《圣惠》论∶小儿龟胸者，缘肺热胀满，致使胸高如龟。又云∶多食热乳，亦能致此也。
张涣论∶凡乳母乳儿，常捏其宿乳。夏常洗乳净，捏去热乳。若食儿饮热乳，损伤肺气，胸高胀满。令儿
胸高如龟，乃名龟胸。
《圣惠》治小儿龟胸，肺热壅滞，心膈满闷。大黄丸方
川大黄（三分，锉，微炒） 天门冬（去心焙） 百合 杏仁（汤洗去皮、尖、双仁，麸炒微黄） 木
通桑白皮 甜葶苈（隔纸炒令紫色） 川朴硝（各半两）
上件药捣，罗为末，炼蜜和丸如绿豆大。不计时候，以温水研破五丸服。量儿大小加减服之。
《圣惠》又方
甜葶苈（隔纸炒令紫色） 杏仁（汤浸去皮、尖、双仁，麸炒微黄） 麻黄（去芦节） 川大黄（
锉，微炒。以上各半两） 桂心（一分）
上件药捣，罗为末，炼蜜和丸如绿豆大。不计时候，以温水研下五丸。量儿大小临时加减。
《圣惠》治小儿龟胸方。
上取龟尿，随多少摩胸骨上，即瘥。
张涣治龟胸百合丹方
桑根白皮 木通 川朴硝 杏仁（汤浸去皮尖） 川大黄 天门冬（去心。各半两） 百合（一两）
上件捣，罗为细末，炼蜜为丸如黍米大。每服十粒，米饮下。量儿大小加减。
《吉氏家传》龟胸方。
葶苈（熬） 大黄（各三分） 桂心（一分） 麻黄（二分，去节）
上件为细末，炼蜜为丸如梧桐子大。每服十丸，米饮下。
《圣惠》灸法∶龟胸缘肺热胀满攻胸膈所生。又缘乳母食热面、五辛，转更胸起高出。灸两乳前各一寸半，
上两行三骨罅间，六处各二壮，炷如小麦大。春夏从下灸上，秋冬从上灸下。若不根据此法，则灸十而不能一、
二愈也。
《庄氏集》 穴灸龟胸法∶取九家灰一料盛簸箕中，令儿合面，印胸迹于上，于龟胸从上当中及两边，令三
姓人同下火，各于灰上灸三壮，弃灰于河流或水中。
The *Shenghui Fang* discusses: Infantile pectus carinatum (keel chest), caused by lung heat and distension, resulting in a chest that protrudes high like a turtle shell. It also states: Excessive consumption of hot-natured breast milk can also cause this condition.
Zhang Huan discusses: Whenever a nursing mother feeds her infant, she should frequently express and discard retained milk. In summer, the breasts should be washed clean regularly, and hot-natured milk expressed. If the infant consumes hot-natured milk, it damages Lung Qi, causing the chest to become high and distended. When the infant's chest protrudes high like a turtle, it is named pectus carinatum (keel chest).
The *Shenghui Fang* treats infantile pectus carinatum with symptoms of Lung heat stagnation and fullness/stuffiness in the heart and diaphragm. Da Huang Wan (Rhubarb Pill) formula:
Radix et Rhizoma Rhei (Sanfen, crushed, slightly stir-fried) [Ephedrae Herba (Mahuang, 麻黄) - *Note: Original text lists Mahuang in next formula, here strictly translating listed items*] Asparagus Fern Root (Tianmendong, 天门冬, remove core and bake) Lilii Bulbus (Baihe, 百合) Apricot Seed (Xingren, 杏仁, wash with water, remove skin and tip, double-kernel removed, bran-stir-fried until slightly yellow) Akebia Stem (Mutong, 木通) Mulberry Root Bark (Sangbaipi, 桑白皮) Lepidium Seed (Tiantili, 甜葶苈, stir-fried between papers until purple) Mirabilite (Piaoxiao, 川朴硝) (each Banliang, half tael).
Crush the above ingredients, sieve into fine powder, mix with refined honey to form pills the size of mung beans. Take at any time, crush five pills in warm water and administer. Adjust dosage according to the child's age and size.
Another formula from the *Shenghui Fang*:
Lepidium Seed (Tiantili, 甜葶苈, stir-fried between papers until purple) Apricot Seed (Xingren, 杏仁, soak in water, remove skin and tip, double-kernel removed, bran-stir-fried until slightly yellow) Ephedra Herb (Mahuang, 麻黄, remove rhizome and nodes) Radix et Rhizoma Rhei (Dahuang, 川大黄, crushed, slightly stir-fried; each Banliang, half tael for these three) Cinnamon Twig Heart (Guixin, 桂心, Yifen, one part).
Crush the above ingredients, sieve into fine powder, mix with refined honey to form pills the size of mung beans. Take at any time, crush five pills in warm water and administer. Adjust dosage temporarily according to the child's age and size.
Formula from the *Shenghui Fang* for treating infantile pectus carinatum:
Obtain urine from a turtle, apply an appropriate amount to rub on the sternum, and the condition will heal.
Zhang Huan's Baihe Dan (Lily Pill) for treating pectus carinatum:
Mulberry Root Bark (Sangbaipi, 桑根白皮) Akebia Stem (Mutong, 木通) Mirabilite (Piaoxiao, 川朴硝) Apricot Seed (Xingren, 杏仁, soak in water, remove skin and tip) Radix et Rhizoma Rhei (Dahuang, 川大黄) Asparagus Fern Root (Tianmendong, 天门冬, remove core; each Banliang, half tael) Lilii Bulbus (Baihe, 百合, Liang, one tael).
Crush the above ingredients, sieve into fine powder, mix with refined honey to form pills the size of millet seeds. Take ten pills per dose, swallow with rice drink. Adjust dosage according to the child's age and size.
Formula from *Jishi Jiachuan* for pectus carinatum:
Lepidium Seed (Tingli, 葶苈, roasted) Radix et Rhizoma Rhei (Dahuang, 大黄; each Sanfen, three parts) Cinnamon Twig Heart (Guixin, 桂心, Yifen, one part) Ephedra Herb (Mahuang, 麻黄, Erfen, two parts, remove nodes).
Grind the above ingredients into fine powder, mix with refined honey to form pills the size of sophora seeds. Take ten pills per dose, swallow with rice drink.
Moxibustion method from the *Shenghui Fang*: Pectus carinatum arises from Lung heat and distension attacking the chest and diaphragm. It may also be exacerbated if the nursing mother consumes hot-natured wheat flour foods and the "Five Pungent Spices" (Wuxin, 五辛), further causing the chest to rise prominently. Moxibustion is applied at six points: each point is located one and a half cun anterior to the nipples, in the intercostal spaces between the third ribs of the upper two rows. Apply two moxa cones at each point, with cones the size of a wheat grain. In spring and summer, moxibustion proceeds from bottom to top; in autumn and winter, from top to bottom. If this method is not followed precisely, even ten treatments may fail to cure one or two cases.
Acupoint moxibustion method for pectus carinatum from *Zhuangshi Ji*: Take a portion of ash from nine households, place it in a winnowing basket. Have the infant lie prone with face down, pressing the chest onto the ash to leave an imprint. At the highest point of the keel chest (center and sides), invite three people of different surnames to simultaneously ignite moxa sticks. Apply three moxa cones on the ash at each marked spot. Discard the ash into a river or flowing water.