龟胸之候因风痰停饮，聚积心胸，再感风热，肺为诸脏之华盖，居于膈上，水气泛溢，则肺为之浮，日久凝而为痰，
停滞心胸，兼以风痰内发，其外症唇红面赤，咳嗽喘促，致胸高如覆掌，名曰龟胸。其乳母多食五辛亦能成此疾。先服
宽气饮入姜汁葱汤调服；次清肺饮、如意膏为治。如服药后目睛直视，痰涎上壅，兼以发搐则难治矣。
龟背者，初生婴孩或未满半周，客风吹脊传入髓，故感此症，钱仲阳虽有龟尿点背之言，然终成痼疾者多矣。
批∶丹溪曰∶咳嗽遇冬而发者，寒包热也，解表热自除。有咳至极时呕吐乳食与痰出尽方定，此名风痰壅盛，肝
木
克脾土，宜以南星、半夏、陈皮、天麻、白附子、僵蚕之类。风寒嗽者，鼻塞声重畏寒。火嗽者有声，痰少面赤。痨嗽
者盗汗，夜多寒热。肺胀嗽者，动嗽则喘满气急。痰嗽者，动便有痰声，痰出嗽止。
咳分春夏与秋冬，痰痨火食及寒风。俱用二陈来作主，生姜五片最先锋。春杏芍芩柴五味，夏苓支柏五味攻。秋添
苍芩五味杏，桂枝苏叶细辛冬。痨用四物紫菀杏，五味人参及款冬。嗽久除嗽加粟壳，干嗽之时难奏功。上夜属阴加四
物，黄柏知母五味宗。五更嗽发属食积，神曲山楂枳实从。嗽得出时加半夏，不出去半贝母逢。
〔附方〕
小柴胡汤 见诸吐症内。
葶苈丸（肺实气喘用） 葶苈子（隔纸略炒） 防己 黑豆（炒） 杏仁面（炒去皮尖） 捣膏一两为末，取
蒸枣肉捣和为丸，麻子大，每服五六丸，姜汤下。
麻黄汤（冬用） 桂枝 杏仁 麻黄 甘草
甘桔汤（咽喉热痛用） 桔梗 甘草
泻白散（肺有热、气喘用 ）地骨皮 桑白皮 甘草
白饼子（下痰用） 见惊风症内。
黄芩半夏生姜汤 黄芩 芍药 半夏 生姜 甘草
芍药甘草汤 芍药（三钱） 甘草（二钱） 葛根 升麻
升麻汤 升麻 芍药 葛根 甘草
乌梅丸 蜀椒 细辛 附子（制） 桂枝 人参 当归 黄柏 干姜
茯苓甘草汤 茯苓（二钱） 甘草（一钱） 桂枝（二钱半） 生姜（五片）
异功散 见惊风症内。
参苏饮 紫苏 前胡 陈皮 半夏 干葛 茯苓 枳壳 桔梗 人参 甘草
人参平肺散
六味地黄丸 熟地 丹皮 茯苓 山药 泽泻 山茱萸
六君子汤 见疟疾症内。
宽气饮 见惊风症内。
清肺饮 人参 柴胡 杏仁 桔梗 赤芍 荆芥 枳壳 桑皮 五味 麻黄 旋复花
如意膏 半夏 南星 俱姜制，蜜丸，用姜蜜送下。
龟胸的证候是由于风痰和停饮积聚在心胸部位，再次感受风热所致。肺为五脏六腑之华盖，位于膈肌之上，若水气泛溢，则肺气上浮；日久凝结成痰，停滞于心胸之间，加之风痰内发，其外在症状表现为嘴唇红、面色赤、咳嗽气喘急促，导致胸部高耸如同倒扣的手掌，这种病症称为龟胸。乳母如果过多食用五辛（葱、蒜、韭、薤、兴渠），也能导致婴儿患上此病。治疗时先服用宽气饮，用姜汁和葱汤调服；随后使用清肺饮、如意膏进行治疗。如果服药后出现眼睛直视、痰涎上涌阻塞气道，并伴有抽搐症状，则属于难治之症。
龟背的成因是初生婴儿或未满周岁的幼儿，受到客邪之风侵袭脊柱并传入骨髓，从而引发此症。虽然钱仲阳曾有使用龟尿点涂背部的方法，但最终治愈成为顽固性疾病的情况很少。
批注：朱丹溪说：咳嗽在冬季发作的，属于寒包热证，解除表热后热邪自然消除。有咳嗽剧烈到呕吐乳食，直到痰液吐尽才停止的，这名叫风痰壅盛，是肝木克制脾土，适宜使用天南星、半夏、陈皮、天麻、白附子、僵蚕这类药物。风寒咳嗽者，鼻塞、声音重浊、怕冷。火咳者有声，痰少、面赤。劳嗽者盗汗，夜间多寒热交替。肺胀咳嗽者，活动后咳嗽则气喘胸闷、气息急促。痰嗽者，一动就有痰声，痰出后咳嗽停止。
咳嗽需分春夏与秋冬，以及痰、痨、火、食及寒风等不同病因。治疗都以二陈汤为主方，生姜五片作为先锋引药。春季加杏仁、芍药、黄芩、柴胡、五味子；夏季加茯苓、支干（指前胡等）、黄柏、五味子攻邪。秋季加苍术、黄芩、五味子、杏仁，冬季加桂枝、苏叶、细辛。劳嗽用四物汤加紫菀、杏仁、五味子、人参及款冬花。咳嗽日久除常规止咳外加罂粟壳，干咳之时难以奏效。上半夜属阴，加四物汤，以黄柏、知母、五味子为主。五更时分咳嗽发作属于食积，用神曲、山楂、枳实调理。咳嗽能吐出痰液的加半夏，咳不出痰的用半贝母（半夏与贝母）。
