龟胸者，胸高胀满，形如覆掌，多因乳母多服五辛酒面、炙 之类，或夏月热乳宿乳与儿。盖儿肺气最清，
为诸脏华盖，日久痰滞，则生风热，肺受火邪，则胸骨胀起。麻痘之后，多有此证，宜清肺降火，杏仁煎。
龟背，生下不能保护，以客风入于骨髓，或儿坐早，劳伤气血，或咳嗽久，以致肺虚，而肾亦无所生矣。肾
主骨，风寒乘虚而入于骨髓，致精血不能流通，故成龟背。宜松蕊丹，外以龟尿涂法。此从前所论证治也。
予按∶龟胸有治，龟背乃不治之证。前人证治，犹有未善，虽曰客风入骨，坐早劳伤，咳嗽肺虚，然未窥其
病源，无非以现下者言之也。凡小儿禀受真元足者，尝见其赤身裸体，当风露坐，半周之后，坐以座栏，从未闻
有客风入骨，坐早劳伤，嗽久而病龟背之说。此证盖由禀父母精髓不足，元阳亏损者多有之。不观小儿龟背，正
在命门之间，渐
次骨节浮露，其腰如弓，实因骨痿不能支撑之故，岂风邪为患哉？此证百不一救，原无治法。而前人强立松蕊
丹，反用麻黄、大黄、独活、防风一派攻伐之药，适足以速其殇也。若以鄙见，但当以六味地黄丸加上桂、鹿
茸，救其先天，复以四君、六君之类，扶其胃气，或可十中保一，除此之外，并无治法，若谓松蕊丹能治龟背，
吾不信也。
龟胸，表现为胸部高耸胀满，形状像倒扣的手掌。这多是因为乳母过多食用五辛（葱、蒜、韭、薤、兴渠）、酒类面食以及烧烤炙烤的食物，或者在夏季将热奶或隔夜的冷奶喂给婴儿。因为小儿的肺气最为清灵，肺为五脏六腑的华盖（覆盖于其他脏腑之上的脏器），日久痰湿停滞，则滋生风热；肺受到火邪侵袭，就会导致胸骨胀起。麻疹和天花痊愈后，常有出现这种证候的情况，适宜采用清肺降火的方法，使用杏仁煎。
龟背，是指出生后未能得到妥善保护，导致外来的风邪侵入骨髓；或者是婴儿过早坐立，劳损气血；或者是长期咳嗽，导致肺气虚弱，进而使肾气也无法得到滋养。肾主司骨骼，风寒之邪乘虚侵入骨髓，致使精血不能流畅运行，从而形成龟背。适宜使用松蕊丹治疗，外用龟尿涂抹的方法。这是前人关于此证的论证和治疗方案。
我按语认为：龟胸是有办法治疗的，而龟背则是不治之症。前人的论证和治疗，仍有不完善之处。虽然说是外来的风邪入骨、过早坐立劳伤、久咳导致肺虚，但并没有窥探到疾病的根本源头，无非是根据眼前的症状来说罢了。凡是先天禀赋真元充足的小儿，我曾见过他们赤身裸体，在风露中坐着，过了半个月之后，让他们坐在座栏里，从未听说过有因外风入骨、过早坐立劳伤、久咳而导致龟背的说法。这个证候大概是由于禀受父母的精髓不足，元阳亏损的人多有发生。不看小儿龟背的症状，正是在命门之间，逐渐出现骨节浮露，腰部弯曲如弓，实在是因为骨痿（骨骼软弱无力）不能支撑的缘故，难道是风邪为患吗？这个证候百人中难救一人，原本就没有治疗方法。而前人强行设立松蕊丹，反而使用麻黄、大黄、独活、防风这一类攻伐的药物，恰恰足以加速其死亡。如果按照我的见解，只应当用六味地黄丸加上肉桂、鹿茸，来挽救其先天之本，再用四君子汤、六君子汤之类，扶持其胃气，或许能在十例中保住一例。除此之外，并没有其他治疗方法。如果说松蕊丹能治疗龟背，我是不会相信的。
Gui Xiong (Turtle Chest) is characterized by a high and distended chest, shaped like an inverted palm. This is often caused by the wet nurse consuming excessive amounts of "Wu Xin" (Five Pungent Spices: garlic, chives, leeks, shallots, and asafetida), alcohol, wheat-based foods, or roasted/grilled items, or by feeding the infant hot milk or leftover cold milk during summer. Since infants' Lung Qi is the purest, and the Lung serves as the Hu Gai (Canopy covering all viscera) for the five zang organs, prolonged stagnation of phlegm generates wind-heat. When the Lung is affected by fire pathogenic factors, the sternum becomes distended and raised. After recovery from measles and smallpox, this condition frequently occurs; it is appropriate to clear the Lung and descend fire using Xingren Jian (Almond Decoction).
Gui Bei (Turtle Back) refers to the inability to protect oneself after birth, allowing exogenous wind pathogens to penetrate into the bone marrow; or premature sitting by the child, which damages qi and blood; or chronic coughing leading to Lung deficiency, thereby failing to nourish the Kidney. The Kidney governs the bones; when wind-cold enters the bone marrow due to deficiency, causing jing and blood to fail to circulate freely, Gui Bei results. Treatment should involve Songrui Dan (Pine Pollen Pill), with an external application method using turtle urine. This represents the previous scholars' syndrome differentiation and treatment protocols.
In my commentary: Gui Xiong is treatable, whereas Gui Bei is considered incurable. The previous scholars' syndrome differentiation and treatments were still imperfect. Although they attributed it to exogenous wind penetrating the bones, premature sitting causing damage, and chronic cough leading to Lung deficiency, they failed to discern the root cause of the disease, merely describing present symptoms. I have observed children with sufficient innate true yuan (primordial essence) who sat naked in the wind and dew for half a week, then sat in support frames, without ever hearing of cases where exogenous wind entered the bones, premature sitting caused damage, or chronic cough led to Gui Bei. This condition likely arises from insufficient essence inherited from parents and depletion of primordial yang. Observe that in Gui Bei, the deformity centers around the Mingmen (Gate of Life), with gradual protrusion of bone joints and a waist curved like a bow; this is truly due to Gu Wei (bone atrophy/weakness) unable to provide support, not due to wind pathogens. This condition is rarely curable (one in a hundred survives); originally, there was no effective treatment. Yet previous scholars arbitrarily established Songrui Dan, utilizing attacking and dispersing herbs such as Ephedrae Herba (Mahuang, 麻黄), Rheum Radix et Rhizoma (Dahuang, 大黄), Angelicae Pubescentis Radix (Duohuo, 独活), and Saposhnikoviae Radix (Fangfeng, 防风), which only serves to hasten death. In my opinion, one should use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) supplemented with Cinnamon Twig (Guizhi, 桂枝) and Deer Antler (Lurong, 鹿茸) to rescue the congenital foundation, followed by Sijunzi Tang (Four Gentlemen Decoction) or Liujunzi Tang (Six-Gentlemen Decoction) to support stomach qi. Perhaps one in ten could be saved. Aside from this, there are no other treatments. If anyone claims Songrui Dan can cure Gui Bei, I do not believe it.