urination, thirst for water, sunken orbits, emaciated and dry body, red tongue without moisture, thin, rapid, deep, and hidden pulse, and purple stagnant fingerprint patterns. This condition is often seen in children with prolonged illness leading to yin damage or fulminant diarrhea that injures qi, blood, and body fluids. As stated in *The Secret of Child Rearing*: "After a severe illness, body fluids are insufficient, and vital qi sinks to form pits." Hence, symptoms such as sunken orbits, dry and burning skin, red tongue without moisture, and red-purple stagnant fingerprints are observed. It is urgent to support original qi, lift the sinking, and rescue fluids. Modified Yuan-Regulating Decoction with Cimicifuga Rhizome may be selected.

bubble_chart Documentation

1. Xiao'er Weisheng Zongwei Lunfang: "There are also cases of sunken fontanel, which may be caused by diarrhea, frequent urination, or the use of diuretic medications, or due to inherent weakness of qi, or prolonged illness, all of which lead to the deficiency of the viscera and inability to nourish the fontanel, thus resulting in a sunken fontanel."