〔附方〕
小柴胡汤 见诸吐症内。
葶苈丸（用于肺实气喘） 葶苈子（隔纸略炒） 防己 黑豆（炒） 杏仁面（炒去皮尖） 捣膏一两为末，取蒸枣肉捣和为丸，如麻子大，每服五六丸，姜汤送下。
麻黄汤（冬季使用） 桂枝 杏仁 麻黄 甘草
甘桔汤（用于咽喉热痛） 桔梗 甘草
泻白散（用于肺有热、气喘） 地骨皮 桑白皮 甘草
白饼子（用于下痰） 见惊风症内。
黄芩半夏生姜汤 黄芩 芍药 半夏 生姜 甘草
芍药甘草汤 芍药（三钱） 甘草（二钱） 葛根 升麻
升麻汤 升麻 芍药 葛根 甘草
乌梅丸 蜀椒 细辛 附子（制） 桂枝 人参 当归 黄柏 干姜
茯苓甘草汤 茯苓（二钱） 甘草（一钱） 桂枝（二钱半） 生姜（五片）
异功散 见惊风症内。
参苏饮 紫苏 前胡 陈皮 半夏 干葛 茯苓 枳壳 桔梗 人参 甘草
人参平肺散
六味地黄丸 熟地 丹皮 茯苓 山药 泽泻 山茱萸
六君子汤 见疟疾症内。
宽气饮 见惊风症内。
清肺饮 人参 柴胡 杏仁 桔梗 赤芍 荆芥 枳壳 桑皮 五味 麻黄 旋复花
如意膏 半夏 南星 俱姜制，蜜丸，用姜蜜送下。
The syndrome of *Guixiong* (Turtle Chest) is caused by the accumulation of wind-phlegm and retained fluid in the chest and heart region, compounded by a secondary contraction of wind-heat. The Lung is the canopy of all viscera, situated above the diaphragm; when water qi overflows, the Lung becomes hyperinflated. Over time, this condenses into phlegm, stagnating in the chest and heart. Combined with the internal emergence of wind-phlegm, external symptoms manifest as red lips, flushed face, coughing, and rapid breathing, resulting in a chest that protrudes high like an inverted palm. This condition is named *Guixiong*. If the nursing mother consumes excessive amounts of the Five Pungent Spices (Wuxin), it can also cause this disease in the infant. Treatment begins with administering *Kuanqi Yin* (Broad-Qi Decoction), mixed with ginger juice and scallion decoction for ingestion; subsequently, *Qingfei Yin* (Clear-Lung Decoction) and *Ruyi Gao* (Ruyi Ointment) are used. If after medication the patient exhibits fixed staring eyes, upward obstruction of phlegm and saliva, accompanied by convulsions, the condition is difficult to treat.
