Fontanel non-closure, also known as "fontanel non-closure", "ununited skull (hydrocephalus)", "ununited skull (hydrocephalus)", refers to the condition where the fontanel does not close at a certain age in children, leading to the separation of the skull sutures, resulting in a fontanel that is larger than normal.

In full-term newborns, the oblique diameter of the anterior fontanel is about 2.5 centimeters. The cranial sutures of normal children mostly begin to ossify six months after birth, the posterior fontanel closes between two to four months, and the anterior fontanel closes between one to one and a half years of age. If the closure is delayed, it is considered this condition.

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1. Kidney Deficiency with Marrow Weakness︰The anterior fontanel is wide, the cranial sutures are separated, the veins on the forehead are prominent, the complexion is pale, the expression is dull, and in severe cases, the head gradually becomes enlarged and shiny (a two- or three-year-old child's head may resemble that of an eight- or nine-year-old). The body is thin, the neck is slender and weak, the head tilts to one side, and it is often accompanied by downward-drooping eyeballs, with the white of the eye particularly prominent and a lack of luster in the eyes. The tongue texture is pale, the pulse manifestation is deep, thin, and weak, and the finger veins are pale and sluggish. If the fontanel fails to close due to post-illness marrow heat, it may also present with feverish sensations in the palms and soles, dysphoria and restlessness, a dry mouth, a red tongue, a thin and rapid pulse, and purple, sluggish finger veins. This is mostly caused by insufficient innate fetal endowment. Youyou Jicheng Volume 4 states: "Ununited skull (hydrocephalus)... is due to insufficient innate qi and severe congenital deficiency of kidney essence. The kidneys govern brain marrow; when the kidneys are deficient, the brain marrow is insufficient, hence the skull fails to close." Therefore, after birth, the fontanel does not close on time but instead gradually widens and separates, the head noticeably enlarges, the scalp becomes tight and shiny with prominent veins, the eye sockets tighten, the eyeballs droop in a sunset-like manner, and the whites of the eyes are more visible than the dark parts. Due to the weakness of kidney yang, turbid yin fails to descend, and pathogenic fluids ascend to the brain, causing stomach qi to rebel upward, often accompanied by vomiting. There are also cases where post-illness kidney deficiency leads to water failing to overcome fire, with fire rising and qi steaming, heating the marrow, which then separates. Thus, the fontanel fails to close when it should or closes and reopens, gradually expanding into this condition, often accompanied by symptoms of yin deficiency with effulgent fire. The treatment principle generally focuses on tonifying and replenishing marrow and essence. For cases due to insufficient innate fetal endowment, the method should also include warming yang, commonly using the Kidney-Tonifying Rehmannia Pill. For cases of post-illness kidney deficiency with marrow heat, the method should also include enriching yin, commonly using the Placenta Great Life-Endowing Pill. Additionally, the Fontanel-Sealing Powder can be applied externally for treatment. Since the disease lies in the brain marrow, akin to a tree's diseased roots, children suffering from this condition face a critical prognosis.
2. Spleen Deficiency Disorder︰The anterior fontanel is wide with softened edges, the cranial sutures are widened, and the head appears square. The complexion is shallow yellow, accompanied by anorexia and lack of strength, emaciation, flaccid muscles, dry and bundled hair, excessive night sweats, stagnant or gradually decreasing weight, as well as delayed speech and night blindness. The tongue texture is pale red, the pulse is thin and weak, and the finger veins are faint. This is often caused by irregular breastfeeding, improper feeding, insufficient sunlight, nutritional imbalance, or other diseases leading to excessive consumption of qi and fluids, dysfunction of the spleen and stomach, and lack of source for generation and transformation, resulting in malnutrition of the bones and failure of the fontanel to close. As stated in Xiao'er Weisheng Zongwei Lunfang: "The fontanel is connected to the spleen and stomach." Therefore, clinical manifestations include a distended abdomen with visible blue veins, or a sunken abdomen resembling a boat, abnormal eating habits, and other characteristics of infantile malnutrition with accumulation. The degree of cranial suture separation is milder compared to the failure of fontanel closure due to kidney deficiency and weak marrow. Treatment focuses on regulating the spleen and stomach and may refer to the management of malnutrition syndromes. Generally, by the age of two or three, the cranial sutures and anterior fontanel will fully close.

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1. Journal of Traditional Chinese Medicine: "The cause of ununited skull (hydrocephalus) disease is congenital deficiency, but its treatment cannot be achieved by merely tonifying the kidney. This is because the congenital deficiency leads to the inability of true yang to warm and moisten the spleen earth, resulting in spleen dampness that transforms into phlegm. The kidney governs water, and kidney deficiency leads to water overflow, while spleen deficiency results in the inability to control water, and prolonged accumulation of water also turns into phlegm. The kidney is the root of qi, and kidney deficiency causes qi to have no root, leading to the failure of clearing qi to ascend and turbid qi to descend, which then invades upwards. The kidney governs the bones, and bones produce marrow. Kidney deficiency leads to emptiness of the sea of marrow, allowing damp phlegm and turbid qi to invade, resulting in ununited skull (hydrocephalus). Therefore, treatment must focus on qi and phlegm, with the primary method being descending qi and resolving phlegm to expel stasis, supplemented by dispelling wind, using the Powder for Ascending and Descending (as seen in the "Cold-Damage Disease Pestilence Differentiation") with modifications." (Wang Jing'an: A Case Study on the Treatment of Ununited Skull (Hydrocephalus). (6), 32, 1964