*Guibei* (Turtle Back) occurs in newborns or infants under one year of age, where pathogenic wind invades the spine and transmits into the marrow, causing this syndrome. Although Qian Zhongyang mentioned using turtle urine to apply to the back, most cases ultimately become chronic, intractable diseases.
Commentary: Zhu Danxi stated: Coughs that flare up in winter are due to cold enveloping heat; once the exterior heat is resolved, the heat naturally dissipates. In cases where coughing is so severe that it induces vomiting of milk/food until all phlegm is expelled before subsiding, this is termed "exuberant wind-phlegm obstruction," indicating Liver Wood overacting on Spleen Earth. It is appropriate to use herbs such as Tian Nan Xing (Arisaema Cum Bile), Ban Xia (Pinellia Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Tian Ma (Gastrodiae Rhizoma), Bai Fu Zi (Typhonii Rhizoma), and Jiang Can (Bombyx Batryticatus). For wind-cold cough, symptoms include nasal congestion, heavy voice, and aversion to cold. For fire cough, there is a harsh sound, scanty phlegm, and facial flushing. For consumption cough (Lao Sou), there is night sweats and frequent chills and fever at night. For lung distension cough, movement triggers coughing accompanied by chest fullness, shortness of breath, and urgency of qi. For phlegm cough, there is a rattling sound upon movement, which ceases when phlegm is expectorated.
Coughs should be differentiated by spring/summer versus autumn/winter, as well as by etiologies involving phlegm, consumption, fire, food retention, and wind-cold. All should primarily utilize Er Chen Tang (Two-Aged Powder), with five slices of fresh ginger acting as the vanguard herb. In spring, add Xing Ren (Prunus Armeniacae Semen), Shao Yao (Paeoniae Radix Alba), Huang Qin (Scutellariae Radix), Chai Hu (Bupleuri Radix), and Wu Wei Zi (Schisandrae Chinensis Fructus). In summer, add Fu Ling (Poria), Zhi Mu (Anemarrhenae Rhizoma - *Note: Text says 'Zhi' likely referring to Zhi Mu or similar cooling herb, but standard formula often uses Zhi Mu or Huang Bo*), Huang Bo (Phellodendri Cortex), and Wu Wei Zi to attack the pathogen. In autumn, add Cang Zhu (Atractylodis Rhizoma), Huang Qin, Wu Wei Zi, and Xing Ren; in winter, add Gui Zhi (Cinnamomi Ramulus), Su Ye (Perillae Folium), and Xi Xin (Asari Radix et Rhizoma). For consumption cough, use Si Wu Tang (Four-Substance Decoction) combined with Zi Wan (Asteris Radix), Xing Ren, Wu Wei Zi, Ren Shen (Ginseng Radix), and Kuan Dong Hua (Farflos Flos). For chronic cough, besides standard antitussives, add Yu Ke (Papaveris Pericarpium); however, dry coughs are difficult to cure. For coughs occurring in the first half of the night (Yin time), add Si Wu Tang, focusing on Huang Bo, Zhi Mu, and Wu Wei Zi. Coughs occurring at dawn (Fifth Watch) are attributed to food retention, treated with Shen Qu (Massa Medicata Fermentata), Shan Zha (Crataegi Fructus), and Zhi Shi (Aurantii Fructus Immaturus). When phlegm can be expectorated, add Ban Xia; if phlegm cannot be expelled, use Ban Bei Mu (Ban Xia and Bei Mu combination).
[Attached Formulas]
Xiao Chai Hu Tang (Minor Bupleurum Decoction) See within Vomiting Syndromes.
Ting Li Wan (Descurainiae Seed Pill) [For Lung Excess with Asthma] Ting Li Zi (Descurainiae Semen), Fang Ji (Stephaniae Tetrandrae Radix), Hei Dou (Sojae Glycines Semen Nigrum, stir-fried), Xing Ren Mian (Prunus Armeniacae Semen Paste, stir-fried, skin and tip removed). Pound into a paste, mix with one liang of powder, combine with steamed jujube flesh pounded into a paste, form pills the size of hemp seeds. Take 5-6 pills per dose, washed down with ginger soup.
Ma Huang Tang (Ephedra Decoction) [For Winter Use] Gui Zhi (Cinnamomi Ramulus), Xing Ren (Prunus Armeniacae Semen), Ma Huang (Ephedrae Herba), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Gan Jie Tang (Licorice and Platycodon Decoction) [For Heat Pain in Throat] Jie Geng (Platycodi Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Xie Bai San (Drain White Powder) [For Lung Heat with Asthma] Di Gu Pi (Lycii Cortex), Sang Bai Pi (Mori Cortex), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Bai Bing Zi (White Cake Pills) [For Expelling Phlegm] See within Convulsive Disorders.
Huang Qin Ban Xia Sheng Jiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction) Huang Qin (Scutellariae Radix), Shao Yao (Paeoniae Radix Alba), Ban Xia (Pinelliae Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Shao Yao Gan Cao Tang (Peony and Licorice Decoction) Shao Yao (Paeoniae Radix Alba, 3 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian), Ge Gen (Puerariae Lobatae Radix), Sheng Ma (Cimicifugae Rhizoma).
Sheng Ma Tang (Cimicifuga Decoction) Sheng Ma (Cimicifugae Rhizoma), Shao Yao (Paeoniae Radix Alba), Ge Gen (Puerariae Lobatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Wu Mei Wan (Mume Pill) Shu Jiao (Zanthoxyli Pericarpium), Xi Xin (Asari Radix et Rhizoma), Fu Zi (Aconiti Lateralis Radix Praeparata), Gui Zhi (Cinnamomi Ramulus), Ren Shen (Ginseng Radix), Dang Gui (Angelicae Sinensis Radix), Huang Bo (Phellodendri Cortex), Gan Jiang (Zingiberis Rhizoma).
Fu Ling Gan Cao Tang (Poria and Licorice Decoction) Fu Ling (Poria, 2 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian), Gui Zhi (Cinnamomi Ramulus, 2.5 qian), Sheng Jiang (Zingiberis Rhizoma Recens, 5 slices).
Yi Gong San (Extra-Efficacy Powder) See within Convulsive Disorders.
Shen Su Yin (Ginseng and Perilla Infusion) Zi Su (Perillae Folium), Qian Hu (Peucedani Radix), Chen Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), Gan Ge (Puerariae Lobatae Radix), Fu Ling (Poria), Zhi Ke (Aurantii Fructus Immaturus), Jie Geng (Platycodi Radix), Ren Shen (Ginseng Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Ren Shen Ping Fei San (Ginseng Lung-Pacifying Powder)
Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) Shu Di (Rehmanniae Radix Preparata), Dan Pi (Moutan Cortex), Fu Ling (Poria), Shan Yao (Dioscoreae Rhizoma), Ze Xie (Alismatis Rhizoma), Shan Zhu Yu (Corni Fructus).
Liu Jun Zi Tang (Six-Gentleman Decoction) See within Malaria Syndromes.
Kuan Qi Yin (Broad-Qi Infusion) See within Convulsive Disorders.
Qing Fei Yin (Clear-Lung Infusion) Ren Shen (Ginseng Radix), Chai Hu (Bupleuri Radix), Xing Ren (Prunus Armeniacae Semen), Jie Geng (Platycodi Radix), Chi Shao (Paeoniae Radix Rubra), Jing Jie (Schizonepetae Spica), Zhi Ke (Aurantii Fructus Immaturus), Sang Pi (Mori Cortex), Wu Wei Zi (Schisandrae Chinensis Fructus), Ma Huang (Ephedrae Herba), Xuan Fu Hua (Inulae Flos).
Ru Yi Gao (Ruyi Ointment) Ban Xia (Pinelliae Rhizoma), Nan Xing (Arismae Rhizoma). Both processed with ginger, formed into honey pills, taken with ginger-honey mixture.